arrow-small-left Created with Sketch. arrow-small-right Created with Sketch. Carat Left arrow Created with Sketch. check Created with Sketch. circle carat down circle-down Created with Sketch. circle-up Created with Sketch. clock Created with Sketch. difficulty Created with Sketch. download Created with Sketch. email email Created with Sketch. facebook logo-facebook Created with Sketch. logo-instagram Created with Sketch. logo-linkedin Created with Sketch. linkround Created with Sketch. minus plus preptime Created with Sketch. print Created with Sketch. Created with Sketch. twitter logo-twitter Created with Sketch.

Vaginal atrophy occurs when the lining of the vagina becomes dry and thin, leading to problems such as itching, burning, and pain during sex. It is caused by a drop in oestrogen levels around the time of menopause. It’s also common to develop urinary (wee) symptoms including urinary leakage and recurrent urinary tract infections (UTIs). Because the condition causes vaginal, urinary and sexual symptoms, and occurs around or after menopause, vaginal atrophy is also known as genitourinary syndrome of menopause (GSM).

Topics on this page

What is vaginal atrophy?

Around the time of menopause, women experience changes to the vagina and urinary (wee) system that is caused by decreased levels of the hormone oestrogen in the body. These changes are described as vaginal atrophy — also known as genitourinary syndrome of menopause (GSM). Vaginal atrophy affects around 40% of postmenopausal women and the risk increases with age.

Low levels of oestrogen cause thinning of the vaginal lining, vulval skin, bladder, urethra (the tube that leads from the bladder to outside the body) and the pelvic floor muscles. This can cause symptoms in these areas and reduced blood flow in the pelvis. However, treatment for vaginal atrophy and other tissues can be very effective, so if you experience any of the symptoms, speak to your doctor.

2018 JH pelvic diagram 600x400px

What causes vaginal atrophy?

The vagina (and other tissues in the pelvis) needs oestrogen to keep the tissue healthy. When oestrogen levels drop, vaginal tissues become less plump and elastic. Instead, they become drier, thinner and more fragile. This increases the risk of irritation or abrasions that encourage infection of the urinary tract.

Oestrogen levels start to rise and fall unevenly during perimenopause (the years leading up to menopause) and they fall further after menopause (the final menstrual period). Oestrogen levels may also decrease due to:

  • the surgical removal of both ovaries (surgical menopause)
  • breastfeeding
  • medications that suppress or reduce oestrogen levels (ie oral contraceptives)
  • pelvic radiation therapy for cancer
  • chemotherapy
  • hormonal breast cancer treatment.

What are the signs and symptoms of vaginal atrophy?

Vaginal symptoms include:

  • dryness of the vagina
  • pain during sex (dyspareunia)
  • reduced vaginal lubrication during sex
  • burning and/or itching of the vagina
  • spotting or light bleeding, including after sex (*see your GP urgently to check for any abnormal cause)
  • persistent, smelly discharge from the vagina (sometimes mistaken for thrush/candida)
  • itchy vulva
  • vulval irritation, especially when wearing tight pants or lycra
  • shortening and tightening of the vaginal canal or stretching with prolapse
  • the labia (lips of the vulva) and vagina become pale and thin
  • reduction in pubic hair.

Urinary (wee) system symptoms include:

  • frequent or urgent urination
  • pain or burning when urinating
  • urinating more often than usual, including at night
  • blood in the urine
  • urinary incontinence or leakage
  • recurrent urinary tract infections (UTIs).

The risk of UTIs also increases as we age. Weakened pelvic floor muscles can lead to more frequent urination that is difficult to control. If the bladder doesn’t completely empty, a ‘pool’ of urine may be left behind which can lead to infection. The vagina becomes less acidic after menopause and this also increases the risk of urinary tract infections (UTIs). Weakened pelvic floor muscles may lead to urinary leakage especially with actions like coughing, sneezing or laughing.

Mature woman sitting end of bed alone

Who is at risk of developing vaginal atrophy?

Women over 50 years of age or who have gone through menopause are most likely to develop vaginal atrophy. However, other factors that increase your risk include:

  • having had your ovaries removed
  • chemotherapy or radiation treatment
  • lack of sexual activity (sex increases blood flow to the area and makes vaginal tissues more elastic)
  • immune disorders
  • medications that contain anti-oestrogen properties such as tamoxifen (Nolvadex), medroxyprogesterone (Provera), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel)
  • not having a vaginal birth
  • smoking.

