Complete Symptom Guide to Vaginal Atrophy | Stella

Menopause and vaginal atrophy


Vaginal atrophy is a common symptom of menopause. If dryness, pain and tightness are a problem for you, hormonal changes could be the cause. 

While this can be an awkward thing to talk about, it’s worth it! Effective treatments such as vaginal oestrogens are low-risk and readily available to help you feel better.


Vaginal atrophy is a medical term referring to the changes in your vagina during menopause. 

Your vagina and surrounding tissues are rich in microscopic oestrogen receptors. This means that the oestrogen in your body keeps your vagina healthy.  

At menopause, your oestrogen levels decrease dramatically. At this point, vaginal tissues begin to suffer due to the lack of this particular hormone. Levels of collagen and elastin in your vagina decline and this means:

  • Your vagina loses elasticity 
  • The rugae, folds of your vaginal wall, disappear
  • Your vagina becomes shorter and narrower
  • Your vaginal walls become thinner, more delicate and prone to irritation

These changes affect your vagina and your wider genital area. You may find that you notice symptoms in your labia, vulva, perineum and even bladder.

Vaginal atrophy has been used as a catch-all term to describe all of these changes but is now more accurately referred to as genitourinary syndrome of menopause (GSM), as it can affect far more tissues than just your vagina.

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Vaginal atrophy is common and it’s estimated that around 40% of those in menopause have symptoms. 

While other common symptoms, such as hot flushes and mood swings tend to improve eventually, this is not the case for vaginal atrophy unfortunately. Many people will continue to experience symptoms indefinitely due to ongoing low oestrogen levels during postmenopause.

Read more about the stages of menopause.


Vaginal dryness or, conversely, excessive discharge

Vaginal tightness, itching or a burning sensation

Painful sex, also known as dyspareunia

Bleeding, including bleeding after sex

While these are all common with vaginal atrophy, they can also be signs of other conditions. It’s important to check in with your doctor if you notice any new symptoms.


See your doctor

The symptoms of vaginal atrophy are very similar to those seen in a whole host of other medical conditions. It’s really important to get an accurate diagnosis so that you can get proper treatment and rule out potentially serious causes.


Yes, down there. Vaginal moisturisers are available to combat some of the dryness that comes with vaginal atrophy, and you can get them from pharmacies without a prescription. 


If sex is painful, try using a lubricant. Lubricants work in a different way to moisturisers, so you may find it helpful to use both types of product. You may also find it helpful to think about non-penetrative sex if your symptoms mean penetration is painful.

Avoid chemicals

Bubble baths, vaginal washes and other cosmetic products can irritate your vagina, especially if you have vaginal atrophy. Stick to plain water in your bathtub if irritation becomes an issue and avoid any type of intimate wash altogether. Believe it or not, your vagina is self-cleaning!

Consider HRT

HRT is the best treatment available for vaginal atrophy. These symptoms usually respond well to low-risk vaginal HRT which is suitable for most people.


Yes. A range of HRT products are available to treat vaginal atrophy.

Vaginal HRT is a good option. This is effective in reversing the vaginal changes which happen during menopause. It comes in a variety of forms including creams, gels, pessaries and vaginal rings. It’s the lowest-risk form of HRT because of the type of hormones used, and because the hormones stay in the genital area rather than being distributed around the body. Vaginal HRT is considered so safe that it is now available over the counter in England.

Systemic HRT (including pills and patches) can improve symptoms of vaginal atrophy as well as other symptoms of menopause like hot flushes, mood swings and sleep disturbances. However, systemic HRT comes with more risks and side effects than vaginal HRT so it’s not suitable for everyone. Your doctor will be able to tell you more about the best approach for you personally.


HRT can help to reverse the changes seen with vaginal atrophy.

Yes. It is particularly common for vaginal atrophy to cause bleeding after sex, because of the way this condition affects your vaginal walls. 

However, vaginal atrophy is not the only cause of abnormal bleeding, and you should always see your doctor if you notice:

  • Bleeding after sex 
  • Bleeding in between periods
  • Heavier periods
  • A change to your bleeding pattern
  • Any vaginal bleeding if it’s been over a year since your last period

See a doctor if you have any symptoms of vaginal atrophy which are becoming a nuisance. Treatment is available for mild or severe symptoms. In fact, it can be worth starting treatment early to prevent things getting worse.

It’s important to see a doctor to ensure that your symptoms really are due to vaginal atrophy and not another condition. For example, unusual bleeding has many different potential causes and in some cases may need urgent investigation.

Seek an urgent review if you notice:

  • Unusual discharge or smell
  • Unusual bleeding – including bleeding after sex, in between periods or heavy bleeding
  • Abdominal or vaginal pain
  • Any sores on your vulva, vagina or genital area which are not healing
  • Bloating
  • Changes to your bowel habit 
  • Weight loss
  • Any other symptoms that you find concerning


Nine menopause symptoms you can’t ignore. Read more

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Guide to sex and UTIs during menopause. Read more

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Menopause and contraception: your questions answered. Read more

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