Fire Down Below: The Survivor’s Guide To Vaginal Atrophy

Finally, one of the most painful conditions relating to menopause is openly being talked about on social media, largely thanks to the wonderful book “Me & My Menopausal Vagina” by patient expert Jane Lewis (read my review here).

I never thought that, at 56, I would be spending more on moisturisers for my bits than I do on my face but, as the husband annoyingly likes to say, “it is what it is” and a dose of acceptance often takes us further forward than denying, shutting up and pretending everything is fine.

Vaginal Atrophy is the delightful medical term for vaginal dryness which is not just a problem peri- and menopausal women.  It brings with it a whole host of unpleasant and, in some cases, life changing, symptoms – burning, irritation, itching, bleeding, painful sex….  the list is quite extensive – and all the more difficult because of the other related conditions that our vulvas and vaginas have to endure – Thrush, BV and Lichen Sceloris to name a few.

Add to this the woeful lack of knowledge demonstrated by many doctors (male and female!) and the current near impossibility of actually being examined by a GP and you have a recipe for many women suffering this blight with no information, no help and no support.

It would never happen to men, would it!

Then there is the issue of HRT.  Hopefully we are moving away from the dark ages where any menopausal symptom is treated with antidepressants – it’s not our brains that are the problem!  It’s lazy diagnosis and unacceptable in 2020.

But there are quite a few options and it is largely a matter of trial and error to find what works for you – if you are lucky enough to have a GP who will take the right tests to discover which hormones you are deficient in.

For many vaginal oestrogen is a life saver – in the form of Ovestin (cream) or Vagifem (a tablet).  There are other forms but these are the two I am familiar with. And, replacing oestrogen can help with bladder problems too.

I am not a doctor but I would like to share (with their permission of course), the daily routines VA sufferers use to make their symptoms a little more bearable.

This is a huge subject and I heartily recommend reading Jane’s book as a starting point but I hope these tips give you some ideas.

Please, please, please – don’t suffer in silence.  This is not something that you need to put up with because you are getting older.

Tips from VA Sufferers (name withheld)

(You can find links to all the products mentioned at the end of this post)

~Since working from home, I now shower after having a bowel movement to avoid urine infections. I use Hydromol 500 in the shower and Olive and Bee to moisturise after showering. I use Vagifem 4 times a week.

~ I wash in Hydromol Shower Liquid and use Hydromol ointment when I am uncomfortable.  I also like Yes Oil Based lubricant.

~ I use Dermol Shower Emollient or Hydromol ointment for washing, Hydromol, Olive and Bee or VMagic to moisturise.  I use Vagifem and Ovestin internally for my VA and occasionally use Yes VM (Yes Vaginal Moisturiser).

~ I use Vagifem twice a week and Yes VM 3 times a week.

~ I use Vagifem every other night and Yes VM every day.

~ I always wash with Epaderm. I am currently using Estriol and Yes Ob (oil based) but after second appointment today with my doctor I’m going to reintroduce Vagifem. My external symptoms have improved but I am still sore internally.

~ I use Vagifem 5 times a week and Ovestin externally at bedtime. I use Dermol in the shower and also shower after a bowel movement or use peri bottle if not at home. I also use Yes VM if I feel I need extra. (A peri bottle is a bottle with a nozzle you fill up with warm water to wash intimate areas).

~ I wash and moisturise with Hydromol. I use Ovestin every other day.

~ I wash and moisturise with Hydromol. I use Ovestin internally and externally three times a week. I use Yes VM when needed.

~ I use Vagifem x 2 twice a week, Ovestin or a combined oestrogen and testosterone ointment on the vulva. I wash with water or YES Intimate Wash.  I use Yes OB, Emu Oil or olive oil to moisturise. I use YES VM twice a week.

~ I wash/shower with Epimax daily, use Ovestin 3 times a week and am still trying to find a daily moisturiser that suits me. I also use Yes VM for intimate times although I am still left sore. I’m waiting for an appointment with a gynaecologist to sort this cycle out.

~ I use Vagifem 3 times a week and Olive and Bee most days. I also take D-Mannose daily to help prevent UTI’s and so far it has worked.

~ I wash with Aveeno. I use Vagifem 3 times a week and take an HRT tablet each night. I use Olive and Bee for intimate times and when needed.

