Genitourinary Syndrome of Menopause and Vaginal Dryness

It might be a feeling of dryness, soreness or rawness that's there most of the time. It might be itching or burning, or a feeling that things down there just aren't the same. Sitting, walking or wiping can feel uncomfortable, and you may need to pee more often.

This has a name: genitourinary syndrome of menopause, or GSM. It's the medical term for the changes that falling oestrogen causes in the vagina, the vulva (the outer lips) and the bladder. Vaginal dryness in menopause is the best-known part of it.

It's very common, and you're not imagining it. Women's Health Concern, the patient arm of the British Menopause Society, says vaginal dryness affects over half of women aged 51 to 60 after the menopause. Yet only about a quarter of women who have it seek treatment. There's a lot that can help, so it's worth speaking up.

See your GP if you have:

any bleeding from the vagina after your menopause, even a small amount or a one-off (read our page on bleeding after menopause)
bleeding after sex or between periods
a sore, ulcer, lump or wart-like growth on your vulva
white, red or dark patches on the skin of your vulva, or itchy white patches
itching that doesn't get better
unusual discharge, or discharge with blood in it

These symptoms are common and have many possible causes. But they need checking (NHS vaginal dryness, NHS vulval cancer symptoms, NHS lichen sclerosus).

What is genitourinary syndrome of menopause?

GSM is a newer name for an old problem. A 2020 review explains that the term came in during 2014. It replaced older names such as vaginal atrophy, atrophic vaginitis and urogenital atrophy. You may still hear your doctor use any of these.

The newer name covers more than the vagina. The changes can affect three areas:

the vagina: dryness, soreness, itching, burning or a tight feeling
sex: less natural wetness, and pain or discomfort during sex
the bladder: needing to pee more often or more urgently, stinging when you pee, and urine infections that keep coming back

Vaginal changes during menopause: what you might notice

The NHS lists dryness, burning, irritation and itching in and around the vagina among the symptoms of perimenopause and menopause. It also lists more urine infections (UTIs), pain or burning when you pee, and needing to pee more often, including at night.

Women's Health Concern describes some other changes that many women don't expect:

Everyday discomfort. Dryness can make it uncomfortable to sit, stand, exercise or pee, whether you're having sex or not.
Smear tests. Many women find a cervical screening test becomes more painful or difficult.
How things look. It's common for the vulva to look different, and the labia (lips) may become thinner.
Discharge. It may become more watery, a different colour or slightly smelly. Women's Health Concern says this is usually down to hormone changes rather than anything serious. But do get any blood-stained discharge checked.

The Menopause Charity adds that the vulva can feel sore and itchy, or look red and inflamed, and that you may get thrush more often.

Can perimenopause cause vaginal dryness?

Yes. The Menopause Charity says symptoms can start early in perimenopause, while you're still having periods. For others they don't appear until years after the menopause.

They don't always go away by themselves, either. Unlike hot flushes, which tend to get milder over time, the 2020 review says GSM symptoms rarely clear up on their own and usually get worse if they're not treated. The Menopause Charity says seven out of ten women have some of these symptoms after their menopause has ended, even if they already take HRT.

Why does menopause cause vaginal dryness?

It's mainly about oestrogen. Women's Health Concern explains that before menopause, glands near the cervix keep the vagina moist. This moisture is slightly acidic, which helps protect against infections such as thrush.

After menopause, the ovaries stop making much oestrogen. Without it, the skin of the vulva and vagina becomes thinner, less stretchy and drier. Thin skin is more easily damaged, so even gentle rubbing can hurt. The Menopause Charity says the bladder and the tube you pee through (the urethra) can become thinner and weaker too. That's why bladder symptoms are part of the picture.

Other causes of vaginal dryness

Menopause isn't the only cause. The NHS lists:

some medicines, such as hormonal contraception and antidepressants
a hysterectomy, especially if your ovaries were removed too
cancer treatments, such as chemotherapy, radiotherapy or hormone therapy
perfumed soaps, washes and douches
not feeling aroused during sex
health conditions such as diabetes or Sjögren's syndrome

If you take a medicine you think might be playing a part, talk to your GP or pharmacist. Please don't stop it on your own.

It isn't always thrush. Women's Health Concern warns that GSM can feel a lot like thrush or some sexually transmitted infections. Some women treat themselves for thrush again and again, which can make things worse. If you keep getting what feels like thrush, see your GP.

What can help with menopause dryness

Things you can do yourself

These come from the NHS, Women's Health Concern and the Menopause Charity.

Wash gently. Use unperfumed soaps and washes around your vagina. Avoid perfumed soaps, washes and douches.
Only use products made for the vagina. The NHS warns that creams and lotions not meant for the vagina can cause more irritation or infection.
Know the difference between moisturisers and lubricants. Ask your pharmacist about both.

	What it's for	How you use it
Vaginal moisturiser	Everyday dryness and soreness, whether or not you have sex	Every 2 or 3 days. It lasts longer and isn't tied to sex
Lubricant	Comfort during sex	Just before sex, on the vulva and vagina

If you use condoms, the Menopause Charity says to choose a water-based lubricant, because it won't damage the latex.

Treatments to talk to your GP or pharmacist about

Vaginal oestrogen. This is a low-dose form of HRT that you put inside the vagina. The NHS says it comes as a tablet, pessary, cream, gel or ring. Very little gets into the rest of your body, so it doesn't carry the same risks as other types of HRT. It's used for vaginal dryness and irritation. It won't help hot flushes or mood. The NHS says it can take up to 3 months to work fully.

The NHS also says some vaginal oestrogen can now be bought from a pharmacy without a prescription. When the first of these was approved in 2022, the MHRA said it was for women aged 50 and over who hadn't had a period for at least a year. The pharmacist talks with you first to check it's safe and suitable. If that doesn't fit you, your GP can prescribe it.

Vaginal oestrogen with HRT. You can have both. The Menopause Charity says it's safe to use vaginal treatments alongside HRT. This matters because, as above, many women still have symptoms while taking HRT.

If you've had breast cancer. The NHS advises checking with a doctor or specialist nurse before using vaginal oestrogen if you've ever had breast cancer, have unexplained vaginal bleeding, or have had certain other conditions. Women's Health Concern says lubricants and moisturisers can be especially useful for women who aren't suited to oestrogen.

Other options. Women's Health Concern says there are other prescription treatments for women who can't use vaginal oestrogen. Your GP or a menopause specialist can talk you through them.

Talking to your GP about it

Lots of women find this hard to bring up. Women's Health Concern suggests:

writing a list before you go, and starting with the hardest question
printing or saving information (like this page) to show the doctor if you'd rather not explain out loud
handing over a note if you can't face saying it at all
mentioning any medicines you take and how much the symptoms affect you

If you'd feel more comfortable seeing a woman doctor or nurse, you can ask. Our symptoms checklist can help you list everything before the appointment.

When to see a GP about vaginal dryness

The NHS says to see a GP if:

you've had dryness for a few weeks and things you've tried yourself aren't working
it's affecting your daily life
you have unusual discharge
you have bleeding after sex, between periods or after your menopause

The Menopause Charity also says to see your doctor if you've had no improvement after about three months of treatment. And use the box near the top of this page for anything that needs checking soon.

What about sex?

Dryness can make sex painful, and that's common. Painful sex has its own causes and help, so we've given it a page of its own: painful sex after menopause.

GSM often comes with menopause vaginal itching, menopause discharge and urine infections in menopause. You can see them all in our list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms

Genitourinary syndrome of menopause (GSM): vaginal dryness and other changes, and what helps