What you need to know about vaginal atrophy
Written byJodi M Johnson
Reviewed byPatille Joy Madaghjian
Menopause is a big transition and your body goes through a lot – including some unexpected changes, like vaginal atrophy. Here’s how to recognise it and what to do next
Summary
1What is vaginal atrophy?
Vaginal atrophy occurs when the lining of the vagina becomes thinner, drier and less elastic because of reduced oestrogen levels.
2Vaginal atrophy symptoms
Some people experience only mild discomfort, while others find symptoms interfere with daily life, relationships or sexual wellbeing.
3What causes vaginal atrophy?
The main cause of vaginal atrophy is a decline in oestrogen. Oestrogen helps keep vaginal tissues thick, elastic and well lubricated.
Vaginal atrophy is a common condition that affects the health of the vaginal tissues. Although it's most often associated with menopause, it can develop whenever oestrogen levels fall. Despite being common, many people don't realise their symptoms are linked to vaginal atrophy, meaning diagnosis and treatment are often delayed. The good news is that there are effective treatments available. Understanding the signs of vaginal atrophy and seeking medical advice early can help relieve symptoms, improve comfort and protect your long-term vaginal and urinary health.
What is vaginal atrophy?
Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM) or atrophic vaginitis, occurs when the lining of the vagina becomes thinner, drier and less elastic because of reduced oestrogen levels.1-3 Lower oestrogen doesn't just affect the vagina. It can also affect the vulva, bladder and urethra, which is why vaginal atrophy often causes both vaginal and urinary symptoms.1-3 Although vaginal atrophy is most common after menopause, it can affect anyone who experiences a significant drop in oestrogen levels.
Vaginal atrophy symptoms
The symptoms of vaginal atrophy often develop gradually and may become more noticeable over time. Some people experience only mild discomfort, while others find symptoms interfere with daily life, relationships or sexual wellbeing.1-4 Common vaginal atrophy symptoms include:
- vaginal dryness
- genital dryness
- burning, itching or irritation of the vagina or vulva
- reduced natural lubrication during sex
- pain or discomfort during intercourse
- light bleeding during or after sex
- Shortening or tightening of the vaginal canal
- unusual vaginal discharge
As the urinary tract is also affected, signs of vaginal atrophy can also include:
- burning when passing urine
- needing to urinate more frequently or urgently
- urinary incontinence
- recurrent urinary tract infections (UTIs)
- urinary discomfort
Some people also notice changes in sexual function, including:
- reduced sex drive
- difficulty becoming aroused
- changes in orgasm
If these symptoms persist, it's important to speak with a healthcare professional. While they may be caused by vaginal atrophy, similar symptoms can occur with infections and other conditions that also require treatment. There are several effective vaginal atrophy treatment options. The most suitable approach depends on your symptoms, overall health and medical history and should be discussed with your GP.
What causes vaginal atrophy?
The main cause of vaginal atrophy is a decline in oestrogen. Oestrogen helps keep vaginal tissues thick, elastic and well lubricated. When levels fall, the tissues become thinner, drier and more fragile.1-6
Menopause is the most common cause of vaginal atrophy. During the transition through perimenopause and menopause, oestrogen production falls significantly, increasing the likelihood of developing vaginal dryness and other symptoms of vaginal atrophy.1-6 An estimated 27% to 84% of postmenopausal women experience vaginal atrophy.1-5
Although menopause is a leading cause, other situations that reduce oestrogen levels can also lead to vaginal atrophy, including:7
- pregnancy or breastfeeding
- chemotherapy
- pelvic radiotherapy
- anti-oestrogen medications, such as tamoxifen
- surgical removal of the womb, especially if it involves both ovaries (surgical menopause)
- premature ovarian insufficiency (POI)
- certain medical conditions, including diabetes and Sjögren's syndrome
Risk factors for vaginal atrophy
Having one or more risk factors doesn't necessarily mean you'll develop vaginal atrophy, but it may increase your chances. Some factors that may increase your likelihood of developing vaginal atrophy include:1,8-9
- smoking
- excessive alcohol consumption
- little or no sexual activity
- limited physical activity
- not having given birth vaginally
- premature ovarian insufficiency
What happens if vaginal atrophy is left untreated?
