When Lorraine Kelly shared her experience of menopause on her daytime TV show in 2017, she was her own last resort. Initially, she set out to interview a famous woman about her story, but everyone she approached refused.

“I thought, nobody else will talk about it so I’ll do it. It was a breakthrough moment,” said Kelly.

Seven years later, it often feels as though we have reached peak menopause. Michelle Obama, Salma Hayek and Gwyneth Paltrow have all been open about their experiences, encouraging women not to feel ashamed about a biological process an estimated 13 million people in the UK are now going through. And yet there’s still one part of it that is barely spoken about.

Vaginal dryness.

As with so much in this realm, it took a celebrity – Davina McCall in this case – to shine a light on it. For those of us who’d assumed this symptom was a minor inconvenience, which only affected sex and was easily remedied with the kinds of lubrication readily available from high street chemists, it was a brutal wake-up call.

“I had severe dryness, so severe that when I tried to wipe myself after going to the loo, it was so sore I was having to kind of dab,” McCall said in her 2021 documentary, Sex, Myths and the Menopause. “I didn’t know what it was, I had no idea that it was part of being perimenopausal.”

Previously known as vulvovaginal atrophy, now rebranded as genitourinary syndrome of menopause (GSM), vaginal dryness will probably affect between 60% and 80% of women, according to various studies. It is caused by the drop in oestrogen levels, which happens as women go through menopause, causing vaginal tissue to become thinner and less elastic. Despite it being so common, one study has found that a third of female sufferers did not report it to their doctor.

This is partly because of embarrassment, says Haitham Hamoda, consultant gynaecologist and clinical lead of the menopause service at King’s College Hospital. “Most GPs are well informed and offer a great service, but of course, there are variations of what you can access. Part of it is going to be what is available to you, what is offered to you, and what you feel comfortable talking about.”

He continues: “You’d be surprised how many people would come and see you because they’re talking about flushes and sweats and brain fog. And when you say, ‘Do you have vaginal dryness?’ they will say, ‘Oh, yes, it’s really uncomfortable’. But they never really think about bringing it up, unless you specifically ask.”

Hamoda has seen women who are too sore to wear underwear. “You do find people who say clothes are uncomfortable because it’s touching against the area … In extreme cases they find it uncomfortable sitting or walking.”

GP and menopause expert Dr Renée Hoenderkamp has had cases like this too. “I’ve seen women who can’t go about their daily life because of vaginal dryness. It’s absolutely debilitating. They can’t go to the gym any more, can’t wear jeans, can’t go for a bike ride, can’t run up the stairs at the station. It’s all just too painful.”

Clare, 55, says GSM “consumed my whole life”. “I used to sit in a shallow, cold bath, sobbing. It was agony, the burning never let up for one second of the day or night. Even walking was painful.” It began when she was 47, but she never considered her symptoms could have anything to do with being perimenopausal because her periods were regular, and she was not having hot flushes.

But, as Hoenderkamp points out, every menopause is different: “For some women, vaginal dryness will be their first symptom, very early, even before their periods have changed. Other women won’t get it until they’ve gone through it all. It’s really individual.”

She also believes that seeing dryness as just a symptom of menopause can be misleading. “Women who breastfeed for more than six months will suppress their oestrogen to a level where they may get vaginal dryness. The pill can cause it. Antidepressants. It’s not just restricted to menopausal women.”

The implications of vaginal dryness can go far beyond pain, says Hoenderkamp. “Once past menopause, when all of the tissue in and around the vagina and urethra dries and atrophies, women become much more susceptible to urine infections because bacteria are able to attach to the tissue.”

Hamoda has also seen women avoiding or missing cervical screening due to GSM. “Sometimes you can’t open the speculum because they’re so dry and uncomfortable, even though, of course, you’re using plenty of lubrication.” In some cases, he has told patients to “take vaginal oestrogen for the next two months, then come back and we’ll attempt this smear again. Sadly, this is not an uncommon scenario.”

Not every doctor is aware of how to help women with GSM. Emily, 44, sought medical advice as soon as her vaginal dryness began four years ago. “It felt like there was a red hot poker inside of me,” she says. She also suffered from urinary tract infections. Her GP found it so hard to reach a diagnosis that at one point he told her – on the phone – that she might simply have to prepare herself for a life of chronic pain.

As she was 40 when her symptoms began, her doctor didn’t consider perimenopause. She was passed between different NHS services, given courses of antibiotics, a cystoscopy, referrals to urology, gynaecology and physiotherapy. She also paid to see a private vulval pain specialist. As all this was going on, no painkillers could make any difference, and she remained in agony.

“It’s been catastrophic,” she says. “The pain makes it very difficult to concentrate. I’ve had to give up four jobs in the space of four years. I’ve had to sell my house and move away from my friends because I need to have more savings in case I can’t carry on working. It’s had a massive effect on my mental health.”

Out of desperation, Emily began to research her symptoms herself. She found out that one in 20 women go through perimenopause before they’re 45, and, presuming this was what was happening to her, Emily wrote a detailed letter to her GP, asking for vaginal oestrogen. He agreed to put her on a low dose. “And within two days the burning stopped.”

She is still, however, struggling with her UTI symptoms – which include needing to pee around four times an hour. While it’s impossible to know what has caused this, she believes that because her infection was not treated for so long it has got worse. She is now being treated separately for her persistent UTI.

Misdiagnosis is a common thread through this condition. Dr Paula Briggs, a consultant in sexual and reproductive health at Liverpool Women’s NHS Foundation Trust, reports, “It depends who the patient presents to, how likely they are to get the right diagnosis. Loads of women will be told they’ve got thrush.”

It’s a perfect storm – women reluctant to seek medical help in the first place, then a delay in being diagnosed.

“Whereas other menopausal symptoms resolve – generally they get less severe, then they stop – GSM becomes progressively worse over time and is very difficult to reverse,” says Briggs. She now thinks all women should be given vaginal oestrogen at around the age of 45 as a default.

However, as oestrogen pessaries fall under the HRT umbrella, some women remain nervous due to the small increased risk of breast cancer linked to progestogen-containing forms of HRT. Hoenderkamp says that vaginal oestrogen does not carry the same risk. “It is just about as safe as houses, and very easy. I often have women who say I can’t have vaginal oestrogen because I’ve had breast cancer. Well, you can.”

Hamoda is more cautious: “Generally speaking, with breast cancer patients you would try other non-hormonal options first. But on an individual basis.”

However, it is not a problem that will disappear overnight. “In terms of the oestrogen, women are not going to do it for a year and then it will all be OK. It’s probably a lifelong commitment to their vagina,” says Hoenderkamp.

Vaginal oestrogen is available from chemists – although it’s cheaper on prescription from your GP – and there are also moisturisers and lubricants women can buy over the counter as a possible first port of call.

The message overall is clear, though. If you are uncomfortably dry, you should never suffer in silence – it’s not just a part of ageing that happens to everyone, which you have to grin and bear – it’s something that can be treated and, in most cases, eased.

“Awareness is key,” says Hamoda. So, while there has never been so much talk about menopause as there is now, there’s still a lot that needs to be said.

Some names have been changed