February 15, 2021

Understanding Vaginal Atrophy or G.S.M

Thanks to Jane Lewis, author of Me & My Menopausal Vagina for her help with this fact sheet, you can read more about Jane and her book here.

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


Vaginal ATROPHY, officially known as Genitourinary Syndrome of Menopause (G.S.M) is a common symptom of menopause affecting about 70% of women yet only 7% will ask for help from their GP.

Unfortunately many decide to self-treat, but this is not recommended.

Firstly, your symptoms could be something else, and secondly, there are various different vaginal oestrogen and non-oestrogen products available on prescription that can really help to make you more comfortable and resume an intimate relationship, if desired.

The symptoms of vaginal dryness can vary from mild to life changing and anything in between. Due to declining oestrogen the whole of the pelvic area can really suffer, the skin of the vagina and vulva thins and atrophies which can lead to painful or impossible sex, painful or impossible smear tests, pain, bleeding, soreness, itching, burning and/or splitting skin. Women are also more prone to prolapses and urinary leakage. The bladder also suffers from a lack of oestrogen making women more prone to getting a U.T.I (Urinary Tract Infection)

Local oestrogen can really help and around 25% of women will need HRT too. The vast majority of women can use local oestrogen including those who have had breast cancer and those who are breast feeding as a woman who is breast feeding can also suffer from vaginal dryness due to her reduced oestrogen.

In the U.K. we have various options available which are listed below. Please note ALL vaginal oestrogens are NOT the same as HRT, they are extremely low doses and don’t require the addition of progesterone and they can be used for Life. It is not advisable to stop treatment as symptoms will return and could potentially be harder to control. Vaginal symptoms need to be managed for life and can become worse if left untreated.

Unfortunately, local oestrogens don’t have their own instruction leaflet so can scare a lot of women; this is a shame as it’s a very effective treatment. The accompanying leaflet should be ignored with regards to the majority of side effects as this is for HRT; some healthcare professionals are trying to get the leaflets changed to make it clearer.


Local oestrogen products:

  • 1. Vagifem– vaginal pessary inserted via a plastic disposable applicator (can be used up
    to 5 times per week if required)
  • 2. Vagirux – an alternative to Vagifem both are small pessaries inserted into the vagina. The Vagirux is applicator used to insert the pessary into the vagina is reusable unlike
    the Vagifem applicator making it more environmentally friendly.
  • 3. Imvaggis – vaginal pessary inserted via your finger.
  • 4. Ovestin cream- for internal and external use, comes with a reusable applicator.
  • 5. Estriol cream– (weaker than Ovestin) for internal and external use, comes with a reusable applicator.
  • 6. Estring– a vaginal ring made from medical grade silicone that stays in the vagina 24/7 and releases a small amount of oestrogen every 24 hours for 90 days. The majority can insert and remove it themselves, if not your GP can do this for you.
  • 7. Blissel – a vaginal oestrogen gel used internally with a reusable applicator.
  • 8. Intrarosa – a non-oestrogen vaginal treatment derived from DHEA.
  • 9. Ospemifene– an oral tablet that (unlike the others that work directly) has a different mechanism in its delivery and symptom relief of vaginal dryness.

As with any medications, what suits one may not suit another so it can be trial and error if the first or second choice doesn’t suit you. There are other options also; depending on how advanced your vaginal symptoms are can affect how well you will respond to treatment, so it is better to start sooner rather than later.

Dose and regularity of use will be dependent on the severity of your symptoms and some women will require much more than others.