~ I use Vagifem twice a week and MD Replens when I need it. I just use water no soap of any kind. I have a teaspoon of pumpkin seeds and one of sesame seeds on weetabix every morning, eat either fresh or in juice peaches every day. These foods help our bodies to produce oestrogen.

~ I am using systemic HRT (estradot estrogen patches), progesterone every night, vagifem 5-7 nights per week and hydromol ointment after I urinate and Yes OB every evening.

~ I use Estrodiol and testosterone in cream form, progesterone at night in pill form. I use Olive and Bee moisturizer 3 times a day.

~ I started using Imvexxy last year and it has helped more than words can say. Before that i used Estrace cream and had tried Vagifem.

~ I use Vagifem 5 nights per week. I use Estriol Cream mixed with Olive & Bee externally on alternate nights. I use Olive & Bee after my morning shower but use water only to wash with. I use Balance Activ BV pessary weekly to maintain vaginal pH while on long term antibiotics. I have an 100 mcg Estradot patch and a daily blob of Testogel.

~ I use Estriol gel 2 pumps daily, Progesterone, Vagifem daily, Ovestin (all at night) Yes WB in morning and when needed and a gallon for sex if it ever happens.

~ I have an Estring ring which dispenses my HRT for 3 months. I use a Balance Active VM pessary every 3 days.

~ I’m on my third month using Intrarosa.  I moisturise with olive & bee twice a day,  use yesVM every couple of days and wash with Yes intimate wash.

~ I wash with Avène body wash, Dermol 500 for intimate areas in showers only. I use HRT gel daily with progesterone every 3 months. I use VMagic and YesOB when needed. I have Cheeky Panda toilet paper and use Avène water spray after every visit to the toilet.

~ my routine:  Ovestin twice a week, Vagifem twice a week, Yes Oil Based daily, VMagic when I am particularly irritated.  Yes Water Based and Yes Oil Based for intimacy.

As you can see, most of us are getting by with a mix of prescribed HRT and over-the-counter treatments.  It’s noticeable that there is no ‘one size fits all’ when it comes to dealing with this but what is important is that you take charge of your body and seek (demand!) help for your VA if you are suffering.

Sometimes something simple like a special cushion for sitting might help. There are ways to adapt your lifestyle to make you more comfortable for example by swopping to reusable cloth sanitary towels and liners and carrying a travel size vaginal moisturiser in your handbag.

Most importantly, make sure you examine yourself regularly (Jane’s book covers this thoroughly) and make sure you report any changes to your GP.  It doesn’t matter how old you are either.  There is no reason for any woman at any age to be uncomfortable.  I have heard from other women that they are now helping their older mums and relatives to seek advice if they are suffering from VA.  And what about older ladies in residential care?  I can only hope that someone cares enough to check that they too receive help if they are suffering from VA.

If you are suffering pick up the phone and ask for a GP appointment (telephone or zoom probably at the moment).  Don’t be fobbed off.  Do your research and ask for what you need.  If it helps write it down and read from your notes.  (Just say: “I’ve listed a few points I would like to run through with you).

Above all, let’s continue the conversation by talking about these issues with other women – and men too.  Our husbands and partners need to know what they can do to help.

Products Used



An estradiol ring which is inserted into the upper third of the vagina for 90 days and replaced by a new ring as appropriate.

Estriol Gel

Estriol (estrogen) delivered internally in a gel.

Imvexxy – an alternative vaginal estrogen product in the USA.

Intrarosa – a pessary containing prasterone

Ovestin – a vaginal cream to supplement estrogen

Vagifem – estradiol vaginal inserts in pessary form.

Over the counter


Cheeky Panda toilet paper


A skincare brand specialising in creams, emollients, lotions and treatments for dry, sensitive skin and chronic skin conditions such as eczema.

Emu Oil

Expensive but some ladies swear by it.


Another emollient for dry skin.


An emollient and barrier cream for dry skin.  I have previously had this one on prescription.  It’s a decent moisturiser but not my favourite.

Olive and Bee Intimate Cream

This is a 100% natural intimate cream which contains organic ingredients and can be used as used as an intimate moisturiser, lubricant or massage oil.

Very popular but I found it stung slightly on application.


Another intimate cream designed for the instant relief and soothing of irritated skin.  I quite like this one and it does seem to do what it claims.

