When Lorraine Kelly discussed her journey through menopause on her daytime show back in 2017, she found herself stepping into the spotlight, having no one else willing to share their stories. Initially aiming to interview a notable figure, she faced repeated refusals.

“I realized that if no one else wants to address this topic, then I will. It turned out to be a pivotal moment,” Kelly stated.

Fast forward seven years, and there seems to be an increasing openness surrounding menopause. High-profile figures like Michelle Obama, Salma Hayek, and Gwyneth Paltrow have all candidly shared their experiences, inspiring women to embrace a natural process that approximately 13 million individuals in the UK are navigating. Yet, there remains a topic that is often overlooked.

Vaginal dryness.

As with many issues in this sphere, it took another celebrity—Davina McCall—to bring it to light. For those who believed this symptom was merely a trivial inconvenience affecting intimacy and easily resolved with over-the-counter lubricants, it was a harsh awakening.

“I experienced profound dryness that made basic actions, like wiping after using the bathroom, significantly painful,” McCall revealed in her 2021 documentary, Sex, Myths and the Menopause. “I was unaware this was part of perimenopause.”

Vaginal dryness, previously referred to as vulvovaginal atrophy and now termed genitourinary syndrome of menopause (GSM), is expected to impact 60% to 80% of women, according to research. This condition results from decreased estrogen levels during menopause, leading to thinner and less elastic vaginal tissue. Despite its widespread occurrence, studies indicate that a third of women affected do not report it to their healthcare provider.

Embarrassment often contributes to this silence, notes Haitham Hamoda, a consultant gynecologist and clinical lead for the menopause service at King’s College Hospital. “Most general practitioners are knowledgeable and provide excellent support, but access can be inconsistent. It hinges on what is available and how comfortable the patient feels discussing it.”

He adds: “Many women will discuss hot flashes, sleep disturbances, or cognitive issues but overlook asking about vaginal dryness until prompted.”

Hamoda has encountered women experiencing such discomfort that they avoid wearing underwear. “Some report that clothing feels irritating against the affected area… In severe situations, even sitting or walking can be a challenge.”

Dr. Renée Hoenderkamp, a GP and menopause specialist, has witnessed similar cases. “I’ve seen women whose activities of daily living are severely impaired due to vaginal dryness. It can be truly debilitating. Simple tasks like going to the gym or running errands can feel impossible.”

Clare, age 55, describes how GSM “took over my life.” “I would sit in a shallow, cold bath crying. The burning sensation was relentless, every moment, day and night. Even walking was a struggle.” What began at 47 went unrecognized as a symptom of perimenopause since she had regular periods and no hot flashes.

However, as Dr. Hoenderkamp highlights, menopause varies greatly for each woman: “For some, vaginal dryness may be the first symptom, emerging even before changes in their menstrual cycle. For others, it may not occur until later.”

She cautions against viewing dryness solely as a menopausal symptom. “Women who breastfeed for extended periods may find their estrogen levels suppressed, leading to similar issues. Certain contraceptive methods and antidepressants can also contribute.”

The effects of vaginal dryness extend beyond discomfort, says Hoenderkamp. “Post-menopause, if vaginal and urethra tissues become dry and atrophied, women may be more prone to urinary infections due to a higher likelihood of bacteria adhering to the tissue.”

Hamoda has seen women skip cervical screenings because of GSM. “Sometimes, we cannot perform a smear test as the patient is too dry and uncomfortable, despite ample lubrication being applied. In some cases, I’ve advised patients to use vaginal estrogen for a couple of months before attempting the smear again.” It’s a scenario he encounters frequently.

Unfortunately, not all medical professionals are equipped to handle GSM effectively. Emily, 44, experienced severe vaginal dryness for four years. “It felt like I had a burning sensation inside me,” she recounted, while also battling urinary tract infections. Her GP struggled with a diagnosis and suggested she might need to accept a life of chronic pain during a phone conversation.

Having begun her journey at 40, her doctor did not consider perimenopause, leading to multiple referrals and tests without resolution. Despite her efforts, including consultations with specialists, she remained in pain without relief.

“The impact has been devastating,” she noted. “The pain disrupts my ability to focus. I’ve had to leave four jobs within four years, sold my home, and distanced myself from friends for financial reasons.”

Driven by desperation, Emily researched her symptoms extensively, discovering that one in 20 women experience perimenopause before the age of 45. Convinced this was her situation, she wrote a thorough letter to her GP requesting vaginal estrogen. Fortunately, he obliged and within two days, her burning sensation subsided.

However, she continues to struggle with urinary tract infection symptoms, needing to urinate frequently. While the cause remains uncertain, she believes her untreated infection has escalated over time, necessitating separate treatment.

Misdiagnosis is common in these cases. Dr. Paula Briggs, a consultant in sexual and reproductive health at Liverpool Women’s NHS Foundation Trust, notes, “The quality of diagnosis can vary greatly depending on whom a woman sees. Many are misdiagnosed with thrush.”

This creates a challenging scenario—women hesitating to seek help, compounded by delays in accurate diagnosis.

“Unlike other menopausal symptoms that typically resolve or lessen, GSM often progressively worsens and is challenging to remedy,” explains Briggs. She advocates for all women to receive vaginal estrogen treatment around the age of 45 as a standard practice.

Despite the benefits of estrogen pessaries, hesitation remains due to the associated small increase in breast cancer risk with progestogen-containing HRT. Dr. Hoenderkamp assures that vaginal estrogen poses minimal risk. “It is extremely safe and simple. Many women express concerns after a breast cancer diagnosis, but vaginal estrogen is typically an option.”

Hamoda advises a more cautious approach, “For patients with a history of breast cancer, exploring non-hormonal options is standard before hormone therapy but must be tailored to the individual.”

Nonetheless, this isn’t an overnight fix. “For many women, vaginal estrogen isn’t a one-year solution but a long-term commitment,” notes Dr. Hoenderkamp.

Vaginal estrogen can be obtained from pharmacies—though it’s more affordable on prescription—and numerous moisturizers and lubricants are available for initial treatment options.

The overarching message is clear: If you experience vaginal dryness, don’t endure it in silence. It’s not just an inevitable part of aging, but a condition that can be addressed and often alleviated.

“Raising awareness is essential,” emphasizes Hamoda. While conversations around menopause are becoming more prevalent, there is still much to discuss.

Some names have been altered for privacy.