In this guide12 sections
- Key Points
- What Is Vaginal Atrophy?
- Vaginal Atrophy Symptoms
- Vaginal Atrophy Treatment: First-Line Options
- Vaginal Atrophy and Bladder Symptoms
- Laser for Vaginal Atrophy: What Does the Evidence Show?
- Vaginal Rejuvenation After Menopause
- When to See a Doctor About Vaginal Atrophy
- Vaginal Atrophy Assessment at Centre for Surgery
- Frequently Asked Questions
- Vaginal Atrophy Treatment in London
- References
Key Points
- What is vaginal atrophy? Thinning, drying and loss of elasticity of the vaginal and vulval tissues caused by low oestrogen, most often after menopause. Doctors now call it genitourinary syndrome of menopause (GSM), as it affects the bladder too.
- Vaginal atrophy symptoms include dryness, burning, itching, pain during sex, light bleeding after sex, urgency and repeated urine infections.
- Vaginal atrophy treatment starts simply: regular vaginal moisturisers and lubricants for sex, then low-dose vaginal oestrogen, which NICE recommends and which can be used long term.
- Vaginal oestrogen works: a Cochrane review of 30 trials and 6,235 women found creams, tablets and rings all relieve symptoms better than placebo, with no clear difference between them.
- Vaginal dryness after menopause does not usually go away on its own, but symptoms improve within weeks of starting treatment and return if it is stopped.
- Laser for vaginal atrophy is a non-hormonal option, but sham-controlled trials of CO2 laser have found no benefit over a sham treatment, and evidence for erbium laser is very uncertain. NICE says it should only be used in research.
- Any bleeding after menopause must be checked by your GP, even if you think it is due to dryness.
Vaginal atrophy is one of the most common effects of menopause and one of the least discussed. Many women notice vaginal dryness, soreness or discomfort during sex in the years after their periods stop, yet many put up with it for years, assuming nothing can be done or feeling too embarrassed to ask. Unlike hot flushes, vaginal atrophy tends to get worse over time rather than better. The good news is that vaginal atrophy treatment is usually simple, safe and effective.
This guide explains what vaginal atrophy is, why it is now called genitourinary syndrome of menopause, the symptoms to look out for, and every treatment option in the order most women should try them: moisturisers, lubricants and vaginal oestrogen first, then other options such as RenovaLase laser with an honest look at the evidence. It also covers what “vaginal rejuvenation after menopause” means in practice. If bladder symptoms are your main problem, read our guide to urinary incontinence in women. The NHS guide to vaginal dryness ↗ is a helpful starting point too.
What Is Vaginal Atrophy?
Oestrogen keeps the lining of the vagina thick, moist, elastic and well supplied with blood. It also supports the healthy bacteria that keep the vagina slightly acidic, and it maintains the tissues of the vulva, urethra and bladder neck. When oestrogen levels fall, these tissues become thinner, drier, paler and more fragile. The vagina may become shorter and narrower, natural lubrication during arousal decreases, and the tissues tear or become sore more easily.
This is vaginal atrophy, also called atrophic vaginitis or vulvovaginal atrophy. It is most common after menopause, but it can also happen:
- while breastfeeding, when oestrogen levels are naturally low
- after surgical removal of the ovaries
- during or after treatment for breast cancer, particularly with medicines that block oestrogen
- with some contraceptives and medicines that lower oestrogen
- after chemotherapy or pelvic radiotherapy
Genitourinary syndrome of menopause: why the name changed
In 2014, the International Society for the Study of Women’s Sexual Health and the North American Menopause Society agreed that “genitourinary syndrome of menopause” (GSM) was a more accurate and less stigmatising term than vulvovaginal atrophy. GSM describes the full collection of symptoms caused by low oestrogen across the labia, clitoris, vaginal opening, vagina, urethra and bladder, including genital dryness and burning, sexual symptoms such as pain and reduced lubrication, and urinary symptoms such as urgency, pain on passing urine and recurrent infections[1]. You will see both names used, and they describe the same condition.
Vaginal Atrophy Symptoms
Symptoms vary from mild dryness to constant soreness. You do not need to have all of them:
- vaginal dryness, burning or itching
- soreness or a feeling of rawness
- pain or discomfort during sex, and less lubrication when aroused
- light bleeding or spotting after sex
- changes in vaginal discharge
- needing to pass urine urgently or more often, or stinging when you do
- repeated urine infections
- the vaginal opening feeling tighter or narrower
- thinning or shrinking of the labia
Many women mistake vaginal atrophy for thrush and buy repeated antifungal treatments that do not help. Other conditions, such as lichen sclerosus, skin allergies to soaps or pads, and infections, can cause similar symptoms, which is why a proper examination is worthwhile.