How is vaginal atrophy diagnosed?

Your doctor will ask questions about your symptoms, past health history and family health history. A physical examination will include a pelvic examination to check your vulva and vagina for signs of vaginal atrophy. If there is vaginal discharge, your doctor may take a vaginal swab to check for any infection. If you have urinary symptoms, your doctor may also order a urine test to check for a UTI.

Complications of vaginal atrophy

The vagina becomes less acidic after menopause and these changes can mean that bacteria and other organisms are more likely to grow and thrive. This can increase your risk of developing vaginal infections. Urinary changes linked to vaginal atrophy can increase the likelihood of urinary tract infections and urinary incontinence.

Treatment for vaginal atrophy

Treatment for vaginal atrophy can involve non-hormonal and hormonal options.

Non-hormonal treatments

  • Applying cool compresses can help itching and mild discomfort. Dilute ½ teaspoon of bicarb soda in 1 litre of water, soak a washcloth in the solution and apply it gently to your vulva a few times a day, taking care to pat the area dry afterwards instead of rubbing it.
  • Water or silicone-based vaginal lubricants can help make sex more comfortable. Some women find that some lubricants with alcohol and preservatives sting. Remember to avoid using oil-based lubricants with latex condoms as they can damage the condom.
  • Non-hormonal moisturisers (eg Replens®) can help to plump up cells in the vagina and add more moisture which can improve symptoms.
  • Eating 2 tablespoons of freshly ground linseed (also known as flaxseed), a plant-based oestrogen or phytoestrogen, each day may also help with vaginal dryness. You can add this food to your cereal, in salads or smoothies.

Hormonal treatment

Vaginal oestrogens, available as tablets, pessaries or creams, are an effective treatment for vaginal atrophy. They deliver oestrogen directly to the vagina without raising oestrogen levels in the rest of the body. Vaginal oestrogen treatment improves blood flow in the pelvis and increases vaginal secretions.

Oestrogen creams come with an applicator, but many women find it easier to apply the cream to their finger and insert it into their vagina. Any excess can be smeared onto the skin of the vulva. It is recommended to insert the oestrogen only into the lower third of your vagina (about 2-3 cm). This will improve the tissues of the pelvis: the vulva, vagina, bladder, urethra and pelvic floor muscles.

Menopausal hormone therapy (MHT) will also improve vaginal symptoms and can be used if women are also experiencing menopause symptoms that affect the whole body such as hot flushes and night sweats. Ask your doctor if MHT is appropriate for you.

Hormonal treatment may not be suitable for women with a history of oestrogen receptor positive cancer. Discuss your risk factors with your doctor.

Prevention of vaginal atrophy

Regular sexual activity (with or without a partner) may help prevent vaginal atrophy. Sexual activity improves blood flow to the vagina which helps keep vaginal tissues elastic and flexible. Sexually active women report fewer symptoms of vaginal atrophy compared to women who don’t have regular sex.

When to see your doctor

Many women experience the symptoms of vaginal atrophy but don’t seek treatment because they feel embarrassed. Others think there is nothing that can be done and that they just have to ‘grin and bear it’. If you experience any of the signs or symptoms mentioned, make an appointment with your doctor because treatment can be very effective. If pain, irritation or other symptoms continue after treatment, please see your doctor to check for another cause.

What you can do

Reducing vaginal irritation can help with some of the symptoms of vaginal atrophy. These recommendations may help:

  • wear cotton underwear
  • change underwear daily and go without underwear when possible (eg going to bed)
  • avoid tight-fitting underwear, tights or pants
  • limit time in damp clothing such as exercise clothes or bathers
  • wash clothing in non-perfumed, low-allergenic products and avoid fabric softeners
  • avoid feminine sprays and douching
  • avoid scented toilet paper, pads and tampons
  • avoid shaving or waxing the genital area
  • avoid using soaps, bubble baths and shower gels on the vulva

Visit our webpage on Vaginal irritation for more information.

Find out what’s normal when it comes to vulval health, what causes irritation, how it can be managed and handy health tips to keep in mind.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at October 2021.

Last updated: 18 February 2022 | Last reviewed: 15 October 2021

Was this helpful?

YES, it was
NO, it wasn't

Thank you for your feedback

Related Topics