Vaginal dryness, pain and bladder symptoms

As oestrogen falls, the skin and lining of the vagina, vulva and bladder can get thinner, drier and more easily irritated. It is one of the most common menopause problems, and unlike hot flushes it usually does not get better by itself. The good news is that treatments are simple and they work. Doctors call these genitourinary symptoms.

What it can feel like

• Dryness, burning, soreness or itching in and around the vagina
• Pain or discomfort during sex, or bleeding afterwards
• Needing to pee more often or urgently, including at night
• Leaking when you cough or laugh
• More urinary tract infections, or symptoms that feel like a UTI

What you can do yourself

• Use a water-based lubricant for sex. Do not use oil-based ones with condoms, as they can damage them.
• Try a vaginal moisturiser, used regularly (not just before sex). A pharmacist can help you choose, in private.
• Skip perfumed soaps, washes and douches. Use only products made for the vagina.
• Take your time and enjoy lots of foreplay.

What a doctor can offer

NICE says vaginal oestrogen should be offered to people with these symptoms (including if you also take HRT). It comes as a cream, gel, tablet, pessary or ring, and you decide together which suits you. A tiny amount gets into your bloodstream, so serious side effects are very rare, and the NHS says it does not increase the risk of breast cancer or blood clots. It is safe to use long term. It works well alongside moisturisers and lubricants.

• Symptoms often come back when you stop, and you can restart.
• If you had breast cancer or cannot use vaginal oestrogen, non-hormonal moisturisers and lubricants come first. Your breast team or a menopause specialist can talk through other options.
• If those do not work, NICE says other options include vaginal prasterone, or an oral medicine (ospemifene) in some situations.
• NICE does not recommend vaginal laser treatment outside research trials.
• For repeat UTIs, vaginal oestrogen can help prevent them. Ask your GP.
• Low sex drive has many causes. HRT may help, and a specialist may consider testosterone. Relationship, stress, pain and body image matter too.