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Menopause is a big transition and your body goes through a lot – including some unexpected changes, like vaginal atrophy. Here’s how to recognise it and what to do next
Summary
1Vaginal atrophy symptoms
Vaginal atrophy occurs when the walls of the vagina become drier and thinner – causing dryness, irritation, painful sex and more.…
2What causes vaginal atrophy?
The main cause is low oestrogen after menopause, but treatments, surgery and health conditions can also play a role…
3How to treat vaginal atrophy
There are a few options when it comes to treatments for vaginal atrophy, both hormonal and non-hormonal…
Feeling drier than usual? Or noticing a burning feeling, maybe after sex or using the loo?
If you're nearing menopause, this could be a sign of vaginal atrophy – one of the less talked about but oh-so-common symptoms.
Anyone with a vagina can experience vaginal atrophy but it’s most common after menopause.1-3
Vaginal atrophy symptoms
Vaginal atrophy occurs when the walls of the vagina become drier and thinner – often without you even realising it at first. But the symptoms that come about as a result can be hard to ignore.1-3
Here’s what to watch for:1-4
- genital and vaginal dryness
- irritation, burning or itching of the vulva or vagina
- vaginal discharge
- burning when you pee
- frequent or urgent need to pee
- recurrent urinary tract infections (UTIs)
- bleeding during or after intercourse
- discomfort or pain during sex
- less natural lubrication during sex
- decreased sex drive, arousal and orgasm
These symptoms can be pretty unpleasant and depending on their severity might have a real impact on your quality of life, relationships and daily activities.4
Don’t hesitate to reach out to your healthcare provider – they’re there to provide support, advice and treatment if you need it.
How is vaginal atrophy diagnosed?
The symptoms of vaginal atrophy can overlap with several other conditions, often being mistaken for vaginal or urinary tract infections or even sexually transmitted infections (STIs).1,2
That’s why it’s important to make an appointment with your healthcare provider. They can help pinpoint the issue and recommend the most appropriate and effective treatment.
To diagnose vaginal atrophy, your doctor or nurse will perform a pelvic exam. This involves visually checking your vulva, vagina and cervix as well as gently feeling your pelvic organs for any signs of the condition.5
What causes vaginal atrophy?
Vaginal atrophy happens when your oestrogen levels decrease.1,5
A common reason for this drop is menopause – between 27% and 84% of postmenopausal women will experience vaginal atrophy.1,5
So, why exactly does menopause lead to vaginal atrophy?
As you transition through perimenopause and menopause, your hormone levels change and oestrogen production can drop by a whopping 95%.1 This drastic decrease may affect the structure and function of the tissues in your vagina and vulva, as well as your bladder and urethra, leading to the symptoms listed above.1,6
Other factors that can cause a decrease in oestrogen levels and cause vaginal atrophy include:1,4,5
- radiotherapy to the pelvic area
- chemotherapy
- hormonal cancer treatments (such as anti-oestrogen medications, like Tamoxifen)
- oophorectomy to remove both ovaries (surgical menopause)
- underlying conditions such as diabetes or Sjögren’s syndrome
- breastfeeding
Vaginal atrophy risk factors
As with most conditions, certain things can increase your chances of developing vaginal atrophy. Risk factors include:1,7,8
- not having given birth vaginally
- alcohol abuse
- smoking
- infrequent and no sexual activity
- lack of exercise
- a condition called premature ovarian failure (POI)
How to treat vaginal atrophy
There are a few options when it comes to treatments for vaginal atrophy, both hormonal and non-hormonal. Your healthcare provider will be able to recommend the best treatment for you based on your symptoms, general health and medical history.
