Extremely common after menopause, rarely raised, and one of the most treatable things there is.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
Vaginal dryness is part of a wider condition now called the genitourinary syndrome of the menopause — falling oestrogen thins and dries the tissues of the vulva, vagina, urethra and bladder. That broader name matters, because this is not only about sex. It is also behind a great deal of urinary urgency, discomfort passing urine, and recurrent urine infections after 50.
It affects well over half of postmenopausal women. And unlike hot flushes, it does not settle with time — it progresses. That single fact is the most important thing here, because women are frequently told to wait it out, and waiting makes it worse.
The treatment is vaginal oestrogen: highly effective, minimally absorbed into the bloodstream, safe for long-term use, and suitable for a great many women who cannot take systemic HRT. It is one of the most effective and most under-prescribed treatments in general practice.
Part of the reason it is under-used is the patient information leaflet, which lists the risks of systemic HRT and frightens people off. Those warnings do not apply in the same way to a low-dose vaginal preparation, and that mismatch is a recognised problem — covered properly below.
It is gradual, progressive, and it does not fluctuate. Thrush comes and goes; this does not. Hot flushes fade over a few years; this does the opposite.
This affects women whether or not they are sexually active — the urinary symptoms and daily discomfort are reason enough to treat it. Only a minority of affected women ever raise it, mostly through embarrassment or an assumption that it is simply part of ageing to be endured. It is neither.
Falling oestrogen after the menopause. Oestrogen maintains the thickness, elasticity and blood supply of these tissues, and keeps the vaginal environment acidic through the lactobacilli that depend on it. Without it, tissue thins, lubrication falls, and the pH rises — which is also why urinary infections become more frequent.
Lichen sclerosus — which causes itching with pale, thin, fragile skin and gradual loss of the normal vulval shape. It is a distinct condition needing potent topical steroids and follow-up, and untreated it causes permanent scarring and carries a small cancer risk. It is regularly mistaken for menopausal dryness or recurrent thrush for years.
Also: vulval eczema or contact dermatitis, often from the products being used to treat the presumed problem; psoriasis; and Sjögren's syndrome, where dry eyes and a dry mouth accompany it.
The diagnosis is usually clear from the history — gradual, progressive dryness and soreness in a woman around or after the menopause, often with urinary symptoms alongside. That makes it well suited to a remote consultation, and treatment can begin without any test.
Usually unnecessary. In a woman over 45 the menopause is a clinical diagnosis and hormone tests are unreliable — levels fluctuate widely and a single normal result excludes nothing. Testing has a role under 45, and where premature ovarian insufficiency is suspected.
We cannot examine you, and there are situations where examination is what settles it:
We also cannot perform cervical screening, which is a physical procedure and free on the NHS — if you are due, we will say so.
Available as a pessary, cream, gel or a ring. It restores tissue thickness, elasticity, lubrication and the healthy bacterial population, and it substantially reduces recurrent urinary tract infections.
This deserves addressing directly, because it stops a great many women from starting or continuing treatment.
The patient information leaflet lists the risks associated with systemic HRT — breast cancer, clots, stroke. Vaginal oestrogen is a low dose acting locally, with minimal absorption into the bloodstream, and those risks do not apply in the same way. It does not require a progestogen to protect the womb lining, and it is regarded as suitable for long-term use.
Reading that leaflet and quietly stopping is an extremely common outcome. If it has worried you, please raise it rather than abandoning the treatment.
Women on aromatase inhibitors or tamoxifen frequently have severe symptoms and are frequently told nothing can be done. Vaginal oestrogen is often considered acceptable after discussion with the oncology team, particularly where non-hormonal measures have failed and quality of life is significantly affected.
That is a decision made with your cancer team rather than around them — and it is a conversation worth having rather than assuming the answer is no.
Symptoms not responding, suspected lichen sclerosus, or where specialist options such as vaginal DHEA or ospemifene are being considered.
