Let’s Talk About Vulval and Vaginal Changes in Menopause

It’s not just dryness. It’s irritation, itching, soreness, and sometimes even leaking when we laugh or sneeze. And for many of us, there’s a frustrating shift in how often we need to wee and how urgently. Some women also find themselves getting more urinary tract infections (UTIs) than they ever did before. Alongside the other symptoms of menopause it can feel like there’s so much to cope with - and that’s exactly why we need to talk openly about these changes.  

The Role of Oestrogen in Vaginal Health

These changes are largely caused by the drop in oestrogen that comes with perimenopause and menopause. Oestrogen is a key hormone for keeping the vaginal tissues plump, elastic and well-lubricated. When levels fall, the walls of the vagina can become thinner, drier and more fragile. This is genitourinary syndrome of menopause (GSM) - formerly known as vaginal atrophy.

GSM doesn’t just affect the vagina itself. It also affects the vulva (the external area around the vagina), and the urethra, which also relies on oestrogen. That’s why we might notice new sensitivity, or struggle with leaks and urgency that weren’t a problem before. Sex can become painful or uncomfortable, and UTIs can crop up more often because the natural balance of the vaginal microbiome is disrupted.

Can we treat it?

Vaginal oestrogen is one of the most effective treatments for GSM. It’s prescribed as a cream, tablet or ring that’s inserted directly into the vagina. It works locally to replenish oestrogen in the tissue and restore hydration, elasticity and protection. Importantly, vaginal oestrogen stays mostly within the vaginal tissues, so it doesn’t significantly increase systemic oestrogen levels and is considered very safe - even for women who can’t take systemic HRT. For many, it’s a game changer.

If you're already taking systemic HRT (like patches, gels or tablets), it may help with some GSM symptoms, but it’s not always enough on its own. That’s why some women use both: systemic HRT to support their overall hormone balance, and vaginal oestrogen to directly treat local symptoms.

Moisturisers, Oils - and What to Avoid

In addition to hormone treatment, using a vaginal moisturiser or oil regularly can make a huge difference. Unlike lubricants, which are for short-term relief during sex, moisturisers are designed for ongoing hydration and comfort. They can be used internally and externally to support the health of the vaginal tissues, and soothe irritation around the vulva.

But be careful what you choose. Many over-the-counter products contain ingredients that can do more harm than good. Glycerin, parabens, and harsh preservatives like chlorhexidine can all irritate delicate tissues, throw off your pH balance and make symptoms worse. Always look for products that are free from these irritants. The YES range is a brilliant example - their products are designed to be pH-balanced, hypoallergenic and safe for both vaginal and vulval use.

Your intimate health is as important as the rest of your body

If you’re ever unsure about what’s safe to use, speak to a menopause-trained GP or pharmacist. You deserve to feel comfortable and confident in your body, and there are things that can help. Our vaginas, vulvas and bladders deserve that care just as much as the rest of us.