--- title: "Vaginal dryness and genitourinary symptoms" description: "How menopause can affect comfort in the vagina and when you pee, what treatments can help, and when to get symptoms checked." url: "https://myruva.co/learn/vaginal-dryness-and-gsm" language: "en-GB" topic: "Menopause" published: "2026-10-18" updated: "2026-10-19" author: "Ruva team" reading_minutes: 4 --- # Vaginal dryness and genitourinary symptoms How menopause can affect comfort in the vagina and when you pee, what treatments can help, and when to get symptoms checked. *Written and reviewed by the Ruva team · Updated 2026-10-19 · Menopause* ## Key points - Falling oestrogen can cause vaginal dryness, itching and discomfort. - Vaginal moisturisers and lubricants do different jobs. You can use them without any hormone treatment. - You can be offered vaginal oestrogen alongside systemic HRT. - Bleeding after menopause needs a medical check, even if it’s only spotting. Dryness can mean itching or burning during the day, discomfort during sex, or soreness around the vagina. Falling oestrogen around menopause can make the tissue of the vagina drier and thinner. These symptoms are worth talking about even if you’re not having sex. ## What GSM describes Genitourinary syndrome of menopause (GSM) is the name for vaginal and urinary symptoms linked to menopause. These can include dryness, irritation, pain during sex and discomfort when you pee. You may also hear it called vaginal atrophy. Menopause isn’t the only possible cause of dryness. Medicines, including some antidepressants and hormonal contraception, can play a part. So can perfumed washes. Tell your clinician what you use, including products you buy without a prescription. A new symptom can have other causes. ## Moisturisers and lubricants do different jobs A vaginal moisturiser helps keep the vagina moist day to day. A lubricant is used before or during sex to make it more comfortable. You can buy both without a prescription. Ask a pharmacist for a product made for use in the vagina, and follow its instructions. The NHS suggests a water-based lubricant before sex. You can use it with a sex toy or on fingers, as well as during intercourse. Use unperfumed products to wash around the vagina, and avoid douches (washing inside the vagina). Ordinary body lotions and moisturisers shouldn’t be used instead of vaginal products. They can cause irritation or infection. ## Local oestrogen, including alongside HRT Vaginal oestrogen comes as a cream, gel, tablet, pessary (a small tablet you put into the vagina) or ring. It treats symptoms where they are. NICE says only a very small amount gets into the bloodstream and serious side effects are very rare. Your GP, doctor or pharmacist can tell you whether a product suits you and how to use it. NICE recommends offering vaginal oestrogen for vaginal and urinary symptoms, even if you already take systemic HRT. You can also use it with a non-hormonal moisturiser or lubricant. Vaginal oestrogen doesn’t treat hot flushes or sleep problems. In the UK, you can buy some vaginal oestrogen products from a pharmacy without a prescription. The pharmacist can check whether they suit you. US patient guidance describes vaginal oestrogen on prescription, alongside moisturisers and lubricants you can buy without one. Ask locally how to get the product you need. If you have had breast cancer, talk to your care team about treatment. NICE recommends trying non-hormonal moisturisers or lubricants first. Vaginal oestrogen may be considered if symptoms carry on. If you take an aromatase inhibitor, your breast cancer specialist needs to help choose your treatment. The NHS says vaginal oestrogen can take up to 3 months to work fully. NICE advises checking how well it’s working and how you’re getting on with it. Ask your clinician what improvement to look for and how to report problems while you use it. Symptoms often come back when you stop vaginal oestrogen. If treatment isn’t helping enough or is hard to use, ask for a review. NICE lists other prescription options, including vaginal prasterone if the first treatments haven’t helped or you couldn’t use them. Your doctor can talk through what suits you. Don’t change a prescribed treatment on your own. ## When urinary infections keep returning Menopause can bring more urinary tract infections (UTIs), or symptoms that feel like an infection. Tell your clinician about any burning, discomfort and changes in how often you pee. For UTIs that keep coming back, NICE says clinicians can consider vaginal oestrogen if changes to habits and hygiene haven’t helped or aren’t suitable. It doesn’t recommend systemic HRT just to prevent repeat UTIs. Call 999 now (UK) or 911 (US), or your local emergency number, if you become confused, unusually drowsy or have difficulty speaking. Contact your GP or NHS 111 today (UK), or your doctor or urgent care service (US or elsewhere), if problems peeing come with fever or shivering, pain in your back just below the ribs, blood in your pee, or symptoms that get worse quickly. ## Getting symptoms checked Book a GP appointment in the UK, or see your doctor in the US or elsewhere, if dryness affects daily life or doesn’t get better with self-care. Ask for a check if you have unusual discharge or bleeding after sex. Any bleeding after menopause needs checking, even a small amount of spotting. You can start with plain words: “It burns when I sit down”, or “Sex has become uncomfortable”. Bring the names of products you’ve tried and say what changed. Ask what the treatment is meant to help with and how you’ll review it together. ## When to get help - **Emergency:** Call 999 now (UK) or 911 (US), or your local emergency number, if you become confused, unusually drowsy or have difficulty speaking. - **Same day:** Contact your GP or NHS 111 today (UK), or your doctor or urgent care service (US or elsewhere), if problems peeing come with fever or shivering, pain in your back just below the ribs, blood in your pee, or symptoms that get worse quickly. - **Book an appointment:** Book a GP appointment (UK) or see your doctor (US or elsewhere) if dryness affects daily life, doesn’t get better with self-care, or comes with unusual discharge or bleeding. ## Where you live Services and advice differ between countries. - **UK:** You can buy some vaginal oestrogen products from a pharmacy without a prescription. Ask the pharmacist whether they suit you. - **US:** The Office on Women’s Health describes moisturisers and lubricants you can buy without a prescription, and vaginal oestrogen on prescription. - **Elsewhere:** Elsewhere, ask a local clinician which vaginal treatments suit you and are available. ## Sources 1. [Vaginal dryness](https://www.nhs.uk/symptoms/vaginal-dryness/), NHS 2. [Menopause: identification and management](https://www.nice.org.uk/guidance/ng23/resources/menopause-identification-and-management-pdf-1837330217413), NICE 3. [About vaginal oestrogen - Brand names: Vagifem, Gina, Ovesse, Estriol, Vagirux](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/), NHS 4. [Menopause symptoms and relief](https://womenshealth.gov/menopause/menopause-symptoms-and-relief), Office on Women's Health 5. [Symptoms of menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/), NHS 6. [Recommendations | Urinary tract infection (recurrent): antimicrobial prescribing](https://www.nice.org.uk/guidance/ng112/chapter/Recommendations), NICE 7. [Vaginal dryness](https://www.womens-health-concern.org/help-and-advice/factsheets/vaginal-dryness/), Women's Health Concern / British Menopause Society 8. [Urinary tract infections (UTIs)](https://www.nhs.uk/conditions/urinary-tract-infections-utis/), NHS --- This guide is general information to help you keep and use your own records. It isn’t medical advice. If you’re worried about a symptom, or something changes suddenly, talk to a doctor, nurse or pharmacist.