Seek prompt assessment — these are not attributed to dryness — for:
Book a routine consultation if:
A vaginal moisturiser is used regularly regardless of sex, two to three times a week, to maintain tissue hydration. A lubricant is used at the time. They do different jobs, and using a lubricant alone while expecting it to fix the underlying dryness is a very common mistake.
Vaginal moisturisers and lubricants are available over the counter cheaply, and they help a great deal. They are different things and both are worth having: a moisturiser used regularly rehydrates the tissue over time, a lubricant is used at the time.
The treatment that changes this condition is vaginal oestrogen, and it is free on the NHS. Your NHS GP can prescribe it, and it is now also available over the counter as a low-dose pessary for women over 50, which many people do not realise.
The single most useful thing on this page is that vaginal oestrogen is not the same as HRT, and the risks people worry about do not apply. Absorption into the bloodstream is minimal. It can be used long term, does not require a progestogen, and is generally considered suitable even for many women who cannot take systemic HRT — including, after specialist discussion, some with a history of breast cancer.
That misunderstanding causes real suffering. Women endure years of discomfort, painful sex and recurrent urinary symptoms because they believe oestrogen is dangerous.
Where a consultation is worth paying for is having that conversation properly, and getting the treatment started — it needs regular use for several months before judging it, and it does not work as a one-off.
Any bleeding after the menopause needs assessment, never treatment.
NICE NG23, Menopause: diagnosis and management, is the governing guideline. It recommends vaginal oestrogen for urogenital atrophy, including for women on systemic HRT who have persistent symptoms, and states it can be continued for as long as needed.
NG23 is explicit that vaginal oestrogen does not require progestogen opposition and that systemic absorption is minimal — the basis for the reassurance above.
NG23 also recommends explaining that symptoms often return when treatment stops, and that treatment may need to be long term.
British Menopause Society guidance covers the use of vaginal oestrogen in women with a history of breast cancer, which requires discussion with the oncology team but is not an absolute contraindication.
NICE CKS, Menopause, covers vaginal moisturisers and lubricants as non-hormonal options.
NICE NG12 requires urgent assessment of postmenopausal bleeding, which is never attributed to atrophy without investigation.
No — and this is the key difference from other menopausal symptoms. Hot flushes and night sweats usually settle over a few years. Vaginal and urinary symptoms are progressive: without treatment they slowly worsen. Waiting it out is the one strategy that reliably does not work.
Yes, for the great majority of women. It is a low dose acting locally with minimal absorption into the bloodstream, it does not need a progestogen to protect the womb, and it is considered suitable for long-term use. It is safe for many women who cannot take systemic HRT at all.
This is the commonest reason women stop, and it is worth understanding. The leaflet lists the risks of systemic HRT, which do not apply in the same way to a low-dose vaginal preparation. It is a known and unhelpful feature of the packaging. If it has worried you, raise it rather than quietly stopping.
Often, yes — after discussion with your oncology team. Women on aromatase inhibitors and tamoxifen frequently have severe symptoms and are frequently told nothing can be done, which is not accurate. Vaginal oestrogen is commonly considered acceptable where symptoms are significantly affecting quality of life. It is a conversation worth having rather than an automatic no.
Indefinitely, for as long as you want the benefit. The underlying cause — low oestrogen — does not resolve, so symptoms return within a few months of stopping. It is a maintenance treatment rather than a course.
A moisturiser is used regularly — two or three times a week — to maintain the tissue. A lubricant is used at the time of sex. They do different jobs, and using only a lubricant while expecting the underlying dryness to improve is a very common and understandable mistake.
Because the same oestrogen loss thins the urethra and changes the protective bacteria in the vagina. Vaginal oestrogen substantially reduces recurrent urinary infections, and it is one of the most effective and least offered treatments for that problem. If you have recurrent UTIs after 50, ask about it by name.
Absolutely. The urinary symptoms, the daily soreness and the recurrent infections are reason enough on their own. This condition is not only about sex, and treating it improves comfort regardless.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
Patient reviews
