This is the symptom women are most likely to suffer with in silence — so let's talk about it plainly, because it's common and very treatable.

What's happening. The tissues of the vulva, vagina, and bladder are rich in oestrogen receptors. As oestrogen falls after menopause, these tissues become thinner, drier, and less elastic — doctors call this "genitourinary syndrome of menopause." It can cause dryness, itching or burning, discomfort or pain during sex, and more frequent or urgent urination or urinary infections.

Why it matters that it doesn't just "pass." Unlike hot flushes, these changes relate to a sustained low-oestrogen state, so they tend to persist or progress without support. That's not a reason to despair — it's a reason to treat it.

The options, from gentle to medical:

• Vaginal moisturisers (used regularly, not just for sex) and lubricants (for comfort during sex) help many women and are available without prescription.
• Local vaginal oestrogen (creams, pessaries, or a ring) delivers a very low dose directly to the tissue. It's highly effective for these symptoms, and because it acts locally, it's suitable for many women — including some who don't take, or can't take, systemic HRT. Discuss it with your clinician.
• Staying sexually active (alone or with a partner) supports blood flow and tissue health.
• Pelvic floor support can help with the urinary side of things.

Please don't be embarrassed to raise it. Clinicians hear about this every day, and a short conversation can change your comfort and your intimate life completely.

Comfort and closeness don't have to end at menopause. With the right approach, most women find real relief.

Choosing from the shelf: a plain guide

Standing in the pharmacy aisle, three products sit side by side and all promise comfort, but they do different jobs. A lubricant reduces friction in the moment, mainly for sex, and works only while it is on. A moisturiser hydrates the tissue itself and is used regularly, most days, whether or not you are having sex. Local vaginal oestrogen, described above, treats the underlying cause and needs a prescription. Many women use more than one: a moisturiser for everyday comfort and a lubricant for intimacy.

A few things worth knowing before you buy:

• Favour "pH-balanced," lower-osmolality formulas. A lubricant’s osmolality is how concentrated it is. The technical safety limit set by the World Health Organization is below 1200 mOsm/kg, because very concentrated products draw water out of the delicate tissue and can cause tiny tears, the opposite of what you want. Healthy vaginal fluid sits far lower, around 260 to 370 mOsm/kg, so gentler formulas stay closer to that.
• Skip the extras. Fragrances, warming or tingling agents, flavours, colours and spermicides are common irritants, and menopausal tissue is thinner and more easily irritated.
• Mind condoms. If you use them, choose water- or silicone-based. Oil-based products, including coconut oil, weaken latex.
• Never substitute body lotion. It is not formulated for this tissue and can cause irritation or infection.

If simple products are not enough, or symptoms are worsening, that is the moment to talk to your GP about local oestrogen, used alongside these rather than instead of them.

When to see your GP sooner rather than later

Dryness itself is uncomfortable, not dangerous, and the steps above resolve it for most women. But a few symptoms are worth a prompt appointment, because they need a proper look rather than a product from the shelf:

• Any bleeding after menopause. If you have gone a full year without a period, any bleeding afterwards, even a single spot or a little brown discharge, should be checked. It is usually caused by something harmless like thinning tissue, but around one in ten women with postmenopausal bleeding turns out to have a treatable womb condition that is far easier to deal with when found early. This is a “book the appointment now” symptom, not a “wait and see” one.
• Pain that does not settle with moisturisers, lubricants or local oestrogen, or pain that is getting worse.
• Recurring urinary infections, or burning and urgency that keep coming back.
• A lump, sore, or persistent itch on the vulva that does not clear up.

None of these means something is wrong, and most turn out to be minor. But they are the signs that deserve a clinician’s eyes rather than a self-help fix. In the UK you should not have to wait more than two weeks to be seen for postmenopausal bleeding.

Common questions

Does vaginal dryness after menopause go away on its own?

Usually not — it relates to lasting low oestrogen, so it tends to persist without treatment. The good news is that effective options exist.

Is vaginal oestrogen safe?

For many women it is, because it acts locally at a very low dose. It's an individual decision to discuss with your clinician.

Keep reading: Where did my libido go? · Low libido in women: the full picture · Medications that can lower libido · The truth about HRT · Take the free Hormone Quiz