Vaginal dryness and genitourinary symptoms

Dryness can mean itching or burning through the day, discomfort during sex, or soreness around the vagina. Falling oestrogen around menopause can make vaginal tissue drier and thinner. These symptoms are worth discussing even if you’re not having sex.

What GSM describes

Genitourinary syndrome of menopause, often shortened to GSM, describes vaginal and urinary symptoms related to menopause. These can include dryness, irritation, pain during sex and discomfort when peeing. You may also hear the term vaginal atrophy.

Menopause is not the only possible explanation for dryness. Medicines, including some antidepressants and hormonal contraception, can contribute, as can perfumed washes. Tell your clinician what you use, including products bought without a prescription. There can be other reasons for a new symptom.

Moisturisers and lubricants do different jobs

A vaginal moisturiser helps keep the vagina moist. A lubricant is used before or during sex to make it more comfortable. Both are available without a prescription. Ask a pharmacist for a product intended for vaginal use, and follow its instructions.

The NHS suggests water-based lubricant before sex. It can be used with a sex toy or on fingers as well as during intercourse. Use unperfumed products for washing around the vagina, and avoid douches. Ordinary body lotions and moisturisers are not suitable substitutes for vaginal products: they can cause irritation or infection.

Local oestrogen, including alongside HRT

Vaginal oestrogen comes as a cream, gel, tablet, pessary or ring. It treats symptoms locally. NICE says that only a very small amount reaches the bloodstream and serious side effects are very rare. Your GP, doctor or pharmacist can advise whether a product is suitable for you and how to use it.

NICE recommends offering vaginal oestrogen for vaginal and urinary symptoms, including if you already take systemic HRT. It can also be used with a non-hormonal moisturiser or lubricant. Local treatment does not treat hot flushes or sleep problems.

In the UK, some vaginal oestrogen products can be bought from a pharmacy without a prescription; the pharmacist can check suitability. US patient guidance describes prescription vaginal oestrogen alongside non-prescription moisturisers and lubricants. Ask locally how to get the product you need.

If you have had breast cancer, discuss treatment with your care team. NICE recommends non-hormonal moisturisers or lubricants first; vaginal oestrogen may be considered if symptoms continue. People taking an aromatase inhibitor need their breast cancer specialist involved in choosing treatment.

The NHS says vaginal oestrogen can take up to 3 months to work fully. NICE advises a review of how well it works and how you are getting on with it. Ask your clinician what improvement to look for and how to report problems while you are using it.

Symptoms often return when vaginal oestrogen is stopped. If treatment is not helping enough or is difficult to use, ask for a review. NICE lists other prescription options, including vaginal prasterone when initial treatments have not helped or are not tolerated. Your doctor can discuss what is suitable; do not change a prescribed treatment on your own.

When urinary infections keep returning

Menopause can bring more urinary tract infections, or symptoms that feel like an infection. Describe burning, discomfort and changes in how often you pee to your clinician. For recurrent UTIs, NICE says clinicians can consider vaginal oestrogen when changes to habits and hygiene have not helped or are unsuitable. It does not recommend systemic HRT specifically to prevent recurrent UTIs.

Call 999 now (UK) or 911 (US), or your local emergency number, if you become confused, unusually drowsy or have difficulty speaking.

Contact your GP or NHS 111 today (UK), or your doctor or urgent care service (US or elsewhere), if urinary symptoms come with fever or shivering, pain in your back just below the ribs, blood in your pee, or symptoms that worsen quickly.

Getting symptoms checked

Book a GP appointment in the UK, or see your doctor in the US or elsewhere, if dryness affects daily life or continues despite self-care. Ask for a check if you have unusual discharge or bleeding after sex. Any bleeding after menopause needs assessment, including a small amount of spotting.

You can start with plain words: “It burns when I sit down”, or “Sex has become uncomfortable”. Bring the names of products you have tried and say what changed. Ask what the treatment is meant to help and how you will review it together.