Vaginal dryness after menopause
Vaginal dryness after menopause is the most common symptom. It is often first noticed during sex, as natural lubrication takes longer or does not happen, but it can also cause discomfort when walking, sitting, exercising or wearing tight clothes. It is not a sign of low desire or a relationship problem: it is a change in the tissues, and it can be treated.
Can vaginal atrophy be reversed?
Yes, in most women the changes improve substantially with treatment. Vaginal oestrogen restores the thickness, moisture and acidity of the vaginal lining within weeks to a few months. However, the underlying cause, low oestrogen, does not go away after menopause, so symptoms usually return if treatment is stopped. Most women need to continue treatment long term to keep the benefit.
Vaginal Atrophy Treatment: First-Line Options
The NICE menopause guideline ↗ recommends offering vaginal oestrogen to women with urogenital atrophy, and moisturisers and lubricants alone or alongside it. These are the right first steps for nearly everyone.
Vaginal moisturisers
Vaginal moisturisers are non-hormonal gels or pessaries that are used regularly, usually every two to three days, not just before sex. They cling to the vaginal lining and help it hold water, easing everyday dryness and soreness. They are available from pharmacies without a prescription, and some are available on prescription. Choose products designed for vaginal use and avoid perfumed products.
Lubricants
Lubricants are used just before or during sex to reduce friction and pain. Water-based and silicone-based lubricants are both suitable. Oil-based lubricants can damage latex condoms. If you are sensitive, choose products without perfume, warming agents or glycerin, which can irritate fragile tissue.
Vaginal oestrogen
Vaginal oestrogen is the most effective treatment for vaginal atrophy. It replaces oestrogen directly in the vaginal tissues at a very low dose, so very little reaches the bloodstream. It comes as:
- a cream, inserted with an applicator or applied to the vulva
- a small vaginal tablet or pessary
- a gel
- a soft vaginal ring that releases oestrogen slowly for three months
A 2016 Cochrane review of 30 trials and 6,235 women ↗ found that vaginal oestrogen in each of these forms relieved symptoms of vaginal atrophy better than placebo, with no clear difference in effectiveness between creams, tablets and rings[2]. The choice comes down to preference.
Most women start with a nightly dose for about two weeks, then reduce to twice a week. Improvement in dryness and comfort is usually noticeable within a few weeks, and the urinary symptoms often improve too. Vaginal oestrogen can be used long term, can be used alongside HRT if you need extra local treatment, and at these low doses it is not thought to carry the risks linked to HRT tablets or patches. Some women over 50 can now buy low-dose vaginal oestrogen tablets from a pharmacist after a short consultation; otherwise your GP can prescribe it.
If you have had breast cancer, talk to your oncology team before using vaginal oestrogen, as the decision depends on the type of cancer and the treatment you are having. Non-hormonal moisturisers and lubricants are the usual starting point.
Other prescription options
For women who cannot or prefer not to use vaginal oestrogen, a specialist may discuss other prescription options, including a nightly vaginal pessary containing DHEA, a hormone the vaginal cells convert locally, and an oral tablet that acts like oestrogen on the vaginal lining without being oestrogen itself. Each has its own suitability criteria.
Pelvic floor exercises, dilators and staying sexually active
Pelvic floor exercises help with the urinary symptoms that often accompany atrophy. If the vagina has become narrower or penetration is painful, gradually sized vaginal dilators, used with lubricant, can help restore comfort. Regular sexual activity or stimulation, with or without a partner, increases blood flow to the vaginal tissues. Avoid perfumed soaps, bubble baths and douches, which dry and irritate the vulva.
Vaginal Atrophy and Bladder Symptoms
The urethra and bladder neck share the vagina’s dependence on oestrogen. After menopause, many women notice needing to pass urine more often or more urgently, stinging, and repeated urine infections. These are part of the genitourinary syndrome of menopause and often improve with vaginal oestrogen. If leaking is the main problem, our guide to causes of urinary incontinence in women explains the different types and first-line treatment. Our article on whether labiaplasty can prevent urinary tract infections also explains why surgery is not a treatment for recurrent UTIs.
Laser for Vaginal Atrophy: What Does the Evidence Show?
