An estimated 1.5 million women – around 80 per cent of those going through menopause – will experience symptoms such as hot flushes and night sweats – and the media and society in general are getting better about talking about these. However, for the women who suffer the menopausal effect of vaginal atrophy (VA), there is still very low awareness of their problems – with the result that such women can fail to seek treatment and often suffer in silence.

In its first guidelines for treating the menopause, UK medicines’ watchdog the National Institute of Health and Care Excellence (Nice) makes clear that women need to talk with their clinician if they need advice – and that it’s very important that the discussion they have includes all relevant options, including drug and non-drug treatments, as well as lifestyle changes.

“Women often find it very difficult and embarrassing to discuss gynaecological issues, especially related to the vulva and vagina and confusing terminology does not help.”

Up to 50 per cent of all postmenopausal women can experience symptoms of VA, which are caused by the effect of declining and low levels of oestrogen on the vagina. But this figure is probably the tip of the iceberg, believes Dr Heather Currie, Associate Specialist gynaecologist, at the Dumfries and Galloway Royal Infirmary, chairman of the British Menopause Society and MD of Menopause Matters: many women simply do not report symptoms, making this figure almost certainly an underestimate.

One reason for the underreporting is that symptoms only become noticeable a few years after periods or treatment with Hormone Replacement Therapy have stopped.

The stigma of vaginal problems is another. Dr Currie’s view is that the terminology used in VA has a lot to do with this. Vaginal dryness or atrophy, vulvovaginal or urogenital atrophy and, most recently, genitourinary syndrome of the menopause (GSM)… “none of these terms rolls easily off the tongue, which is indeed part of the problem”, she says. “Women often find it very difficult and embarrassing to discuss gynaecological issues, especially related to the vulva and vagina and confusing terminology does not help.”

"We are getting better about talking about this condition, but we can’t be complacent – there is still a lot of work to do.”

But talk women must.

The symptoms of VA can include vaginal dryness, irritation and pain during sexual intercourse, as well as reduced sensation and response. Women with VA can also be at increased risk of vaginal and urinary infections.

All these symptoms can cause significant discomfort and distress to the woman, and can have a massive effect on a woman’s confidence and self-esteem, as well as their personal and sexual relationships. These are also symptoms that will not usually resolve on their own and, in fact, will usually gradually worsen with time – so much so, that Nice recommends that treatment should be “started early before irreversible changes occur”.

Dr Currie says: “Women need to be aware of VA, to know the signs, and to feel able to seek help and treatment. We are getting better about talking about this condition, but we can’t be complacent – there is still a lot of work to do”.