Vaginal atrophy, now called genitourinary syndrome of menopause (GSM), affects up to 84% of postmenopausal women. Unlike hot flushes that often improve over time, GSM tends to worsen without treatment. Effective options range from moisturisers and lubricants to local oestrogen therapy, and speaking with a healthcare provider can help you find the right approach.
If you've noticed changes in your intimate health during perimenopause or menopause, you're not alone. Vaginal atrophy is one of the most common yet least discussed symptoms of menopause. Many women experience discomfort, dryness, or pain but hesitate to bring it up with their healthcare provider. The reality is that these symptoms are incredibly common, affecting more than half of all postmenopausal women, and effective treatments are available.
Understanding what's happening in your body and knowing your options can help you feel more in control of your menopause journey. This guide explains what vaginal atrophy is, why it happens, and what you can do about it.
What Is Vaginal Atrophy?
Vaginal atrophy occurs when the tissues of the vagina become thinner, drier, and less elastic due to declining oestrogen levels. In 2014, medical experts introduced a new term, genitourinary syndrome of menopause (GSM), to better describe this condition [1]. The updated name reflects that these changes affect not just the vagina but also the vulva, urethra, and bladder.
GSM is now the preferred medical terminology because it captures the full range of symptoms women may experience. These can include genital discomfort, urinary issues, and sexual health concerns, all connected to the same underlying cause: reduced oestrogen.
Why the Name Change Matters
The shift from 'vaginal atrophy' to GSM isn't just medical jargon. It acknowledges that these symptoms are part of a broader pattern affecting multiple areas of your body. This broader understanding helps healthcare providers offer more comprehensive care and encourages women to discuss all their symptoms, not just the most obvious ones.
Understanding the Connection to Menopause
During your reproductive years, oestrogen keeps vaginal tissues healthy by maintaining their thickness, elasticity, and natural moisture. As you approach menopause, oestrogen levels begin to decline significantly. Menopause causes a significant reduction in oestrogen production, with oestradiol levels declining substantially as the ovaries cease their reproductive function [1].
This hormonal shift affects the genital and urinary tissues in several ways. The vaginal walls become thinner and less flexible. Natural lubrication decreases. The vaginal pH becomes less acidic, which can increase susceptibility to infections. These changes can begin during perimenopause and continue to progress after menopause.
Unlike vasomotor symptoms such as hot flushes that often diminish over time, GSM typically worsens without treatment. Due to increasing longevity, women may experience these symptoms for decades if left unaddressed.
If you're experiencing other menopause symptoms alongside intimate health changes, it's worth discussing the full picture with your healthcare provider.
Recognising the Symptoms of GSM
GSM can present with a range of symptoms affecting genital, urinary, and sexual health. Research shows that vaginal dryness is the most common complaint, affecting up to 93% of women with GSM [1].
Genital Symptoms
Common genital symptoms include:
- Vaginal dryness and reduced moisture
- Burning, itching, or irritation
- Changes in vaginal discharge
- Thinning of pubic hair
- Changes to the vulva and labia
Urinary Symptoms
Many women don't realise that urinary changes can be related to GSM. These may include:
- Frequent or urgent need to urinate
- Burning sensation during urination
- Recurrent urinary tract infections
- Mild urinary incontinence
Sexual Health Changes
GSM can significantly impact intimate relationships. Symptoms may include:
- Pain during intercourse (dyspareunia)
- Reduced lubrication during sexual activity
- Discomfort or bleeding after sex
- Low libido or reduced interest in intimacy
Research indicates that among sexually active women with GSM, reduced lubrication affects approximately 90% and painful intercourse affects around 80% [1].
How GSM Affects Quality of Life
The impact of GSM extends beyond physical symptoms. Studies show that one in four women report that these changes negatively affect their sleep, sexual health, and general happiness.
Many women feel embarrassed discussing intimate health concerns, leading to what researchers call a 'silent epidemic'. The condition remains significantly underdiagnosed and undertreated, with many women suffering in silence for years [2].
It's important to recognise that these symptoms are real, common, and treatable. You deserve to feel comfortable and supported in addressing them.
Treatment Options for GSM
The good news is that effective treatments are available. Your healthcare provider can help you find an approach that suits your symptoms, preferences, and health history.
Non-Hormonal Options
For mild to moderate symptoms, non-hormonal approaches are often recommended as a first step [2]:
Vaginal moisturisers are applied regularly, typically several times per week, to maintain vaginal moisture. They can help restore comfort for everyday activities.
