What happens if genitourinary syndrome of menopause is not treated?

Lower oestrogen after menopause can make vaginal and vulval tissues thinner, drier and less flexible. Without care, dryness, itching, burning and pain during sex may continue. Some people also notice urinary urgency, discomfort when passing urine or recurrent urinary symptoms. Tightening of the vaginal opening and pelvic-floor guarding can make penetration increasingly uncomfortable.

These changes are not a personal failure and they are not something you must simply tolerate. Low sex drive may reflect pain, dryness, sleep disruption or mood rather than a lack of interest alone. Bleeding after menopause should not be attributed to this condition without an assessment.

Make an appointment with a GP or gynaecology clinician if symptoms interfere with washing, exercise, intimacy, sleep or urination. Mention all vaginal and urinary symptoms, medicines, past cancers, unexplained bleeding and whether you want local or non-hormonal options. Vaginal moisturisers, lubricants, vaginal oestrogen therapy and pelvic-floor support may be considered for suitable people. A dilator plan should be gradual and guided when pain or narrowing is present.

Contact a clinician promptly for any bleeding after menopause, blood in the urine, new pelvic pain, sores, unusual discharge or repeated urinary symptoms. Seek urgent help for severe pelvic pain, fever, vomiting, fainting or inability to pass urine. These signs need assessment because they may point to another problem.

Ask whether your symptoms fit genitourinary syndrome of menopause, whether an examination or urine test is needed, which moisturiser or lubricant is suitable, and whether local oestrogen is appropriate for your history. Ask how to manage pain during sex safely.