February 15, 2021

Understanding Vaginal Atrophy or G.S.M

Download as a  PDF hereAlso, try our vaginal atrophy/GSM symptom checker.

Vaginal atrophy (VA) is a symptom of menopause which affects approximately 70% of women, however only 7% will seek advice from their GP. Unfortunately, many women will choose to self-treat which can lead to inappropriate treatments being used, continuing and deteriorating symptoms, and other conditions being missed. There are hormonal and non-hormonal products available on prescription which can significantly improve the condition and lead to you feeling much more comfortable and able to resume an intimate relationship if you wish.

Symptoms of vaginal atrophy can be both vaginal and urinary, they can be mild or life changing. The whole female pelvic area is highly dependent on oestrogen, losing this oestrogen as we become menopausal can lead to the following symptoms:

Vaginal dryness

Vulval or vaginal soreness

Vulval or vaginal irritation or itching

Vulval or vaginal pain or burning

Thinning of the vulval skin leading to splits, tears, and micro-cuts

Shrinkage or change in shape of the labia

Shrinkage and/or pain in the clitoris

Watery vaginal discharge

Painful episiotomy scars, even years after the procedure was performed

Abnormal vaginal bleeding

Painful intercourse (dyspareunia)

Bleeding after intercourse

Repeated urinary tract infections/cystitis (often without a positive laboratory result)

Urinary urgency

Needing to pass urine during the night (nocturia)

Pain on passing urine (dysuria)

Urinary frequency (needing to pass urine more frequently)

Stress incontinence (leakage when coughing/sneezing/jumping/laughing)

Pelvic organ prolapse

Painful smear tests

There are practical steps which can be taken to improve the situation. Avoiding the use of soap to wash the genitourinary area, using a vaginal/vulval moisturiser, and using lubricants for penetrative sex can all be helpful in managing symptoms; however, you should try to avoid perfumed or flavoured products (soap, moisturisers, lubricants, sanitary towels etc) as they can be irritant. Pelvic floor exercises are significantly helpful in managing the urinary symptoms and a visit to a pelvic health physiotherapist may be beneficial.

Many women will need to use a vaginal oestrogen preparation. These are available on prescription from your GP and should be used on a long-term basis. Vaginal oestrogens are prescribed at extremely low doses which have been shown to have minimal systemic absorption, therefore they are suitable for the majority of women and can be safely used alongside systemic HRT. (It is worth noting that breastfeeding mothers may also experience vaginal dryness, therefore the use of local oestrogen products is also suitable for them).


Prescribable products to treat Vaginal Atrophy

Method of Delivery Name Product
Vaginal Pessary Vagifem Estradiol 10mcg
Vagirux Estradiol 10mcg
Imvaggis Estriol 30mcg
Estring (90-day preparation Estradiol 7.5mcg/24 hours
Intrarosa Prasterone 6.5mg (non-oestrogen
Vaginal Cream Estriol Estriol 0.01%
Ovestin Estriol 1mg
Vaginal Gel Blissel Estriol 50mcg
Oral Tablet Senshio Ospemifene


The book ‘Me and My Menopausal Vagina’ written by Jane Lewis, is highly recommended for more information and advice about Vaginal Atrophy.