Talk to me about vaginal atrophy

[its2025]

HI All.
I am 52 and must be in peri menopause but i'm still having fairly regular periods with just the odd one here and there that's late but generally speaking still having a regular cycle.

I've recently noticed that sex is becoming painful. I cant say I've noticed any dryness as such but having Googled around it would seem vaginal atrophy is the most likely cause. I'm not having any other ongoing peri menopausal symptoms - no hot flushes - no brain fog (or none more than usual!! LOL). I'm not keen on resorting to HRT as it seems daft to medicate for this one symptom.

Has anyone had mild atrophy like this - just impacting sex. Would a vaginal moisturiser help? In which can can anyone recommend a brand.

or do I just use lube??

The one recommended in the Menopause groups I’m in is called YES. It’s PH matched and better than the average lube. I have very sensitive skin and fine with it

It’s not remotely daft to medicate just for this. Moisturising wont help with the ongoing atrophy issue. You just need a localised treatment - a tiny dose in a pessary such as vagifem, or one of the estrogen creams.

This is really easily sorted if you catch it early (once it progresses it's harder to reverse.)

The treatment is vaginal estrogen. (Despite the way it's sometimes described, it's not actually HRT- it's "topical estrogen" - meaning it's applied to the skin and doesn't work systemically like HRT.)

Your GP can prescribe - there is a cream which is 0.1% estradiol, or there is a tiny pessary called Vagifem. You use both every day for 2 weeks then 2/3 times a week afterwards- forever.

If you want to buy Vagifem yourself, you can buy it OTC and it's called Gina. However it's more expensive than an NHS prescription and probably more useful if you can't get an appt soon-ish with your GP!

It's also personal preference which you use- the cream can also be used externally as some times that feels sore too.

I see another poster has suggested Yes. This is a moisturiser and one which is preferred by menopause specialists BUT it's not a treatment as such for VA. It really is better to use it alongside estrogen. This is because although it moisturises it isn't a 'treatment' and won't reverse the changes of atrophy.

It's important to know that pain during sex can be the start of VA , but left untreated it can progress to affecting the bladder (which depends on estrogen to keep the lining healthy) and overall pelvic health.

What @JinglingSpringbells has said. My GP could only see “a tiny bit of dryness” but my urethra and bladder were so severely affected it was like having a permanent UTI. Miserable and debilitating. Estriol 1mg cream has changed my life x

Like the OP, VA is the absolute only symptom of menopause that I've had, which has made me reluctant to go to the doctor. I don't have sex any longer either, so it's really not made much of an impact, but the scary stuff about it being harder to treat the longer it goes on makes me think I should do something...

You must! It’s so easy to get on top of with the estriol cream. I too had no other symptoms but the VA ruined my life for years. Ask your GP to prescribe x

Now to begin the ten year experience of 'Getting a Doctor's Appointment;...

Thank you all for supportive comments especially @JinglingSpringbells. Sounds like i need to get myself to my GP before things get worse :(
That would probably be sensible anyway just to ensure that VA is indeed definitely what I'm dealing with and not anything else.
I may try one of the over the counter remedies just while I wait for an appointment.

ooh - so looks like Gina may not be good for me. On Boots website and says only suitable for those who haven't had a period for 12 months. I'm still having a cycle.

You can buy it- Boots, Superdrug, etc. Ask for Gina. Or you buy it online from online pharmacies - until you can get an appt.

They may ask a few questions like your age (it's licensed for women over 50 if you buy it OTC- which is a bit ridiculous as it often needs to be used before 50.)

If you just tell your GP what you said here, they shouldn't need to examine you.

It's such a common thing and not a 'big deal.

I've used it for around 18 years.

Gina absolutely would be suitable but it probably has tighter regulations on being sold over the counter than on prescription.

Best to get it from the GP. Age doesn't matter and it's cheaper!

THANK YOU. I have been meaning to get hold of some but didn't know I could buy it OTC, and I really think I should. I can at least give it a try and if it works then I can get an appointment at my leisure and get it on prescription (when it will be free!)

It's the OTT licensing rules.

These products were only made available last year and there was huge publicity over their 'release' (ie being available OTC.)

Considering how weak they are, it's a bit of a nonsense. So the 'red tape' around it is for women post menopausal and over 50.

This doesn't apply if you get it from your GP. (and if you're desperate you just say you're post meno- they won't know.)

To put the dose into context, if you use vaginal estrogen 2 x a week for a year, that's the same amount of estrogen as 1 day of systemic HRT.

Thanks - all very useful info. And will help anyone else looking up this subject on MN not just me!

Hi OP. I’ve attached a booklet where there is a useful GSM symptom checker you can use to tick off all you’re experiencing to discuss with your doctor.
https://menopausesupport.co.uk/wp-content/uploads/2023/06/MEN0921351544-005_Menopause-Support-Booklet-5-3.pdf

As you’ve established Gina is only for if you’re only 50 and haven’t had a period for 12 months plus other more stringent requirements. Also you’d have to pay a lot more for it than via a prescription from your GP. For anyone unaware Ovestin/Estriol 1mg cream is also available OTC after screening in the same way from Boots - called Ovesse.

The dose in topical treatments is absolutely tiny when compared to systemic HRT and there is little systemic absorption. When used for a year, this is the total equivalent dose of one oral HRT pill. It takes time to work and is recommended to give three months and then review with your doctor

As mentioned first line treatment in the UK is usually estradiol pessaries (Vagifem or generic Vagirux), or an estriol cream which could also be used externally on the vulva/clitoris/perineum.

Yes VM is great as a vaginal moisturiser. It can sting a bit if the tissue is already sore, in which case try Yes OB instead which is oil based, and can also be used as a lube when having sex, sometimes along with Yes WB. Check out the Yes website for more info.

I had horrific atrophy, even sitting down was painful. None of the lubes worked effectively, in the end I had HRT. Initially localised (Vagifem) small estrogen tablet inserted in the vagina. I’m now on patches and progesterone separately (still have a womb) as other menopause symptoms were becoming intolerable. Now I’m lovely and moisturised, no more pain especially during sex 🤗

HI Everyone I just thought I'd pop back with an update for anyone reading this thread in future.

I did try a generic unbranded vaginal moisturiser while I waiting for a GP appointment - that certainly did relieve the symptoms short term. I went to my GP and we discussed my symptoms and menopause in general - actually she was pretty helpful. I did have to have an exam - but it wasn't as bad as a smear test and GP just wanted to confirm there was no other cause of the discomfort. She prescribed Estrodil cream which I've been using since. I find it really good easy to apply and not messy.

Happy to report that sex is great again. I do also sometimes use lube but not all the time. Sorry if this is TMI for some - but my BF also able to confirm he hasn't noticed any odour or taste during oral which was another concern of mine.

Thanks for this very helpful. I had ordered vagirux on the internet. Almost finished the first packet but started to worry as I realised it mentioned over 50’and no longer having a cycle.
in erratic but still going and not yet 50

you set my mind to rest for now. Thank you!

I suffered really badly with this although was totally unaware what was going on until reading threads on here until the penny dropped.

I felt dry and itchy and yes, sex was painful. I also had a constant dull ache, sort of like mild period paid (which was weird seeing as I had had a hysterectomy) and lots of UTIs within a short period. The GP prescribed Estriol and it has been a game changer, I don't get UTIs any more and things are much improved.

Moisturisers and lubricants are going to help with the dryness but are not going to deal with the other effects the lack of estrogen may be having. It's worth discussing with your GP. They may wish to examine you but in my direct experience this is a very quick look and does not involve speculums!