Healthcare professionals may recommend hormonal treatments for controlling symptoms. These include:1-5,8,9
- hormone replacement therapy (HRT) – often used in the treatment of menopause symptoms, HRT replaces oestrogen to relieve symptoms such as hot flushes, night sweats and vaginal atrophy
- topical vaginal oestrogens – applied via pessaries, creams, gels or vaginal rings, these deliver oestrogen directly to the vaginal area, improving vaginal elasticity and natural moisture, and even helping protect against urinary infections
In addition to hormonal treatments, there are several non-hormonal options you might be offered to help manage vaginal atrophy:1-5,10
- vaginal moisturisers and lubricants – these can provide short-term relief from dryness and itching, and can make sex more comfortable and enjoyable
- engaging in regular sexual activity – whether solo or with a partner, regular sexual activity helps maintain vaginal health
Can vaginal atrophy be reversed?
Vaginal atrophy is a chronic, progressive condition, meaning it won’t get better on its own and can worsen without treatment.1
While it can’t be fully reversed, consistent treatment can slow its progression, relieve symptoms and improve your quality of life.1,10
What are the complications of vaginal atrophy?
If left untreated, vaginal atrophy can increase your risk of vaginal infections and recurrent UTIs.8 It can also lead to chronic vaginal dryness, urinary incontinence and painful sex, all of which can have a significant impact in your quality of life.1,8
Getting the treatment you need as soon as possible can not only help keep your physical symptoms under control, but will also reduce their impact on your mental health, self-esteem and even your relationships.1,8
The final say
Whether you’re experiencing vaginal atrophy or just want to know more about it, remember that it’s a common condition, and there’s absolutely no shame in it.
If you have symptoms, it’s important to talk to your healthcare provider as soon as you can. They can recommend the best treatments to keep your symptoms in check, so you can continue living your life without interruption.
Whether it’s vaginal atrophy or any other menopause-related symptom you want to know more about, our menopause hub is full of helpful information and tips.
Disclaimer - This article provides informational advice and is not a substitute for medical care. Curated by experts for accuracy, we take great care to ensure the information is up-to-date and relevant. However, you should always consult your GP or healthcare professional before using supplements or alternative products, particularly if you have medical conditions or are under supervision.
1. Carlson K, et al. Genitourinary syndrome of menopause. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/
2. The British Menopause Society. The management of urogenital atrophy: A British Menopause Society Consensus Statement [Internet]. [cited 2025 Mar 31]. Available from: https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
3. NHS Wales. Atrophic vaginitis [Internet]. [cited 2025 Mar 31]. Available from: https://wisdom.nhs.wales/health-board-guidelines/c-vgleafletfile/atrophic-vaginitis2cvg-leaflet-2022pdf/
4. British Society for Sexual Medicine. Guidelines on the management of genitourinary syndrome of menopause (GSM) [Internet]. [cited 2025 Mar 31]. Available from: https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
5. West Sussex Healthcare NHS Trust. Atrophic vaginitis / genitourinary syndrome of the menopause (GSM) [Internet]. Reference No. 6647-1. Issue date: 07 Aug 2020; review date: 07 Aug 2023 [cited 2025 Sep 04]. Available from: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Gynaecology/6647-1-Atrophic-vaginitis-genitourinary-syndrome-of-the-menopause-GSM.pdf
6. Ulhe SC, et al. Study of vulvovaginal atrophy and genitourinary syndrome of menopause and its impact on the quality of life of postmenopausal women in Central India. Cureus. 2024;16(2):e54802. https://doi.org/10.7759/cureus.54802
7. Angelou K, et al. The genitourinary syndrome of menopause: An overview of the recent data. Cureus. 2020;12(4):e7586. https://doi.org/10.7759/cureus.7586
8. Royal United Hospitals Bath NHS Foundation Trust. Atrophic vaginitis [Internet]. [cited 2025 Mar 31]. Available from: https://www.ruh.nhs.uk/patients/Urology/documents/patient_leaflets/Atrophic_Vaginitis.pdf
9. Harper-Harrison G, et al. Hormone replacement therapy. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493191/
10.
Benini V, et al. New innovations for the treatment of vulvovaginal atrophy: An up-to-date review. Medicina (Kaunas). 2022;58(6):770. https://doi.org/10.3390/medicina58060770
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