Vaginal dryness: the symptom nobody mentions, and it is treatable

What is happening

Vaginal, vulval and urinary tissue is rich in oestrogen receptors. When oestrogen falls, that tissue becomes thinner, less elastic, less well lubricated and more fragile. Blood flow reduces. The natural acidity changes, which makes urinary infections more likely.

The clinical name is genitourinary syndrome of menopause, which covers the vaginal and urinary symptoms together because they share one cause.

What it feels like

• Dryness, and a sensation of tightness or soreness
• Burning or itching
• Discomfort or pain during sex, sometimes with bleeding afterwards
• Needing to pass urine more often, or urgently
• Recurrent urinary tract infections
• Discomfort from clothing, sitting or exercise, not just during sex

It is worth saying that this is not only a symptom of sex. Plenty of women notice it first on a bike, in jeans, or during a long day at a desk.

The thing most women do not know

Hot flushes tend to peak and then gradually fade over years. Vaginal symptoms do not.

Because they are caused by ongoing lack of oestrogen in the tissue rather than by fluctuation, they usually persist and often worsen if left. Waiting it out is the one strategy that reliably does not work.

What treats it

Vaginal oestrogen is the treatment for this specifically. It comes as a cream, pessary or ring, applied locally. It works directly on the tissue and delivers very little hormone to the rest of the body.

That last point matters. Because absorption is minimal, vaginal oestrogen can often be used by women who cannot take systemic HRT, including many women with a history of breast cancer, though that is a conversation to have with your own specialist team.

It usually needs to continue rather than being a short course, because symptoms return when it stops. It typically takes several weeks to a few months for full effect.

Systemic HRT, as patches or capsules, helps many women, but it does not always fully resolve vaginal symptoms. It is common and entirely normal to need both.

Moisturisers and lubricants are worth using alongside. Vaginal moisturisers are used regularly to maintain tissue comfort; lubricants are used at the time of sex. Neither treats the underlying tissue change, but both genuinely help. Choose products designed for the purpose rather than improvising.

What we include

Vaginal oestrogen is included in the fira plan at no extra cost when it is clinically appropriate for you. It is not an add-on and it is not billed separately.

That is worth checking against other services, several of which charge for it monthly on top of the main plan. It is one of the few places in this market where the difference is easy to verify for yourself.

When to see a doctor rather than start treatment

Some things need looking at rather than treating on assumption:

• Any bleeding after menopause, including after sex
• A lump, ulcer or persistent skin change on the vulva
• Severe pain
• Symptoms that do not respond to appropriate treatment after a few months

Getting it looked at

Our assessment asks about these symptoms directly and in plain words, which is the point: you do not have to raise it, because the questions do. Free, online, about five minutes.