Vaginal / Sexual and HRT Risks in Menopause

What are the risks of vaginal and sexual symptoms without HRT?

This page explores the risk of experiencing uncomfortable vaginal and sexual symptoms, also known as Genitourinary Syndrome of Menopause (GSM), which can occur during perimenopause and menopause. These symptoms are a natural result of your body producing less estrogen.

The good news is that there are many ways to manage these symptoms! This interactive page helps you explore different treatment options—known as mitigating factors—and understand how they might change your risk.

Your baseline risk of experiencing these symptoms without any treatment is between 40% and 84%.

How can you mitigate the risk?

There are several ways to reduce your risk and find relief from vaginal and sexual symptoms. Your choice will depend on what is right for you, and a doctor can help you decide.

Choose a mitigation strategy

What kind of treatment are you considering?

Here is a summary of the data regarding the timing of HRT initiation for vaginal and sexual symptoms:

Symptoms are Progressive: Genitourinary Syndrome of Menopause (GSM), which includes vaginal dryness, pain, and other symptoms, is a chronic and progressive condition caused by a lack of estrogen. These symptoms do not improve with time and can worsen if left untreated.

Local vs. Systemic HRT:

Local HRT (creams, rings, or tablets inserted vaginally) is considered the gold standard for treating GSM symptoms when they are the primary concern. It has a very low risk profile because it delivers estrogen directly to the vaginal tissues with minimal systemic absorption. It is effective regardless of how long a woman has been in menopause.

Systemic HRT (pills, patches, gels) is typically used for women who have other significant menopausal symptoms, such as hot flashes. While also effective for GSM, a key consideration for its use is the "timing hypothesis."

The "Timing Hypothesis" and HRT Risks:

Studies suggest that for healthy women, starting systemic HRT before age 60 or within 10 years of menopause may offer more benefits than risks.

The risk of certain side effects, particularly cardiovascular complications and blood clots, may be higher if systemic HRT is initiated more than 10 years after menopause or after age 60.

In conclusion, while the timing of systemic HRT initiation is a crucial factor in the overall risk-benefit analysis, data shows that treatment for vaginal and sexual symptoms with both local and systemic HRT remains effective regardless of whether it is started in perimenopause, menopause, or post-menopause.

Learn more

See the data page for all of the details on how these risks are calculated.

Initially created by Gemini (Google).