Introduction

You avoid intimacy because it hurts.
You worry something is wrong, but you don’t say it out loud.
You feel burning when you urinate, yet tests come back normal.
Sex feels like dancing in shoes two sizes too small.

Your doctor might tell you: “It’s your age, it happens to everyone.”
You wonder if this will be your new normal.

It isn’t.

Vaginal dryness in menopause and perimenopause is a medical condition with proven treatments.

Painful sex, vaginal dryness, irritation, burning, and recurrent urinary infections are not a normal part of ageing. They are signs of a treatable medical condition caused by low oestrogen levels in the genital and urinary tissues.

This condition has a name:
Genitourinary Syndrome of Menopause.

And it can be treated safely and effectively.

Guide Overview

In this guide, you’ll learn:

what Genitourinary Syndrome of Menopause (GSM) is
how to recognise symptoms early
why it happens in peri- and post-menopause
risk factors you might not expect
evidence-based treatments that work
(hormonal and non-hormonal)
when to seek medical help
safety facts that most women are never told

If you recognise yourself in this description, you are not alone — and there are solutions.

PART 1 — Why vaginal dryness happens in menopause

1.1— The Role of Oestrogen

Oestrogen keeps the vaginal and urinary tissues healthy — elastic, well-lubricated, and resistant to infection. When oestrogen declines, especially during peri- and post-menopause:

the vaginal walls become thinner
natural lubrication decreases
pH changes
blood flow to the tissues is reduced
the microbiome becomes less protective

This makes the area drier, more fragile, and more sensitive, especially during sexual activity.

These changes are biological, not emotional — and they have nothing to do with desire, nor with ageing gracefully.

1.2 — Vaginal dryness in menopause - part of a Recognised Medical Condition

This combination of genital, sexual and urinary symptoms has a medical name:

Genitourinary Syndrome of Menopause (GSM).

GSM includes:

Genital symptoms:
dryness, burning, itching, irritation.

Sexual symptoms:
painful intercourse (dyspareunia), discomfort, reduced lubrication.

Urinary symptoms:
pain during urination, recurrent urinary infections, urgency, frequency.

GSM is:

common
progressive
chronic
underdiagnosed
undertreated

According to patient surveys, although many women have at least one symptom, only 38% know this is a medical condition, and 50% believe it is simply ageing.

GSM… and can be discussed in a private consultation to understand your options

PART 2 — Who Can be Affected?

2.1 — Not Only Post-Menopause

While GSM is more frequent in post-menopausal women, it can also affect:

peri-menopausal women
women with very low oestrogen due to strict diets or intense exercise
women after bilateral oophorectomy
women undergoing endocrine therapies
trans women under hormone regimens
younger women using certain contraceptives

Any situation that creates hypo-oestrogenism can increase the risk.

2.2 — Lifestyle Factors That Increase Risk

Certain factors can aggravate GSM symptoms:

cigarette smoking
low sexual frequency
certain medications, such as:
- tamoxifen
- aromatase inhibitors (AIs) – e.g., anastrozole, letrozole
- antihistamines (allergy medicines that can dry mucous membranes)
- SSRIs (antidepressants that can reduce lubrication)
diabetes or autoimmune disease
pelvic radiation or chemotherapy

These factors do not cause GSM, but they can intensify symptoms.

PART 3 —Evidence-based Treatments

You do not have to live with pain, dryness or recurrent infections.
Effective and safe therapies exist, both hormonal and non-hormonal.
The choice depends on your symptoms, medical history, and preferences.

Subtopic 3.1 — Local Oestrogen: The First-Line Treatment

Local vaginal oestrogen is considered the first-line therapy for vaginal dryness and painful intercourse when there are no contraindications to oestrogen therapy.

Treatments include:

oestradiol
estriol
promestriene
low-dose vaginal tablets, creams or rings

Benefits demonstrated in clinical research include:

improved lubrication
reduced pain during sex
reduced burning and irritation
improved urinary symptoms
fewer recurrent urinary infections
improved vaginal tissue health

Safety:
Clinical studies show that blood oestradiol levels remain within post-menopausal range when using local oestrogen.
There was no endometrial stimulation and no cases of endometrial hyperplasia or cancer after 12 months using 10 µg oestradiol vaginal tablets.

Local oestrogen therapy has a more favourable risk profile than systemic hormone therapy for these symptoms.

3.2 — Other Evidence-Based Options

When local oestrogen is not suitable, or as complementary treatment, other options can help:

Local Androgens
(e.g. DHEA, testosterone)
Intravaginal DHEA (prasterone 6.5 mg) is approved for the treatment of painful intercourse in post-menopausal women, acting locally without significant changes in serum hormone levels.

Selective Oestrogen Receptor Modulators (SERM)
(e.g. ospemifene)
Shown to reduce vaginal dryness and dyspareunia, and may reduce recurrent urinary infections.

Non-Hormonal Treatments

hyaluronic acid
lubricants and emollients
laser therapy (selected cases, complementary approach)

Hyaluronic acid can improve symptoms, especially in women whose oestrogen levels are reduced by oncological therapy.

Laser therapies can stimulate collagen, improve lubrication and tissue quality, but are usually best when combined with local oestrogen and should be used with medical guidance.

PART 4 — When to Seek Help

4.1 — Signs You Should Speak With a Specialist

You should consider a consultation if you have:

painful intercourse
vaginal dryness
burning or irritation
recurrent urinary infections
bleeding after sex (not due to GSM; requires medical assessment)
pain when urinating
fear or anxiety around intimacy
symptoms affecting your relationship

Early treatment prevents progression and protects sexual and urogenital health.

Subtopic 4.2 — Why a Personalised Plan Matters

Every woman’s story is different:

your age
your hormonal history
medications
contraception
cancer history
relationship context
psychological impact
lifestyle
level of discomfort
personal preferences

A personalised plan lets you:

choose the safest option
find the most effective treatment
avoid unnecessary suffering
feel comfortable again
restore intimacy and confidence

As a menopause specialist, I help women understand their symptoms and choose evidence-based treatment options.

References

The information in this article is based on evidence from clinical research and peer-reviewed sources, including:

Gandhi J, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, aetiology, and management. American Journal of Obstetrics & Gynaecology. December 2016.

REVIVE Survey (understanding awareness and treatment gaps in post-menopausal women)

Archer , et al. TX-004HR vaginal oestradiol has negligible to very low systemic absorption of oestradiol

Is vaginal dryness a normal part of menopause?

No. It is common, but it is not a “normal” part of ageing. It is a symptom of Genitourinary Syndrome of Menopause, a treatable medical condition.

Does local oestrogen enter the bloodstream?

Studies show that blood oestradiol levels remain within the post-menopausal range during treatment with low-dose vaginal oestrogen.

Is local oestrogen safe if I have a history of breast cancer?

This depends on individual factors. A specialist consultation is needed to evaluate risks and benefits with your oncology team

How long until I feel improvement?

Many women feel better within 3–6 weeks, depending on the treatment selected.

Can I use gels or lubricants instead?

Lubricants and moisturisers can reduce discomfort, but they do not correct the underlying oestrogen-related changes. They work best as complementary support.

Vaginal Dryness in Perimenopause & Menopause — Proven Treatments