News
Genital menopause symptoms: What to expect and when to see a doctor
Article produced in association with Spital Clinic
Genitourinary syndrome of menopause (GSM) affects around one in two women after the menopause — and fewer than one in three of those affected ever bring it up with a doctor.
The condition covers a cluster of vaginal, urinary, and sexual symptoms caused by falling oestrogen levels during and after the menopause transition.
It is one of the most common and most treatable consequences of that hormonal shift, and yet it remains one of the least likely topics to come up in a clinical consultation.
What Is Genitourinary Syndrome of Menopause?
The term genitourinary syndrome of menopause replaced older descriptions like atrophic vaginitis and vulvovaginal atrophy because those names missed the point — this condition is not confined to the vagina.
It affects the entire lower genitourinary tract: the vulva, vagina, urethra, and bladder neck, all of which depend on oestrogen to maintain their structure and function.
As oestrogen levels fall during the perimenopause and drop further after the menopause, these tissues change in tangible ways.
The vaginal lining thins; mucus production decreases; vaginal pH rises, making bacterial imbalance more likely; and the cushioning fat tissue around the vulva diminishes.
Crucially, these changes are progressive — without treatment, they continue to worsen rather than settling on their own.
NICE guideline NICE guideline NG23: Menopause — identification and management, updated in November 2024, defines genitourinary symptoms as a core part of the menopause syndrome. The guidelines support active treatment across all severity levels — not just when symptoms are severe.
The Full Symptom Picture: Genital, Urinary and Sexual
Genital symptoms are the most widely recognised.
Vaginal dryness is the most common, affecting up to 93 per cent of women with GSM — and described as moderate to severe in 68 per cent of those affected.
Other symptoms include burning, itching, soreness, and unusual or offensive discharge caused by changes in the vaginal environment.
The tissue can become fragile enough to bleed from minor friction, including during a gynaecological examination.
Urinary symptoms arise because the urethra and bladder neck are equally dependent on oestrogen.
These include needing to urinate more often or urgently, waking in the night to urinate, pain or burning when urinating, recurrent urinary tract infections, and stress incontinence — leakage triggered by coughing, sneezing, or exercise.
Many women with recurrent UTIs are treated again and again with antibiotics without the underlying GSM ever being identified or addressed.
Sexual symptoms complete the picture: painful intercourse from reduced lubrication and tissue fragility, spotting or bleeding after sex, and reduced arousal, lubrication, and ability to orgasm.
These changes are physical in origin, not psychological — though if symptoms go unmanaged for long enough, the two often start to reinforce each other.
Prevalence data from North Tees and Hartlepool NHS Foundation Trust shows that vaginal dryness affects around one in four women in the lead-up to the menopause, rising to one in two after it, and approximately seven in ten women in their seventies.
Symptoms can begin during the perimenopause — well before periods have stopped.
Anyone noticing these changes can seek assessment through a GP or NHS sexual health service — or through a private gynaecology specialist.
Why GSM Does Not Improve Without Treatment
Unlike hot flushes and night sweats — which typically ease over two to five years — genitourinary symptoms do not improve over time and return once treatment stops.
They are chronic and progressive: the longer they go untreated, the more entrenched the underlying tissue changes become.
This makes the gap between prevalence and treatment especially significant.
Around 70 per cent of women with GSM symptoms never raise them with a healthcare professional, and only 4 per cent to 35 per cent use any form of treatment — partly from embarrassment, partly because many assume nothing can be done.
A condition with safe, effective, NICE-recommended treatments goes largely unmanaged.
First-Line Self-Care: Moisturisers, Lubricants and OTC Options
Vaginal moisturisers — such as Replens, Regelle, and Sylk gel — differ from vaginal lubricants: they are for regular, ongoing use (typically two to three times per week) to maintain tissue hydration.
They do not treat the underlying hormonal cause, but are effective at reducing dryness and discomfort and are NICE NG23-supported as first-line non-hormonal management.
Vaginal lubricants are for use during sexual activity. Water-based lubricants are compatible with latex condoms and diaphragms; oil-based products are not. Both are available over the counter and are a reasonable first step for mild or early symptoms.
