Vaginal atrophy and GSM: what it is and what helps

Q: Is local vaginal oestrogen safe to use long term?

Local vaginal oestrogen can be used for as long as you need it, including if you are already taking systemic HRT. It is a prescription-only medicine, so how long you use it is a decision to make with your GP or menopause specialist, who can also point you to the patient information leaflet for the product you are given.

Q: What if I am already taking HRT but still have vaginal symptoms?

Up to 25% of women on systemic HRT still get GSM symptoms. Adding local vaginal oestrogen is a well-recognised way to get fuller relief. If that sounds like you, speak to your GP or prescriber about whether a local treatment alongside your current HRT would suit you. If symptoms persist despite treatment, your specialist will also look at other potential causes to make sure nothing is being missed.

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If you have noticed vaginal dryness, a nagging itch, or a soreness that does not seem to have an obvious cause, these sensations often come down to falling oestrogen. As oestrogen drops, the tissue in your vagina tends to thin and dry out, a change known as vaginal atrophy, or atrophic vaginitis. The broader term now used is Genitourinary Syndrome of Menopause (GSM), because low oestrogen affects the surrounding vulval tissue and urinary tract as well. Knowing what sits behind these changes, and that effective options exist, is where managing them starts.¹

What GSM is and why sustained low oestrogen causes vaginal atrophy

The moisture, stretch, and thickness of your vaginal tissue depend a lot on oestrogen. When levels fall during and after menopause, the vaginal walls tend to become thinner, drier, and less elastic, and the tissue feels more fragile. The natural acidic balance shifts too, which can make inflammation and infection more likely.²

Effective support is available, and getting it can ease the symptoms.³

Recognising the symptoms

The vaginal side of GSM can show up as dryness, burning, itching, a watery discharge, and a general feeling of discomfort. Over time, the vaginal canal may also shorten and tighten. These are physical changes that come from losing oestrogen, and they are common.⁴

GSM has a urinary side too, which is where the 'genitourinary' part of the name comes in. You may feel a sudden or frequent need to pass urine, a burning sensation when you go, or you may get repeated urinary tract infections (UTIs). If any of these are new or worrying you, it is worth raising them with your GP, since urinary symptoms can have more than one cause and need a proper check.⁵

GSM is common in the years after menopause. You can ask for help, and there are treatments that work.⁶

Everyday steps that can reduce discomfort

A few simple changes can take the edge off irritation. Keeping perfumed soaps, scented bath products, and fragranced sanitary items away from the genital area removes a common source of extra sensitivity. These steps help with comfort, though they will not replace treatment if your symptoms are more than mild.⁷

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How lubricants and vaginal moisturisers differ

Moisturisers and lubricants suit milder symptoms well, and they are a good option if you cannot use hormonal treatments or would rather not. You can also use them alongside hormonal treatments.⁸

Local vaginal oestrogen

Local vaginal oestrogen goes directly into the vagina as a cream, pessary, gel, or ring. It is a well-established and effective treatment for GSM. It can be used for as long as you need it, including if you are also taking systemic HRT.⁹

Symptoms often come back if you stop, so this tends to be a longer-term option rather than a short course. In the UK, local vaginal oestrogen is a prescription-only medicine. Speak to your GP or a menopause specialist about whether it suits you, and read the patient information leaflet that comes with anything you are prescribed.¹⁰

Systemic HRT and its role in GSM

Systemic HRT comes as tablets, patches, or gels, and it sends oestrogen through your whole body, which can ease GSM symptoms. It is usually considered when you also have other menopausal symptoms, like hot flushes or night sweats, rather than for vaginal symptoms on their own.¹¹

It helps to know that up to 25% of women on systemic HRT still find vaginal symptoms linger, and adding local vaginal oestrogen can give fuller relief. If you are already on HRT and still dealing with dryness or discomfort, raising it with your GP or prescriber is the right move.¹²

If you are noticing any of the symptoms here, like dryness, itching, burning, or urinary changes, book an appointment with your GP. They can confirm whether GSM is behind it and talk through which treatment options would suit you best.

Frequently Asked Questions

Is local vaginal oestrogen safe to use long term?

What if I am already taking HRT but still have vaginal symptoms?

Sources

[1] BMS Consensus Statement on Genitourinary Syndrome of Menopause (GSM)

The term 'Genitourinary Syndrome of Menopause' (GSM) is now the preferred medical term because it more accurately describes the full range of vaginal, vulval, and urinary symptoms caused by low oestrogen.
[2] Atrophic vaginitis / genitourinary syndrome of the menopause

When oestrogen levels fall, the vaginal walls become thinner, drier, less elastic, and more fragile. The vagina's natural acidic balance changes, which may increase the risk of inflammation and infection.
[3] BSSM Position statement for management of genitourinary syndrome of the menopause (GSM)

GSM is chronic and progressive; unlike symptoms like hot flushes, GSM symptoms tend to continue and can worsen over time without treatment.
[4] Atrophic vaginitis / genitourinary syndrome of the menopause

Vaginal symptoms of GSM include dryness, burning, itching, a watery discharge, and general discomfort. The vaginal canal may also shorten and tighten.
[5] Visual summary on genitourinary (GU) symptoms associated with menopause

Common urinary symptoms of GSM include an urgent or frequent need to urinate, a burning sensation during urination, and recurrent urinary tract infections (UTIs).
[6] Genitourinary Syndrome of the Menopause (GSM) | UCC-Today

GSM affects a significant proportion of postmenopausal women, yet many do not seek help because they assume the symptoms are simply part of getting older.
[7] Atrophic vaginitis / genitourinary syndrome of the menopause

Avoiding perfumed soaps, scented bath products, and fragranced sanitary items in the genital area can ease irritation.
[8] Recommendations | Menopause: diagnosis and management

Moisturisers and lubricants are appropriate for milder symptoms, can be used as a first-line option for those who cannot or prefer not to use hormonal treatments, and can be used alongside hormonal treatments.
[9] Improving comfort and well-being with vaginal oestrogen for Genitourinary Syndrome of Menopause (GSM)

Local oestrogen acts where it is applied at a low dose, with minimal absorption into the rest of the body.
[10] Recommendations | Menopause: diagnosis and management

UK clinical guidance confirms that local vaginal oestrogen can be offered to women with GSM, including those on systemic HRT, and can be used for as long as needed. Symptoms often return if treatment is stopped.
[11] Recommendations | Menopause: diagnosis and management

Systemic HRT, available as tablets, patches, or gels, delivers oestrogen throughout the body and can improve GSM symptoms; it is generally considered when other menopausal symptoms such as hot flushes are also present.
[12] Genitourinary Syndrome of Menopause (GSM)

Up to 25% of women taking systemic HRT may find that vaginal symptoms persist and require the addition of local vaginal oestrogen for fuller relief.