Vaginal Estrogen: The Simple Fix We’re Not Talking About

The Silence Around GSM

I could write so much on this topic, but instead I want to focus on one clear and simple message.

If you have a sore, itchy, burning, or painful vagina… if sex has become uncomfortable or even impossible… if you find yourself going to the loo constantly, feeling like you need to go all the time, or battling repeated urinary tract infections — you may be experiencing Genitourinary Syndrome of Menopause (GSM).

It’s a bit of a mouthful. It used to be called “vaginal atrophy,” and before that — unbelievably — the “senile vagina.” There’s something particularly inappropriate about how women’s body parts and conditions are often named. At least the terminology has moved on, though the problem itself hasn’t. GSM can also show up at other times in a woman’s life, such as while breastfeeding or when on the contraceptive pill.

What You Need to Know

Here’s the simple, evidence-based message: the most effective treatment for GSM is vaginal estrogen.

And here’s something many women (and doctors) don’t realise: even if you are already on systemic HRT, you can still experience GSM. It can arrive early in the perimenopause journey or not until much later — in a woman’s late 50s or 60s. By then, some women don’t even connect their symptoms to menopause. They just assume it’s ageing and resign themselves to living with it. But make no mistake: GSM can be catastrophic for a woman’s quality of life.

Too often, women are dismissed. I’ve heard stories of doctors telling women, “You’re in your 50s, this is normal,” or “You don’t need sex anyway,” or even, “Just have more sex and it will improve.” All incorrect. And in many cases, vaginal estrogen could fix the problem.

“This isn’t vanity. This is about comfort, confidence, and living without pain.”

One of my earliest symptoms of perimenopause was needing to go to the loo constantly. I counted — some nights I was up at least ten times. I was 46 and living in San Francisco at the time. My doctor, exasperated, kept testing me for UTIs, but every test came back negative. The symptoms eventually passed, but it was exhausting. I even insisted on seeing a specialist and had my ovaries checked — everything was normal. Looking back, it was one of my first brushes with GSM.

The reality is, GSM doesn’t go away on its own. Moisturisers can help with comfort, but they don’t rebuild thinning tissue. Vaginal estrogen, on the other hand, restores the health, thickness, and elasticity of the vulvar and vaginal tissues.

It comes in many forms — tablets, suppositories, creams, and rings. And yes, you can use it alongside systemic HRT. Not so long ago, in Singapore, an interim doctor called me questioning why I was taking both. I told her: “Because I need both.” That same doctor has since become something of a menopause guru — I can only assume she knows better now.

The Bottom Line

If you’re suffering from the symptoms above, ask your doctor about vaginal estrogen.

A few key things to know:

This is localised estrogen. It doesn’t travel through your body, making it extremely safe — even for women who may be hesitant about hormones.
It can be used at any age, and almost every woman will notice an improvement.
GSM is not a symptom some women will “get lucky” and avoid. Without estrogen — whether systemic or local — the vulvar and vaginal tissues lose their natural resilience. They become thinner, less flexible, and more vulnerable. They need help.

Vaginal estrogen works — and women deserve to know it.

Resources & Further Reading

📄 Websites & Guidelines

NHS – Vaginal Estrogen
British Menopause Society – GSM Guidance
North American Menopause Society (NAMS) – GSM Resources

🎧 Podcasts & Articles

Kelly Casperson, MD – The Difference Between Senile Vagina, Atrophy, and GSM
You Are Not Broken Podcast (Kelly Casperson, MD) — multiple episodes on GSM, vaginal estrogen, and vulvar health

📝 Related Blog Posts

Does Breast Density Really Matter? — exploring breast density, risk, and why women aren’t routinely told
This post: Vaginal Estrogen: The Simple Fix We’re Not Talking About — shining light on GSM and the treatment too few women hear about

OMG: The Women's Health Brief