NICE NG23 supports their use alongside vaginal oestrogen, and recommends them as the primary option when hormonal treatment is not suitable.
Vaginal Oestrogen and Prescription Treatments
For symptoms that persist beyond a few weeks of self-care, or that are moderate to severe from the outset, NICE NG23 sets out the evidence-based first-line treatment: offer vaginal oestrogen to anyone with genitourinary symptoms associated with the menopause — including those already using systemic HRT — and review regularly.
Vaginal oestrogen restores oestrogen levels in local tissue without significant absorption into the wider body.
NHS information on vaginal oestrogen confirms it does not carry the same risks as systemic HRT — the dose is low and very little reaches the general circulation, which matters for women who have been advised against systemic treatment. It comes as a tablet, pessary, cream, gel, or ring.
NICE NG23 specifically recommends vaginal oestrogen for women already using systemic HRT as well as those who are not — recognising that between 10 per cent and 25 per cent of women on systemic HRT still experience genitourinary symptoms that systemic treatment alone does not fully address.
Two further prescription options are available for women who cannot use vaginal oestrogen or have not responded to it.
Prasterone — a DHEA vaginal pessary — is recommended by NICE NG23 when vaginal oestrogen or non-hormonal treatments have not worked or are not tolerated.
Ospemifene, an oral tablet, is recommended where locally applied treatments are not practical — for example, due to physical disability.
Choosing between these options involves a clinical review of individual history, any contraindications, and personal preference.
A BMS-accredited private menopause assessment can provide that review alongside a full discussion of treatment options.
On laser therapy: the RCOG Scientific Impact Paper No. 72 concluded that vaginal laser treatment for GSM should not be offered outside of randomised controlled trials, and NICE NG23 takes the same position.
For women with a history of breast cancer, non-hormonal moisturisers and lubricants come first; vaginal oestrogen may be considered if those are ineffective, but only with the involvement of the treating oncologist.
When to See a Doctor
The NHS recommends seeking assessment when genital menopause symptoms have persisted for more than a few weeks despite self-care, when they are affecting daily life or sexual function, or when they involve post-menopausal bleeding, unusual discharge, or recurrent urinary tract infections.
Post-menopausal bleeding always warrants prompt GP review. It should not be assumed to be friction-related or attributable to GSM without a clinical examination — it is a red flag symptom that requires investigation to rule out other causes.
Recurrent UTIs in a postmenopausal woman — particularly without an obvious cause — are worth assessing for an underlying GSM component, rather than treating with repeated antibiotic courses alone.
A GP can initiate first-line treatment; for more complex presentations or where initial management has not helped, a menopause specialist can offer a more thorough evaluation.
The shift from terms like atrophic vaginitis to genitourinary syndrome of menopause reflects something important: these are medical symptoms, not a normal inconvenience to be quietly endured.
Effective treatment exists at every level of severity — from OTC moisturisers through to NICE NG23-recommended prescription options.
Anyone whose symptoms are affecting quality of life can see an NHS GP, or book a private menopause assessment with a BMS-accredited specialist.
The gap is not in what medicine can offer — it is in how reliably those options reach the women who need them.
This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published NHS and NICE standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Senior executives from the World Economic Forum, Takeda and Gilead are among the latest speakers confirmed for Women’s HealthX, which takes place on 3–4 December 2026 in Boston, Massachusetts, as the event publishes its full agenda.
The newly announced speakers are Melissa Patel, lead for women’s health responsible investing at the World Economic Forum; Nicola Greenway, chief human resources officer at Takeda; and Jyoti Mehra, executive vice president of human resources at Gilead. They join more than 75 confirmed speakers and a delegate list the organisers say will exceed 750 leaders from pharma and biotech, hospitals and health systems, payers and policymakers, all focused on closing the sex-difference data gap in healthcare.
Organisations registered to attend span much of the sector. In pharma and biotech they include Novartis, Merck, Sanofi, AstraZeneca, Eli Lilly, Bayer, Biogen, Johnson & Johnson, Gilead Sciences, Takeda, UCB, Astellas, EMD Serono, Amgen, Bristol Myers Squibb, Boehringer Ingelheim and Chiesi.
