Vaginal and sexual health during menopause
5 min read
Genitourinary syndrome of menopause (GSM) — which includes vaginal dryness, discomfort during sex, and urinary symptoms — affects more than half of women after menopause. Unlike hot flushes, it rarely improves on its own. But it is very treatable.
What is GSM?
As oestrogen declines, the tissues of the vagina, vulva, and bladder thin and lose moisture. This causes symptoms ranging from mild dryness and discomfort to significant pain during sex, urinary urgency, recurrent UTIs, and reduced sensation. Many women don't mention it to their doctor because they assume it's inevitable.
It won't improve without treatment
Unlike vasomotor symptoms (hot flushes) which often reduce over time, GSM is a chronic condition that tends to worsen without treatment. Seeking help early matters.
Treatment options
Local vaginal oestrogen is one effective option and is available in several forms. Systemic absorption is generally low, but suitability should still be discussed with a clinician, particularly after hormone-sensitive cancer.
Non-hormonal vaginal moisturisers and lubricants can provide symptom relief. A healthcare professional can also discuss other prescription options where appropriate.
Sexual health
Reduced libido is common in menopause, influenced by both hormonal changes (declining testosterone as well as oestrogen) and the practical impact of pain, dryness, and fatigue. It is worth discussing directly with your GP. Testosterone supplementation is sometimes prescribed and has evidence for improving libido in menopause.
Clinical reference points
Reviewed against these public guidance sources in September 2026. Content is educational and is not represented as clinician-reviewed.
Educational content only. This guide is intended to inform, not to replace medical advice. Always discuss symptoms and treatment options with a qualified healthcare provider who knows your full history.
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