Understanding Atrophic Vaginitis (Genitourinary Syndrome of Menopause): Why It Happens and How Vaginal Oestradiol Can Help.

By Thrive Medical

Many women expect hot flushes and mood changes during menopause, but one of the most common—and least talked about—consequences of declining oestrogen is the effect it has on vaginal and urinary health.

If you've noticed vaginal dryness, discomfort during sex, recurrent urinary tract infections (UTIs) or increased urinary urgency, you are certainly not alone.

These symptoms are often caused by Genitourinary Syndrome of Menopause (GSM), previously known as atrophic vaginitis or vaginal atrophy.

The good news is that this condition is extremely treatable.

What is Atrophic Vaginitis?

Throughout our reproductive years, oestrogen keeps the tissues of the vagina healthy by maintaining:

• A thick, elastic vaginal lining

• Good blood flow

• Natural lubrication

• Healthy collagen production

• An acidic vaginal environment that supports beneficial bacteria

• Normal urinary tract function

As oestrogen levels decline during perimenopause and menopause, these tissues gradually become thinner, drier and more fragile.

Without treatment, these changes generally continue to progress over time.

Common Symptoms

Women may experience:

• Vaginal dryness

• Burning or irritation

• Itching

• Pain during intercourse

• Light bleeding after sex

• Vaginal tearing

• Reduced natural lubrication

• Urinary urgency

• Increased urinary frequency

• Pain when passing urine

• Recurrent urinary tract infections (UTIs)

• Reduced sexual enjoyment

Many women assume these symptoms are simply "part of getting older," but they are actually the result of a treatable hormone deficiency.

Why Does the Risk of UTIs Increase?

This surprises many women.

Oestrogen doesn't just affect the vagina—it also helps protect the bladder and urethra.

When oestrogen declines:

• The vaginal lining becomes thinner.

• Protective lactobacilli (beneficial bacteria) decrease.

• Vaginal pH becomes less acidic.

• Harmful bacteria are more easily able to colonise the vaginal area.

• These bacteria can then travel into the urinary tract, increasing the likelihood of bladder infections.

For many postmenopausal women with recurrent UTIs, restoring vaginal oestrogen can significantly reduce the frequency of infections.

How Vagifem® Works

Vagifem® is a low-dose vaginal oestradiol tablet that is inserted directly into the vagina using a small disposable applicator.

Unlike systemic HRT, which circulates throughout the body, Vagifem delivers oestrogen primarily to the vaginal tissues where it is needed.

The aim is to restore the health of the vaginal lining rather than produce whole-body hormonal effects.

Benefits of Vagifem®

Over time, Vagifem can help:

• Restore the thickness of the vaginal lining

• Increase natural lubrication

• Improve elasticity

• Increase blood supply to vaginal tissues

• Improve collagen production

• Reduce burning and irritation

• Make intercourse more comfortable

• Improve vaginal moisture

• Restore a healthier vaginal pH

• Encourage the return of protective Lactobacillus bacteria

• Reduce the risk of recurrent urinary tract infections

• Improve bladder and urinary symptoms

Many women also notice improved comfort during exercise, cycling and everyday activities.

When Will I Notice Improvement?

Some women notice improvement within a few weeks.

For others, the tissues continue to recover over several months.

Maximum benefit is often seen after approximately 8–12 weeks of consistent treatment.

Because oestrogen levels remain low after menopause, ongoing maintenance treatment is usually recommended to preserve these improvements.

Is Vagifem Safe?

For most women, yes.

Because Vagifem contains a very low dose of oestradiol that acts primarily within the vaginal tissues, very little is absorbed into the bloodstream.

It is generally considered one of the safest and most effective treatments for vaginal atrophy and is recommended by major international menopause societies for women experiencing symptoms of GSM.

Your doctor will discuss whether Vagifem is appropriate for your individual medical history.

Can I Use Vagifem if I'm Already on HRT?

Absolutely.

Many women taking systemic HRT (such as Oestrogel®, patches or tablets) still experience vaginal symptoms.

This is because the vagina sometimes requires additional local oestrogen to fully restore the tissues.

Using Vagifem alongside systemic HRT is common and is supported by international menopause guidelines when symptoms persist.

Looking After Your Vaginal Health

In addition to treatment, you can support vaginal health by:

• Staying sexually active if comfortable, as blood flow helps maintain tissue health.

• Using vaginal moisturisers regularly if needed.

• Using lubricants during intercourse.

• Avoiding harsh soaps, scented washes and douches.

• Staying well hydrated.

• Seeking assessment early if you develop recurrent UTIs or persistent vaginal symptoms.

The Bottom Line

Genitourinary Syndrome of Menopause is incredibly common, affecting more than half of postmenopausal women, yet many suffer in silence.

The encouraging news is that it is highly treatable.

By restoring oestrogen directly to the vaginal tissues, Vagifem helps rebuild the vaginal lining, improve lubrication, restore the normal vaginal environment and significantly reduce urinary symptoms and recurrent UTIs.

At Thrive Medical, we believe no woman should accept discomfort as a normal part of ageing. If you're experiencing symptoms of vaginal dryness, painful intercourse or recurrent urinary infections, speak with one of our doctors. Effective treatments are available, and restoring vaginal health can have a profound impact on comfort, confidence and quality of life.