Among hospitals, health systems and academic medical centres are Mayo Clinic, Mass General Brigham, Northwell Health, UPMC, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Weill Cornell Medicine, Massachusetts General Hospital, Northwestern Medicine, Mount Sinai Health System, UMass Memorial Medical Center, Tufts Medical Center, Yale School of Medicine, Harvard Medical School, Columbia University Irving Medical Center, University of Pennsylvania Health System and NYU Langone Health.
Payers and health plans represented include CVS Health, Humana, Cigna Healthcare, Kaiser Permanente, Elevance Health, Blue Cross Blue Shield of Tennessee, Blue Cross Blue Shield of Massachusetts, Evernorth, Fidelis Care, Health Plans Inc and UPMC Health Plan. On the government, policy and regulatory side, attendees include the U.S. Department of Veterans Affairs, ARPA-H, the FDA, HHS, the NYC Department of Health and Mental Hygiene, Metro Public Health Department, the Association of State and Territorial Health Officials, the NHS, the Northern Mariana Islands Board of Nursing and Planned Parenthood of Florida. A sample attendee list is available here.
Newly confirmed panels
Patel will join Sheri Schully, deputy chief medical and scientific officer at the All of Us Research Program, and Lindsey Miltenberger, chief advocacy officer at the Society for Women’s Health Research, for a panel titled “Driving Inclusive Health Research on a Global Scale: Using Data to Understand National Priorities and Address Critical Gaps in Women’s Health.” The session will look at the health priorities countries are focusing on today and how data can be used to identify gaps in women’s health that remain overlooked.
Greenway and Mehra will take part in a panel titled “Empowering Workforces Through Women’s Health,” in which corporate health leaders discuss women’s health priorities from both employee and employer perspectives, and which benefits organisations should be prioritising.
The full agenda is now available, and registration is open.
Impli has secured a £1.4m grant to begin clinical use of a real-time hormone patch for infertility treatment.
The startup, which is working with innovations from Imperial College London, is developing a continuous hormone monitoring system for use in in vitro fertilisation, known as IVF.
IVF is a fertility treatment in which eggs are fertilised outside the body before an embryo is transferred to the womb.
Timing is critical in IVF, the most common form of infertility treatment, but most patients are still monitored through blood tests taken every other day at best.
Hormone levels can change within hours, meaning important shifts may be missed.
These can include hormone surges linked to egg release, dips that may contribute to implantation failure and early signs of ovarian hyperstimulation syndrome.
Ovarian hyperstimulation syndrome is a potentially serious reaction to fertility medicines, where the ovaries over-respond and become swollen.
In a treatment with low success rates, these uncertainties can affect patient outcomes and wellbeing.
Impli’s system is based on research by Dr Salzitsa Anastasova in the department of mechanical engineering at Imperial.
The technology uses electrochemical biosensors to sample hormones in the fluid between cells.
These can be used in a subcutaneous implant, meaning one placed under the skin, or in Impli’s Bio-Endocrine Analysis Monitor, known as BEAM, which uses microneedles that pierce the skin.
Microneedles are tiny needles designed to enter the upper layers of the skin with minimal discomfort.
The biosensors continuously measure oestradiol, luteinising hormone and progesterone, which are hormones involved in the menstrual cycle and fertility treatment.
Data is transmitted wirelessly to a smartphone, where AI software converts raw signals into real-time hormone trends.
Sotirios Saravelos, consultant gynaecologist and reproductive medicine subspecialist at the Wolfson Fertility Centre, part of Imperial College Healthcare NHS Trust, said:
“Continuous hormone monitoring has the potential to change the landscape of fertility treatment, both in terms of clinical care and patient experience. Rather than snapshots taken at fixed points in time, with Impli we will have access to a live feed of each patient’s hormonal response, allowing us to personalise care in a way that has not been possible before.”
Saravelos is part of the research consortium that has won a £1.4m grant to take Impli’s BEAM device from prototype to its first human clinical validation for IVF.
The project was designed with support from Dr Simon Hanassab as part of a PhD on how AI can support decision making for IVF.
The work was carried out at the UKRI Centre for Doctoral Training in AI for Healthcare at Imperial, a collaboration between the department of computing and the department of metabolism, digestion and reproduction.
