As oestrogen levels fall during the menopause this can have a massive impact on the health and function of our vaginal and bladder tissue. Sadly, women are often too embarrassed to talk about it until they are in extreme discomfort. Don’t let that be you!


In the pre-menopausal state, the vaginal canal consists of well perfused, moist, stretchy tissue. With declining oestrogen, the tissue can shrink, becoming thin, friable and dry. This can cause pain and bleeding during sex, recurrent urinary infections, and bladder instability. For some it can even be painful to sit or wear under clothes.


I have seen many women for whom this has become so severe that the vaginal introitus (opening) has become so small that having sex or an examination, for say, their smear test is impossible.


The great news is that this symptom of the menopause can be treated. There are vaginal creams and pessaries that will replace some of the lost oestrogen directly into the vagina. This will help to restore the vaginal tissue so that women can feel more comfortable. These can often be used in women for whom systemic HRT is unsuitable because it is such a small dose being used.


So why don’t we talk about it? This can have a huge impact on our quality of life and on our relationships, especially if you want to continue being intimate with your partner. Yes, it is an awful thing to be experiencing and we don’t like talking opening about ‘down there’ but if we don’t address it, it WILL get worse.


As health professionals we have pretty much seen and heard it all, so please don’t be embarrassed about discussing this with us.


You can buy vaginal moisturisers and lubricants which can help to make you more comfortable. Some good brands are ‘Sylk’ and ‘Yes’ . These are also available on prescription. There is also a vaginal oestrogen cream available without prescription, from pharmacies in the UK, for post-menopausal women. This is called ‘Gina’.