Vaginal laser treatments deliver controlled heat to the vaginal wall, with the aim of stimulating collagen, blood flow and thickening of the lining. Two types are used: the fractional CO2 laser, which makes tiny ablative channels, and the non-ablative erbium (Er:YAG) laser, which heats the tissue without breaking the surface. RenovaLase, the treatment we offer, uses a Fotona Er:YAG laser.
Early uncontrolled studies were enthusiastic, but sham-controlled trials, in which some women unknowingly receive a pretend treatment, have been much less positive:
- A 2021 double-blind sham-controlled trial in JAMA ↗ randomised 85 postmenopausal women to three sessions of fractional CO2 laser or sham. At 12 months, there was no significant difference between the groups in symptom severity, quality of life, vaginal health scores or tissue samples[3].
- A 2023 trial in 72 breast cancer survivors taking aromatase inhibitors found both CO2 laser and sham laser improved sexual function, with no significant difference between them at six months[4].
- A small 2023 sham-controlled trial of Er:YAG laser in 44 postmenopausal women found vaginal dryness scores and atrophy scores improved more with laser, but overall symptom scores improved in both groups with no significant difference[5].
A 2025 systematic review in Menopause ↗ brought these together. It concluded that CO2 laser may make little or no difference compared with sham or vaginal oestrogen cream, and that the effects of Er:YAG laser on any outcome are very uncertain. Serious adverse events were not reported, but adverse event reporting was limited[6]. The NICE guidance on transvaginal laser therapy for urogenital atrophy ↗ found no short-term safety concerns but said the evidence on long-term safety and efficacy is inadequate, and that the procedure should only be used in the context of research.
Who might consider RenovaLase?
Laser is not a first-line treatment. It may be worth discussing if you cannot use vaginal oestrogen or would prefer not to, if moisturisers and lubricants have not helped enough, and if you understand that the evidence is uncertain and that results vary. A course of RenovaLase is usually three sessions about a month apart, each taking 15 to 30 minutes, with no anaesthetic and no downtime. Longer-term results are not known, and a yearly maintenance session may be suggested for women who benefit. Our article on what you should know about Fotona SMOOTH explains the technology.
Vaginal Rejuvenation After Menopause
“Vaginal rejuvenation after menopause” is a phrase used to cover several quite different treatments, and it helps to be clear about which problem each one addresses.
- Dryness, soreness and pain during sex are caused by atrophy and are best treated with moisturisers, lubricants and vaginal oestrogen, with laser as a second-line option.
- Loss of volume in the outer labia, which often happens with age and weight change, can be treated with fat transfer or fillers. Our guide to deflated labia explains these.
- Vaginal looseness, usually related to childbirth rather than menopause, is treated with pelvic floor training, laser tightening or vaginoplasty.
- Changes in sensation or orgasm have many causes and need a proper assessment. PRP injections are one option with limited evidence.
Surgery does not treat dryness, and tightening procedures can make pain during sex worse if atrophy is not treated first. A responsible vaginal rejuvenation consultation should always start by checking for and treating atrophy. Our overview of the different types of vaginal rejuvenation explains each option in more detail.
PRP has also been studied for atrophy. A 2025 trial of 90 postmenopausal women found three monthly PRP sessions improved sexual function and vaginal health about as much as 12 weeks of vaginal oestrogen[7]. It was a small, short study, and vaginal oestrogen remains the established first choice.
When to See a Doctor About Vaginal Atrophy
See your GP if symptoms are bothering you, if over-the-counter products have not helped, or if you are unsure of the cause. Book an appointment promptly if you have:
- any bleeding after menopause, including after sex
- white, shiny or thickened patches of skin on the vulva, or persistent itching
- a lump, sore or ulcer that does not heal
- pain that is getting worse
- repeated urine infections
Bleeding after menopause needs to be checked to rule out other causes, even if atrophy is the most likely explanation.
Vaginal Atrophy Assessment at Centre for Surgery
At Centre for Surgery, women with symptoms of vaginal atrophy are assessed by a doctor at our CQC-regulated hospital on Baker Street in central London. We take a full history, examine you and make sure first-line treatment has been considered. If you have not tried vaginal oestrogen and there is no reason you cannot use it, we will usually suggest starting there, in liaison with your GP.
For women who cannot or prefer not to use hormones, or who still have symptoms despite them, we can discuss RenovaLase and explain the trial evidence, including the sham-controlled trials that found no benefit, so you can decide with realistic expectations. The doctor who assesses you is the doctor who treats you, and treatment needs no anaesthetic.
