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Understanding and treating atrophic vaginitis (genitourinary syndrome of menopause)

When menopause brings vaginal dryness, discomfort, and pain, effective treatments can restore your comfort and quality of life
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Atrophic vaginitis, now more commonly called genitourinary syndrome of menopause (GSM), is a condition caused by declining oestrogen levels that leads to thinning, drying, and inflammation of the vaginal walls.

If you’ve noticed vaginal dryness, burning, painful intercourse, or urinary symptoms since entering menopause, you’re experiencing a very common but often undertreated condition. You don’t have to accept these symptoms as a normal part of ageing—effective treatments are available.

At The Women’s Health Vulvo-Vaginal & Genitourinary Clinic, we specialise in treating genitourinary syndrome of menopause. Our team can help you find the right treatment to restore your vaginal health, comfort, and intimacy.

Vaginal atrophy is treatable. Let us help you restore comfort and confidence.

Do you have genitourinary syndrome of menopause (GSM)?

You may have atrophic vaginitis if you experience:

  • Vaginal dryness or lack of natural lubrication
  • Burning or irritation in the vaginal area
  • Painful intercourse (dyspareunia)
  • Vaginal itching or discomfort
  • Bleeding or spotting after intercourse
  • Narrowing or shortening of the vagina
  • Frequent urinary tract infections
  • Urinary urgency or frequency
  • Recurrent vaginal infections

If this sounds familiar, effective treatment is available.

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Common causes and risk factors

1. Natural Menopause

The most common cause is the natural decline in oestrogen that occurs during and after menopause. Symptoms typically begin in perimenopause and worsen over time without treatment.

2. Surgical Menopause

Women who have had their ovaries removed experience a sudden drop in oestrogen, often leading to more severe symptoms.

3. Breast Cancer Treatment

Chemotherapy, radiation, or hormonal therapies (such as aromatase inhibitors or tamoxifen) can cause vaginal atrophy, even in younger women.

4. Breastfeeding

Oestrogen levels are naturally lower during breastfeeding, which can cause temporary vaginal dryness and discomfort.

5. Lack of Sexual Activity

Regular sexual activity helps maintain vaginal health by increasing blood flow. Women who are not sexually active may experience more severe atrophy.

6. Smoking

Smoking reduces blood circulation and can worsen vaginal atrophy symptoms.

How we diagnose and treat GSM

Comprehensive history

We’ll discuss:

  • When symptoms started and how they’ve progressed
  • Menopausal status and timing
  • Impact on sexual function and quality of life
  • Urinary symptoms
  • Previous treatments and their effectiveness
  • Medical history, including breast cancer or other conditions
  • Current medications and hormone therapy
Thorough examination

A careful examination will reveal:

  • Thinning and pale vaginal tissue
  • Loss of vaginal rugae (folds)
  • Vaginal dryness
  • Inflammation or irritation
  • Narrowing of the vaginal opening
  • Tissue fragility or bleeding
pH testing

Vaginal pH is typically elevated (above 5.0) in vaginal atrophy, compared to the normal premenopausal pH of 3.8-4.5.

Treatment approach

Treatment for atrophic vaginitis may include:

  • Topical oestrogen therapy
  • Vaginal moisturisers
  • Lubricants
  • Ospemifene (Osphena)
  • Vaginal DHEA (Prasterone)
  • Laser or radiofrequency therapy
  • Lifestyle modifications

Frequently asked questions

Q: Is vaginal oestrogen safe?

A: Vaginal oestrogen is considered very safe for most women. Because it’s applied directly to the vagina, very little is absorbed into the bloodstream. Even many breast cancer survivors can safely use low-dose vaginal oestrogen, though you should discuss this with your oncologist.

Q: Will symptoms go away on their own?

A: No, vaginal atrophy is a progressive condition that worsens over time without treatment. The good news is that treatment is highly effective.

Q: How long does treatment take to work?

A: Most women notice improvement within 2-4 weeks of starting treatment, with continued improvement over 3 months. Ongoing treatment is needed to maintain results.

Q: Can I use over-the-counter products instead of prescription treatment?

A: Vaginal moisturisers and lubricants can provide some relief, but they don’t address the underlying tissue changes. Prescription oestrogen therapy is the most effective treatment for restoring vaginal health.

Q: Will I need to use treatment forever?

A: Vaginal atrophy is a chronic condition, so ongoing treatment is typically needed to maintain vaginal health. However, once symptoms are controlled, many women can reduce the frequency of treatment.

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Take the first step towards restoring vaginal health

Atrophic vaginitis or genitourinary syndrome of menopause (GSM) is one of the most treatable menopausal symptoms. Don't suffer in silence—effective treatments can restore your comfort, intimacy, and quality of life
Contact usBook a consultation