Without treatment, vaginal atrophy can increase the risk of:
- recurrent urinary tract infections
- vaginal infections
- chronic vaginal dryness
- painful sex
- urinary incontinence
- reduced quality of life
Persistent symptoms can also affect confidence, intimate relationships and emotional wellbeing, making early treatment especially important. If you’re experiencing any of these symptoms then it’s best to consult a healthcare professional.1,9 Some options are topical oestrogen, which may include your doctor prescribing a topical vaginal oestrogen in a cream or tablet form, vaginal moisturisers which don't target vaginal atrophy specifically but do help to make you feel more comfortable and help to restore moisture down there. Then there's water-based lubricants which you can apply before sex to your vagina or your partner’s penis or fingers to help reduce discomfort.
Vaginal atrophy FAQs
Vaginal atrophy is very common, particularly after menopause. Studies suggest that between 27% and 84% of postmenopausal women experience symptoms, although many don't seek treatment because they assume it's a normal part of ageing or feel embarrassed to discuss it.10,11
Yes. Although vaginal atrophy is most common after menopause, it can also occur before menopause if oestrogen levels fall.12 This may happen during breastfeeding, after certain cancer treatments, following surgery to remove the ovaries or because of some medical conditions.7
While vaginal dryness after menopause is common, vaginal dryness can also occur during breastfeeding, after certain cancer treatments or because of medications and other health conditions.7 Persistent vaginal dryness should always be assessed by a healthcare professional.7
Vaginal atrophy can't usually be completely reversed. However, symptoms can often be managed with support from a healthcare professional. If you're experiencing symptoms, your GP or another healthcare professional can assess your situation and discuss appropriate management options.
The final say
Vaginal atrophy is a common condition caused by reduced oestrogen levels that can affect vaginal and urinary health. Although it's most common after menopause, it can also develop for other reasons, including breastfeeding, cancer treatments and surgical menopause. Recognising the symptoms early and speaking with a healthcare professional can help you access effective treatment. If you're experiencing vaginal dryness, pain during sex or ongoing urinary symptoms, don't ignore them, speak to your healthcare professional.
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Disclaimer – This article provides informational advice and is not a substitute for medical care. Working with experts for accuracy, we take great care to ensure the information is up-to-date and relevant. However, you should always consult your GP or healthcare professional before using supplements or alternative products, particularly if you have medical conditions or are under supervision.
1. 1. Carlson K, et al. Genitourinary syndrome of menopause. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/
2. The British Menopause Society. The management of urogenital atrophy: A British Menopause Society Consensus Statement [Internet]. [cited 2025 Mar 31]. Available from: https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
3. NHS Wales. Atrophic vaginitis [Internet]. [cited 2025 Mar 31]. Available from: https://wisdom.nhs.wales/health-board-guidelines/c-vgleafletfile/atrophic-vaginitis2cvg-leaflet-2022pdf/
4. British Society for Sexual Medicine. Guidelines on the management of genitourinary syndrome of menopause (GSM) [Internet]. [cited 2025 Mar 31]. Available from: https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
5. West Sussex Healthcare NHS Trust. Atrophic vaginitis / genitourinary syndrome of the menopause (GSM) [Internet]. Reference No. 6647-1. Issue date: 07 Aug 2020; review date: 07 Aug 2023 [cited 2025 Sep 04]. Available from: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Gynaecology/6647-1-Atrophic-vaginitis-genitourinary-syndrome-of-the-menopause-GSM.pdf
6. Ulhe SC, et al. Study of vulvovaginal atrophy and genitourinary syndrome of menopause and its impact on the quality of life of postmenopausal women in Central India. Cureus. 2024;16(2):e54802. https://doi.org/10.7759/cureus.54802
7. NHS website. Vaginal dryness [Internet]. nhs.uk. 2017 Oct [cited 2026 July 23]. Available from: https://www.nhs.uk/symptoms/vaginal-dryness/
8. Angelou K, et al. The genitourinary syndrome of menopause: An overview of the recent data. Cureus. 2020;12(4):e7586. https://doi.org/10.7759/cureus.7586
9. Royal United Hospitals Bath NHS Foundation Trust. Atrophic vaginitis [Internet]. [cited 2025 Mar 31]. Available from: https://www.ruh.nhs.uk/patients/Urology/documents/patient_leaflets/Atrophic_Vaginitis.pdf
10. Mariette-JB. Genitourinary Syndrome of Menopause (GSM) [Internet]. British Menopause Society. 2025 Nov [cited 2026 July 23]. Available from: https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/
11. Bleibel B, Nguyen H. Vaginal atrophy [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2026 July 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/
12. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal Atrophy. Mayo Clinic Proceedings [Internet]. 2010 Jan [cited 2026 July 23];85(1):87–94. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800285/
