Vaginal dryness around menopause: causes, treatment and when to see a gynaecologist

English version

Vaginal dryness, burning or discomfort is common during perimenopause and after menopause. Lower oestrogen levels can make vaginal and vulval tissues thinner, drier and less flexible.

These changes may also cause painful sexual intercourse, urinary discomfort or recurrent urinary symptoms. Collectively, they may be described as genitourinary syndrome of menopause, or GSM. Unlike some menopausal symptoms, vaginal and urinary symptoms may continue or become more troublesome without treatment. They are common, but women do not have to simply tolerate them.

What symptoms can occur?

• Vaginal dryness, burning or soreness.
• Vulval irritation or itching.
• Pain or tightness during penetration.
• Light bleeding after sexual intercourse.
• Reduced natural lubrication.
• Burning while passing urine.
• Frequent or urgent urination or recurrent urinary infections.
• Discomfort during an examination or insertion of a tampon.

These symptoms are not always caused by menopause. Infection, an allergic reaction, a vulval skin condition, pelvic-floor tension or another gynaecological problem may cause similar complaints.

What may help?

For mild symptoms, non-hormonal options may include a vaginal moisturiser used regularly according to its instructions and a water- or silicone-based lubricant during sexual activity. Avoid perfumed intimate washes, vaginal deodorants and douching. Allow adequate time for arousal and stop if penetration is painful.

A moisturiser is intended for regular symptom relief, whereas a lubricant reduces friction during sexual activity. Household oils, antiseptics and food products should not be placed inside the vagina.

Are hormonal treatments available?

When non-hormonal measures are insufficient, a doctor may discuss low-dose vaginal oestrogen or another suitable prescription treatment. Vaginal oestrogen is available in different forms, such as a cream, tablet or ring.

The most appropriate option depends on symptoms, medical history and personal preference. Women with previous breast cancer, unexplained vaginal bleeding or certain other conditions should obtain individual advice before using hormonal treatment. Do not use hormone products borrowed from someone else or purchased without an appropriate assessment.

When should you arrange a consultation?

• Dryness or pain is persistent or affects intimacy.
• Sex remains painful despite using a suitable lubricant.
• You have repeated urinary burning, urgency or infections.
• There is itching, unusual discharge, odour, sores or skin changes.
• Bleeding occurs during or after sex, or any bleeding occurs after menopause.
• Symptoms began during breastfeeding or after cancer treatment.
• Non-prescription products have not helped.
• You have a history of breast or another hormone-sensitive cancer.

Assessment may include a review of symptoms and medicines, examination of the vulva and vagina, and infection or urine testing where appropriate. Not every patient needs every test.

Vaginal dryness is common and treatable. Identifying whether symptoms arise from menopausal changes, infection, a skin condition or another cause helps guide safe and appropriate treatment.