What are the first signs of genitourinary syndrome of menopause?

Genitourinary syndrome of menopause happens when lower oestrogen levels affect the tissues of the vagina, vulva, urethra, and bladder. Early changes may feel like dryness, itching, stinging, or a less comfortable sensation during washing or sexual activity. Sex may become painful, and some people notice reduced desire because intimacy is uncomfortable.

Urinary changes can include needing to pass urine more often, urgency, burning, or repeated symptoms that resemble a urinary infection. These symptoms can overlap with infection, skin conditions, or other pelvic problems, so new or persistent symptoms deserve a clinical review.

Note when symptoms occur, whether they are linked to sex or urination, and any changes in discharge, odour, or bleeding. A clinician can check for infection and discuss moisturisers, lubricants, vaginal oestrogen therapy, or other options suited to your health history. Vaginal dilator therapy may be discussed when narrowing or pain makes internal examination or penetration difficult; it should be introduced gradually with guidance.

Arrange an appointment for ongoing dryness, itching, pain during sex, urinary burning, or repeated urinary symptoms. Seek prompt assessment for bleeding after sex or any bleeding after menopause, especially if it recurs. Urgent care is appropriate for fever, back or side pain, vomiting, blood in the urine, or feeling very unwell, because these may signal an infection needing treatment.

Ask: Could infection or another condition explain these symptoms? Would vaginal oestrogen therapy be suitable for me? Which lubricant or moisturiser should I use? What should I do if sex remains painful or urinary symptoms return?