The menopause can cause many changes in sexual and vaginal health but this is an area that isn’t often talked about and so many women are suffering in silence. The loss of estrogen with menopause causes the vulval and vaginal tissues to become thin, dry and less elastic. This can cause symptoms of vaginal dryness, itching, soreness and pain with sex. For some women, these symptoms can be really severe and significantly affect their quality of life.

The vagina and bladder are very closely linked and low estrogen causes similar changes to occur in the urethra and bladder. This can cause symptoms that feel like urinary tract infections including urinary frequency and pain on passing urine. It is not uncommon for women to be treated for recurrent thrush or UTIs when in actual fact the symptoms are due to the lack of estrogen rather than infection.

There are lots of effective treatments which can help these symptoms including lubricants, vaginal moisturisers and vaginal hormones including estrogen and DHEA. It is important to recognise that vaginal estrogen is a very safe and effective treatment. The amount of estrogen absorbed into the bloodstream from vaginal creams or pessaries is incredibly low. There is no evidence that vaginal estrogens cause an increased risk of breast cancer. There is also no need for women who are taking vaginal estrogen to be on additional progesterone as vaginal estrogen does not stimulate the womb lining (endometrium) unlike systemic estrogen.

Ospemifene is a oral tablet treatment licensed for treatment of vaginal symptoms of menopause and can be an effective option if people do not wish to use vaginal products or hormones and it can be used in women with previous breast cancer who have completed their treatment.