Vaginal oestrogen for dryness, soreness and urinary symptoms after menopause

Falling oestrogen thins and dries the tissues of the vagina, vulva and urethra. Women may notice dryness, itching, burning, pain during sex, bleeding after sex, urgency, frequent urination and recurrent urinary tract infections. Unlike hot flushes, these symptoms tend to worsen with time rather than settle. Many women do not mention them because of embarrassment, so clinicians increasingly ask directly.

Applying oestrogen directly restores the thickness, elasticity and moisture of the tissues and supports the normal bacterial balance, which can reduce urinary infections. Effects usually build over several weeks, and many women need a few months for full benefit. NICE guidance recommends offering vaginal oestrogen to women with these symptoms, including those already on systemic HRT, if symptoms persist.

• Creams applied with an applicator or fingertip.

• Pessaries or small tablets inserted with an applicator.

• A vaginal ring that is changed every few months, which suits some women who dislike frequent application.

• Lower-dose and higher-dose products exist; clinicians usually start with a loading period and then reduce to a maintenance schedule.

At standard doses, very little oestrogen reaches the bloodstream. NICE and the British Menopause Society advise that vaginal oestrogen is safe for long-term use for most women and does not carry the risks associated with systemic HRT. For women with a history of breast cancer, use should be discussed with the breast or oncology team, since some may suggest non-hormonal approaches first. Any bleeding after starting should be reported.

Regular use of vaginal moisturisers, applied every few days, and lubricants during sex can ease symptoms, particularly for women who cannot or prefer not to use oestrogen. They do not restore tissue health in the same way. Pelvic floor physiotherapy can help with pain and urinary symptoms. Some women ask about vaginal laser or radiofrequency treatments; evidence of long-term benefit and safety is limited, and professional bodies urge caution about their use compared with established options.

Painful sex may also involve muscle tension, skin conditions such as lichen sclerosus or other causes, so a clinician may examine you if symptoms persist. Urinary infections need confirmation by testing rather than being assumed. Prolapse, bladder conditions and skin conditions can mimic or coexist with menopausal changes.

Choose a form you can use consistently. Wash hands, use the applicator as instructed and note when you are due to reduce the frequency. If you miss doses for long periods, symptoms may return. Do not use more than advised. Ask a pharmacist how to dispose of applicators, and tell your GP if you are also taking systemic HRT.