Frequently Asked Questions
Are lubricants good for menopause dryness?
Lubricants help with discomfort during sex but do not treat the underlying dryness. For everyday dryness, a vaginal moisturiser used every two to three days works better, and vaginal oestrogen treats the cause. Many women use a moisturiser regularly and a water-based or silicone-based lubricant during sex.
How do you apply vaginal oestrogen cream?
Vaginal oestrogen cream is usually inserted with the applicator supplied, at bedtime so it stays in place. Most women use it nightly for about two weeks, then twice a week. Some cream can also be applied to the vulva. Follow the instructions from your GP or pharmacist for your product.
What causes vaginal dryness?
The most common cause is low oestrogen after menopause. Breastfeeding, some contraceptives, cancer treatments, removal of the ovaries, certain medicines, perfumed soaps and douches, and stress or low arousal can also cause dryness. If dryness is new or unexplained, ask your GP to check for other causes.
Is there a cream that can help with intimate dryness?
Yes. Non-hormonal vaginal moisturisers are available from pharmacies and ease everyday dryness. Low-dose vaginal oestrogen cream, available on prescription, treats the cause and is the most effective option for dryness after menopause. Avoid perfumed creams, which can irritate fragile tissue.
How can I get wet again after menopause?
Vaginal oestrogen restores the lining and often improves natural lubrication within a few weeks. A lubricant during sex, a regular moisturiser, allowing more time for arousal and staying sexually active all help. If arousal itself has changed, a doctor or psychosexual therapist can help identify other causes.
How long does vaginal atrophy last?
Without treatment, vaginal atrophy usually continues and often worsens over time, as oestrogen levels stay low after menopause. With treatment, symptoms typically improve within weeks, but they tend to return if treatment stops, so most women continue long term.
Is there surgery for vaginal atrophy?
Surgery is not a treatment for vaginal atrophy, as the problem is thin, dry tissue rather than a structural defect. Treatment is with moisturisers, lubricants and vaginal oestrogen, with laser as a second-line option. Surgery may occasionally be needed for scarring or narrowing, but only after atrophy has been treated.
Is laser treatment for vaginal atrophy safe?
Studies have not shown short-term safety concerns, and serious side effects were not reported in trials. Temporary discharge or mild discomfort can occur. The main uncertainty is effectiveness: sham-controlled trials have not shown a clear benefit, and long-term data are limited.
Vaginal Atrophy Treatment in London
If vaginal dryness or discomfort is affecting your life, start with your GP or pharmacist. If you have tried first-line treatment, or cannot use hormones and would like to discuss non-hormonal options, we can assess you and explain whether RenovaLase vaginal atrophy laser treatment is a reasonable option for you.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Portman DJ, Gass MLS. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas 2014;79(3):349–354. doi:10.1016/j.maturitas.2014.07.013 ↗
- Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews 2016;2016(8):CD001500. doi:10.1002/14651858.CD001500.pub3 ↗
- Li FG, Maheux-Lacroix S, Deans R, et al. Effect of fractional carbon dioxide laser vs sham treatment on symptom severity in women with postmenopausal vaginal symptoms: a randomized clinical trial. JAMA 2021;326(14):1381–1389. doi:10.1001/jama.2021.14892 ↗
- Mension E, Alonso I, Anglès-Acedo S, et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause: the LIGHT randomized clinical trial. JAMA Network Open 2023;6(2):e2255697. doi:10.1001/jamanetworkopen.2022.55697 ↗
- Panyawongudom N, Panyakhamlerd K, Suwan A. Number of vaginal lactobacilli in postmenopausal women with vaginal atrophy before and after treatment with erbium-YAG laser: a randomized sham-controlled trial. BMC Women’s Health 2023;23(1):513. doi:10.1186/s12905-023-02590-y ↗
- Zerzan NL, Greer N, Ullman KE, et al. Energy-based interventions for genitourinary syndrome of menopause: a systematic review of randomized controlled trials and prospective observational studies. Menopause 2025;32(2):176–183. doi:10.1097/GME.0000000000002465 ↗
- Sacarin G, Abu-Awwad A, Razvan N, et al. Sexual quality of life in postmenopausal women: a comparative randomized controlled trial of intravaginal PRP therapy versus local hormonal treatments. Medicina (Kaunas) 2025;61(7):1140. doi:10.3390/medicina61071140 ↗
