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Perimenopause guide

Vaginal dryness and urinary changes in perimenopause, what is going on?

Vaginal dryness, discomfort during sex, and changes to your bladder are a common part of perimenopause and beyond, grouped together under the term genitourinary syndrome of menopause. It affects a very large share of women, by some estimates anywhere from around a quarter to more than four in five, and, unlike hot flushes, it tends to persist or progress rather than fade on its own (Journal of Women's Health, 2026). Here is what is happening, and why it is worth raising early rather than enduring quietly.

What genitourinary syndrome of menopause means

It is an umbrella term for a set of related changes driven by falling oestrogen and androgen in the tissues of the vulva, vagina, and lower urinary tract. Symptoms include vaginal dryness, irritation, and pain during sex, along with urinary urgency, discomfort passing urine, and recurrent urinary tract infections (Journal of Women's Health, 2026). They often arrive together because they share the same underlying cause.

Why it does not simply pass

This is the key difference from hot flushes. Vasomotor symptoms tend to peak and then ease over the years after the last period. Genitourinary symptoms behave differently, because the tissue changes are ongoing, they are chronic and progressive, and they commonly get worse over time if nothing is done (Journal of Women's Health, 2026). Waiting it out is therefore the one approach unlikely to work.

Why so many women stay quiet

Genitourinary symptoms are under-reported and under-treated, often because they feel private or are assumed to be an unavoidable part of ageing. That silence has a cost, because effective, well-evidenced treatments exist. The condition is common, it is not a personal failing, and it is very treatable, which is exactly why it is worth naming out loud.

When to talk to a GP

Please raise these symptoms with your GP, especially if sex is painful, if you have recurrent urinary tract infections, or if bladder symptoms are affecting your life. Local vaginal oestrogen and non-hormonal options are effective and can make a real difference. Any unusual bleeding, or pain that does not fit, should be checked. anna does not diagnose, and this article is not medical advice.

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What anna does with this

Genitourinary symptoms are not something a wearable can measure, and anna is honest about that. What anna does is give you an evidence-based, plain-language understanding of the whole transition, so symptoms like these are named and normalised rather than left unspoken, and you know they are worth taking to your GP early. Understanding is what turns a private worry into a solvable problem.

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Sources

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  1. Perelmuter S, Srivastava M, Freedman KP, et al. Vaginal estrogen: pearls for the practitioner. J Womens Health (Larchmt), 2026. DOI
  2. Henson E. Updates in care for patients with genitourinary syndrome of menopause. Nurse Pract, 2026. DOI
This article summarises general research and is not a substitute for personal medical advice. anna does not diagnose.