Download as a PDF. Also, try our vaginal atrophy/GSM symptom checker.
Genitourinary Syndrome of Menopause (GSM) more commonly known as Vaginal Atrophy (VA), are symptoms of menopause which affect approximately 70% of women. Research shows that only around 7% seek advice and treatment 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 going undiagnosed. There are hormonal and non-hormonal products available on prescription and over the counter which can significantly improve the condition and help you to feel much more comfortable and able to resume an intimate relationship if you wish.
Symptoms of GSM can be vaginal, vulval and urinary and they can range from being mild to 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. When choosing vaginal moisturiser or lubricants please be aware that some are of better quality than others so it’s important to do your research. Pelvic floor exercises can be extremely 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 most 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 the symptoms of GSM
| 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 |
As with any medication, what suits one person may not suit another, so it can be trial and error finding the right product or products for you. Dose and regularity of use will be dependent on the severity of your symptoms and some women will require more than others. If you are experiencing genitourinary symptoms, please don’t suffer in silence, seek help sooner rather than later.
The book ‘Me and My Menopausal Vagina’ written by Jane Lewis, is highly recommended for more information and advice about Vaginal Atrophy.
