And yes, there’s a solution

There’s a raft of data suggesting that many women are having more sex after the menopause. Good. Excellent in fact. Long may this continue.

And yet, the same time, changes to the vagina and vulva may be setting in, leading to increased UTIs, leaking, splitting skin, night-time loo trips…and painful sex. To my intense irritation, women are unlikely to be told about this at any point in our lives. Or the straightforward, effective and cheap solutions available to fix this.

Vaginas aren’t embarrassing, they’re a fact of life, and now is the time to tend them as carefully as any other part of your body.

The deeply unappealing cluster of symptoms is known – rather horribly – as Genitourinary Syndrome of Menopause (GSM), and they are basically down to a lack of oestrogen. It’s also something that’s historically been spoken about in hushed voices, laughed at, or totally ignored. Studies suggest that it affects around eighty per cent of women. In reality, from years of interviewing menopausal women, I’d say that number is more likely to be 100 per cent, and especially as we head into our fifties and beyond.

I do know what I’m talking about…

I shan’t go into too much personal detail, but I have some experience here. After treatment for breast cancer, and having to come off HRT aged 51, the main menopause symptom I noticed – within just a few weeks – was vaginal dryness, pain, and skin so dehydrated that it split and bled. It felt like the ultimate insult to be honest. What’s more, nobody had so much as mentioned it as a possibility. It’s only because I write about menopause that I joined the dots myself.

I am grumpy about my experience, because anything to do with cancer treatment makes me feel cross. But I am far more angry about the sheer number of women suffering in silence. This is why menopause education is so vital. If you are reading this with a sense of recognition, please make a GP or practice nurse appointment. Yes, it’s awkward speaking to a healthcare professional about your private parts; but they have honestly heard it all before.

Once you develop GSM it is not going to resolve on its own. Left untreated, it will worsen. As I say, too few of us are even aware that a) the vagina and vulva are affected by peri/menopause, and b) that the best solution is appropriate for almost everyone.

You will perhaps have seen many remedies advertised, and I’d recommend avoiding most of them. You do not need expensive salon treatments. There is research on-going into laser treatments but it’s mostly pretty inconclusive.

What you do need is vaginal oestrogen

This is available on prescription and is applied directly to the area. It comes in the form of a cream, pessary, or ring. Normally you use it once a day for two weeks, and then twice a week indefinitely. Even if you have had a hormonal cancer, it is almost always considered absolutely safe (these are official guidelines obviously, I’m not a medic). There are very few women who are not allowed to use it, as it’s not systemic, meaning that it doesn’t affect the whole body. And you can also use it alongside HRT. There is no breast cancer risk (if you are wondering).

Between doses, a decent vaginal moisturiser can help with extra hydration and comfort. Again, you can ignore expensive options (though there are some rather nice ones available). They can be prescribed or bought over the counter. You may wish to use a lubricant during sex to reduce friction, and here I’d recommend the YES Water-based personal lubricant or Sutil Luxe.

If you can’t bear the thought of discussing this, all the solutions are available over the counter or even online. Including vaginal oestrogen, although this isn’t a cheap route.

Alongside all this, do your pelvic floor exercises, and do them religiously. The pelvic floor is a muscle just like any other, and it needs working out.

What I find staggering is how profoundly GSM can affect our lives. I have interviewed women whose relationships, confidence and daily comfort have been wrecked by it, as well as women post cancer who aren’t ‘allowed’ vaginal oestrogen.

Once I had a prescription my symptoms entirely resolved within a couple of weeks. Easy. But also, so pointlessly and time-wastingly hard.