Vaginal Atrophy During Perimenopause: What It Is, Why It Happens, and What Helped Me
Granted it isn’t an easy subject to talk about is it – our vagina. So, here goes raw (no apology for the word used there) & real.
For many of us going through perimenopause, we expect the mood swings, the irregular periods, maybe even the hot flashes. But one thing that often surprises us — and that almost no one talks about — is vaginal atrophy, also called genitourinary syndrome of menopause (GSM) (yes, a bit of a mouthful!)
It can be uncomfortable, confusing, and even embarrassing, but it’s incredibly common. And the more we talk about it, the easier it becomes for others to recognise what’s going on and get support.
What Exactly Is Vaginal Atrophy?
Vaginal atrophy happens when oestrogen levels start to decline, which is a normal part of perimenopause. Oestrogen is responsible for keeping vaginal tissues:
- Moist
- Elastic
- Well-lubricated
- Supported by healthy blood flow
When oestrogen drops, those tissues can become thinner, drier, and more sensitive. This can cause symptoms like:
- Vaginal dryness
- Burning or irritation
- Painful sex
- More frequent urinary tract infections
- Increased urgency or discomfort when urinating
I’ve experienced the soreness sitting down – on an indoor bike springs to mind as well as going for a wee – sensitivity & burning. Feels like a UTI, yet in reality it may well be vaginal atrophy
Why It Caught Me Off Guard
Perimenopause can start years before periods stop, and symptoms come and go in waves. But vaginal atrophy tends to be more subtle at first — dryness here, sensitivity there — until suddenly it’s impossible to ignore. With me?
Many of us don’t realise these changes are hormonal, so we blame ourselves or assume something is “wrong” with us. In reality, it’s a very common physiological response to shifting
hormones.
Yes, this crept up on me too, until I had some spotting after my total hysterectomy and vaginal atrophy was diagnosed. Those paper-thin vaginal walls of mine
What Helped (and What I Wish I Knew Sooner)
Here are the evidence-based approaches people often use to manage symptoms. None of this is medical advice — just information you can discuss with a healthcare provider if you choose to.
- Moisturizers and Lubricants
Water-based or silicone-based lubricants can make sex more comfortable. Vaginal moisturizers used regularly can help with daily dryness. I suggest YES products (no a publicity campaign here).
- Prescription Options
Many people find relief with treatments like:
- Low-dose vaginal oestrogen (cream, ring, or tablet)
- Vaginal DHEA
- Non-hormonal prescription options
These work by restoring moisture and elasticity directly to the tissues.
I’ve recently converted to an oestrogen cream, whilst I’d be using the pessaries for many years. Suits me better.
- Pelvic Floor Therapy
A pelvic floor therapist can help with discomfort, muscle tension, or pain during sex. I follow the Vaginal Coach on Insta & Facebook. And I do my pelvic floor exercises daily – not pelvic floor exercises to tighten things up btw more ones to relax my pelvic floor as we can have pelvic spam too (me included).
- Gentle Lifestyle Adjustments
Things like hydration, avoiding irritants (soaps, scented products), and regular sexual activity (alone or with a partner) can sometimes make a difference.
I’d recommend you take a look at this product: Issviva x Joylux Vaginal Rejuvenation Device (again not a sales pitch) and and Jane Lewis’s book is a good read: Me & My Menopause Vagina.
Why We Need to Talk About This More
Silence around menopause makes people feel alone or ashamed when symptoms appear. But vaginal atrophy is incredibly common — it affects millions of people worldwide.
Talking about it helps normalise it. Let’s talk more about our vaginas. Seeking care is not about vanity or trying to “stay young”; it’s about comfort, connection, and quality of life. I’m all for cotton underwear these days (Strip & Stare as recommended on the Dig it podcast – hosted by Zoe Ball & Jo Whiley and loose-fitting bottoms all the way!)
Final Thoughts: You Deserve Comfort and Support
If you’re going through vaginal atrophy during perimenopause, you’re not alone — and you’re not “broken.” It’s a normal part of hormone changes, and there are many ways to find relief.
Sharing our stories helps remove the shame and opens the door for better care and understanding.
If you’d like to work with me in a menopause therapeutic coaching vein, then please make contact @nic@clarity-kent.co.uk. Remember you are not alone. Let’s keep talking.