Vulva Harmony

An intimate balm which has a more solid consistency than VMagic and is slightly cheaper.  I am trying this one at the moment so the jury is out.

Yes products:  Yes Intimate Wash, Yes Vaginal Moisturiser, Yes Water Based lubricant, Yes Oil Based lubricant.

I have used all of these and the one I prefer is Yes Oil Based.  In fact, Yes is the range I always return to.  If you sign up to their mailing list, the company periodically offer 25% discount voucher codes which are well worth using if their products are staples for you.

What works for me, though, might not work for you and vice versa.  It really is a matter of trying these out to find what works best for you.  You may even find just a bit of coconut oil or olive oil help but some ladies claim that these have triggered thrush.

A huge thanks to the ladies who have so helpfully shared their regimens with me. I hope you can see that there are things you can do rather than just sitting there in discomfort.

And, as ever, make sure you get professional medical advice with your VA issues – particularly to rule out any conditions related to vaginal cancers.

Feel free to share your tips and stories in the comments below.



  1. Samantha
    9 November, 2021 / 4:13 pm

    Hi, is Hydromol safe to use at the same time as YES oil based? I mean to say if you’ve applied YES OB in the morning is it safe to apply Hydromol later in the day? Or should you wash first? Apologies if this is a silly question. I’m trying to find a lube that is suitable for me as when I did a patch test on my arm for YES water based I had a skin reaction. I’ll also add that I have Vulvodynia and have only applied Hydromol ointment externally after urination since mid August.
    Thank you in advance.

  2. Jay Will
    29 March, 2021 / 11:35 am

    Can you recommend a vaginal moisturiser with a comfortable applicator? The Replens one is sharp and scratchy and I end up stinging. The single use squirty ones are jabby.
    I can’t have hormone treatment because of the risk of breast cancer recurrence.
    Very sore at the moment with intermittent cystitis type feeling and I find sitting for any length of time is uncomfortable. Wondering about some sort of cushion.

    • linda
      29 March, 2021 / 12:25 pm

      I use Yes products – particularly the oil based as a daily moisturiser. You can purchase Yes Water Based and Yes Vaginal Moisturiser in single use applicators. Apply a little Yes Oil Based on the end of the applicator for extra comfort. Balance Activ pessaries seem to be very popular with VA sufferers too.

  3. Jen Woodhall
    24 December, 2020 / 2:51 pm

    Hi, I’m 71 and currently, on Christmas Eve, lying in bed clutching a hot water bottle and, pathetically, crying. I’ve just discovered your page, having spent months of my life reading any article I can find that might help. My problem with vaginal atrophy began 27 months ago. I assumed it was something stress related as I was dashing from one hospital to another, supporting sick family members. 15 months ago I was diagnosed with moderate collapse of the anterior vaginal wall. I have a ring pessary fitted for this and have been prescribed Vagifem (Estadriol) pessaries for the atrophy since September 2018. I use Hydromol for bathing and frequently find myself sitting on my bidet hoping for relief. The overriding feeling is that of a very heavy period. I don’t know what else to do and find it hard to come to terms with the fact that this may be for the rest of my life. Your forum has given me some more options to investigate on Boxing Day.

    • linda
      24 December, 2020 / 7:05 pm

      Hi Jen – sorry you’re suffering. I highly recommend you read Me & My Menopausal Vagina by Jane Lewis and join her Facebook forum where you will find hundreds of ladies in your predicament willing to help. is the link. I would also suggest that you book an appointment with a women’s health physio who will be able to advise on your prolapse and suggest suitable exercises (note: NOT necessarily kegels). I see Gillian McCabe in Cardiff who is brilliant but the ladies in the Facebook group will know of help near you. You don’t mention HRT and it may be that Vagifem on its own is not enough or if you can’t tolerate it you might be better off with Ovestin cream. I am not a doctor, however but I do think you need specialist advice. Hold tight because there are solutions out there. When you say ‘heavy period’ I am assuming you just mean cramping? Could you have another type of infection – thrush, BV, cystitis? Has your water been checked? Ever had endometriosis? I’ve never been particularly impressed by Hydromol and personally use Yes Oil Based as a daily moisturiser – which you can use with vagifem and ovestin.Lastly, if you’ve been under a lot of stress, have you also had IBS ruled out?

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