Lubricants are used during sexual activity to reduce friction and discomfort. Water-based, glycerine-free options are generally recommended.
Vaginal dilators may be helpful if narrowing of the vaginal opening has occurred. These devices gently stretch and stimulate the vaginal tissues.
Hormonal Treatment Options
When non-hormonal approaches don't provide adequate relief, local oestrogen therapy is generally considered the gold standard for managing GSM [1]. Local treatments deliver oestrogen directly to the vaginal tissues at low doses.
According to clinical guidelines, local vaginal oestrogen is effective for improving vulvovaginal discomfort, dryness, and painful intercourse [2]. Research indicates that local therapy provides symptom relief in 80-90% of cases.
Your doctor can discuss whether hormonal options may be appropriate based on your individual health history and circumstances.
Important: Treatment decisions should be individualised based on your medical history. Your doctor will assess whether specific treatments are appropriate for you based on your symptoms and risk factors.
Lifestyle Approaches
Several lifestyle factors can support vaginal health alongside medical treatment:
- Stay sexually active: Regular sexual activity or masturbation increases blood flow to vaginal tissues, helping maintain their health
- Quit smoking: Smoking decreases blood flow and oestrogen levels, worsening GSM symptoms
- Avoid irritants: Perfumed soaps, douches, and some personal care products can aggravate symptoms
- Stay hydrated: Good overall hydration supports tissue health throughout the body
When to Seek Help
If you're experiencing symptoms of GSM, it's worth speaking with a healthcare provider. You should particularly consider seeking help if:
- Vaginal symptoms interfere with your daily activities
- Sexual intercourse is painful and lubricants don't provide relief
- You experience frequent urinary tract infections
- You notice bleeding or unusual discharge
Many women delay seeking help because they feel embarrassed or assume symptoms are just 'part of getting older'. However, GSM is a medical condition that responds well to treatment. You don't need to simply accept ongoing discomfort.
At Emsee, we understand that discussing intimate health concerns can feel uncomfortable. Our comprehensive menopause support is designed to help you feel heard and empowered throughout your journey.
Frequently Asked Questions
Can vaginal atrophy be reversed?
While the underlying hormonal changes of menopause are permanent, the symptoms of GSM can be effectively managed and often significantly improved with treatment. Many women experience substantial relief with appropriate therapy.
Is vaginal atrophy the same as a yeast infection?
No. Although some symptoms overlap, such as itching and discomfort, these are different conditions. Yeast infections are caused by fungal overgrowth and typically respond to antifungal treatment. GSM is related to hormonal changes and requires different management. Your healthcare provider can help determine what's causing your symptoms.
How long does treatment for GSM take to work?
Many women notice improvement within a few weeks of starting treatment, though the full benefits may take several months. Ongoing treatment is often needed to maintain symptom relief, as GSM is a chronic condition related to sustained low oestrogen levels [2].
Is it safe to use vaginal oestrogen long-term?
Clinical guidelines indicate that local low-dose vaginal oestrogen does not increase the risk of endometrial concerns when used at appropriate doses [2]. Your doctor can discuss the safety profile based on your individual health history.
Conclusion
Vaginal atrophy, or genitourinary syndrome of menopause, is an incredibly common but often overlooked aspect of the menopause transition. Affecting the majority of postmenopausal women, these symptoms can significantly impact quality of life, intimate relationships, and overall wellbeing.
The most important thing to know is that you don't have to suffer in silence. Effective treatments are available, ranging from simple moisturisers and lubricants to local hormone therapy. Speaking with a healthcare provider who understands menopause can help you find the right approach for your individual needs.
If you're ready to address your symptoms and feel like yourself again, Emsee's menopause-focused telehealth service provides accessible, holistic care from the comfort of your home.
This information is for educational purposes only and is not medical advice. Consult your healthcare provider for personalised recommendations. Treatment decisions should be individualised based on your medical history and circumstances.
References
- Angelou, K., Grigoriadis, T., Diakosavvas, M., Zacharakis, D., & Athanasiou, S. (2020). The genitourinary syndrome of menopause: An overview of the recent data. Cureus, 12(4), Article e7586. https://doi.org/10.7759/cureus.7586
- The North American Menopause Society. (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause, 27(9), 976-992. https://doi.org/10.1097/GME.0000000000001609
