More than half of perimenopausal women experience vaginal dryness — yet surveys consistently show that fewer than 25% ever mention it to their doctor. The silence around this symptom means millions of women are suffering unnecessarily when effective treatments exist. If sex has become painful, if you feel dry and uncomfortable, if you are experiencing burning or itching — this is not something you have to accept.
What Is Genitourinary Syndrome of Menopause (GSM)?
The medical term for vaginal dryness and related symptoms is Genitourinary Syndrome of Menopause (GSM). It encompasses vaginal dryness, reduced lubrication, vaginal thinning (atrophy), painful sex, urinary frequency, urgency, and recurrent UTIs. Unlike hot flushes, which often improve after menopause, GSM tends to worsen over time without treatment.
💡 💡 Important: GSM is not inevitable and it is not something you simply have to live with. There are multiple effective treatments — from over-the-counter moisturisers to prescription therapies — that can significantly improve or resolve these symptoms.
Why Does It Happen?
The vaginal tissues are highly responsive to oestrogen. Oestrogen maintains the thickness, elasticity, and lubrication of vaginal tissues. As oestrogen levels decline during perimenopause, the vaginal lining becomes thinner, drier, and less elastic. The natural pH of the vagina also changes, which can increase susceptibility to infections.
Treatment Options
Non-Hormonal Options
- Vaginal moisturisers — used regularly (2–3 times per week), not just during sex. Replens and similar products are available over the counter.
- Lubricants — water-based or silicone-based lubricants used during sex
- Pelvic floor physiotherapy — a women's health physio can help with pain and tissue health
Hormonal Options
- Local vaginal oestrogen — creams, pessaries, or rings applied directly to the vaginal tissue. Minimal systemic absorption, suitable for most women including those who cannot take systemic MHT.
- Systemic MHT — helps GSM as part of broader hormone therapy
- Ospemifene — an oral tablet option for women who prefer not to use vaginal products
Having the Conversation With Your GP
Many women feel embarrassed to raise this topic with their doctor. You do not need to be. A simple way to start the conversation: 'I have been experiencing vaginal dryness and it is affecting my quality of life — I would like to discuss treatment options.' Your GP should be able to help, or refer you to a women's health specialist.