Symptoms
Dryness, burning and itching. Pain with sex, or tearing and bleeding. Needing to pass urine urgently or often, day and night. Leaking. Repeated urine infections. Discomfort wearing tight clothes or sitting for long periods.
Everyday care
Wash the vulva with water only. Skip soap, bubble bath and scented products. Use a vaginal moisturiser two to three times a week, every week, not only before sex. Use a water or silicone lubricant during sex.
Vaginal oestrogen
Low dose vaginal oestrogen is the most effective treatment. It comes as estradiol pessaries, estriol cream or gel, or an estradiol ring changed every three months.
Very little reaches the bloodstream. It can be used long term, does not need a progestogen alongside it, and does not carry the risks of oestrogen taken as a tablet. It also cuts repeat urine infections.
Other options
Vaginal prasterone is another hormonal treatment available in some countries. Pelvic floor physiotherapy treats urgency, leaking and pain. Laser treatments are not recommended outside research, because good trials have not shown benefit.
After breast cancer
Moisturisers and lubricants come first. If they are not enough, low dose vaginal oestrogen can be discussed with your oncology team. Many teams support it for women on tamoxifen, with more caution on aromatase inhibitors.
See a practitioner if
- You have pain with sex
- You have more than two urine infections in six months
- You have urgency or leaking
- You have any bleeding after menopause
Common questions
How long do I need vaginal oestrogen?
As long as you want the benefit. Symptoms usually return within months of stopping.
Is it safe if I am already on hormone therapy?
Yes. Some women on hormone therapy still need vaginal oestrogen for full relief.
Can I use coconut oil?
Oil breaks down latex condoms and can irritate some women. A purpose made moisturiser or lubricant is a safer choice.
Sources
- The Menopause Society, 2020 Genitourinary Syndrome of Menopause Position Statement
- American College of Obstetricians and Gynecologists, Committee Opinion on vaginal oestrogen after breast cancer
- Li and colleagues, JAMA, 2021, randomised trial of vaginal laser
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.