Hanassab is now working part-time as Impli’s head of AI.
The grant comes from the National Institute for Health and Care Research Invention for Innovation programme.
It will support a 30-month project bringing together Impli, Imperial College Healthcare NHS Trust, the London Institute for Healthcare Engineering at King’s College London and the patient advocacy network Fertility Europe.
Specialist medical device manufacturer TTP is also involved.
BEAM is the first step in Impli’s plan to develop a broader platform of fully implantable, long-duration monitoring systems.
Anna Luisa Schaffgotsch, founder and chief executive of Impli, said:
“We are not just building a device, we are building the evidence base to show that continuous hormone monitoring is possible, clinically meaningful and ready for the real world. With an exceptional consortium behind us, we now have the funding, the expertise and the clinical pathway to do that properly.”
According to the company, the same core technology could later have applications in hormonally driven cancers, polycystic ovary syndrome, endometriosis and menopause.
Polycystic ovary syndrome is a common hormonal condition that can affect periods, fertility and metabolism.
Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus, often causing pain.
BEAM’s development builds on more than 15 years of biosensor research at Imperial, with intellectual property covering the sensing approach, device architecture and data interfaces.
Impli has so far delivered three functional prototypes, completed pre-clinical laboratory trials and begun animal trials, which the company said have shown positive results.
It also has a strategic partnership with Bayer on real-time hormone biosensing and relationships with IVF clinics internationally.
Spain will triple annual women’s health research funding to €18m under a programme focused on discrimination in medical research.
Spain’s Ministry of Science will increase investment in research and development projects focused on women’s health to €18m a year.
The initiative was announced on Monday by prime minister Pedro Sánchez during the presentation of Somos. Contamos: Fin de la discriminación de las mujeres en la investigación de la salud, which translates as We Are. We Count: Ending Discrimination Against Women in Health Research.
Sánchez said:
“This will boost research, diagnosis and treatment in areas that affect the lives of thousands of women in our country, who have not received the necessary attention.”
The plan is divided into three main areas.
These include a specific mission on women’s health through the centre for technological development and innovation, which will support companies and research centres working on research and development projects.
It also includes a new funding line for the Carlos III health institute and measures to build the research workforce in the field, including predoctoral contracts for projects focused on women’s health.
Sánchez said conditions such as endometriosis reflected discrimination faced by women in healthcare.
Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus, often causing severe pain and, in some cases, fertility problems.
The prime minister said the condition affects one in seven women and can take a decade to diagnose.
He said:
“This cannot be allowed in Spain today.”
Sánchez added:
“If a disease affected one in seven men, causing chronic pain, difficulty working, and fertility problems, would we accept a decade-long delay in diagnosis? The answer is obvious: certainly not. So it’s high time we said ‘no’ with the same clarity when we talk about diseases that affect millions of women.”
Other diseases where diagnosis and treatment suffer from a lack of a gender perspective include chronic pain, autoimmune and thyroid diseases, cardiovascular and mental health conditions, menopause and hormonal imbalances.
Autoimmune diseases occur when the immune system mistakenly attacks the body, while thyroid diseases affect a gland in the neck that helps regulate metabolism, energy and hormones.
Sánchez said:
“There can be no equality while science continues to respond better to some lives than to others.”
The prime minister also addressed the delay in diagnosing women.
He said:
“It is a paradox that says a lot about our past, that challenges our present, but that also drives us to change the future, including through politics.”
Menopause3 weeks agoPerimenopause misinformation ‘putting women at risk’
Hormonal health4 weeks agoNHS urged to update website following renaming of PCOS
Events3 weeks agoWomen’s Health Innovation Summit opens submissions for 2026 Innovation Showcase
News3 weeks agoWomen still being failed when they reach menopause, experts say
Insight2 weeks agoBritish women among angriest in Europe, health survey reveals
Menopause3 weeks agoSweden eyes domestic production of oestrogen patches amid menopause treatment shortage
News3 weeks agoThree menopause innovators shortlisted for Femtech World Award
News4 weeks agoLow insulin diet and avoiding four food groups may prevent menopause weight gain