Treatable, common, and talked about here.
Genitourinary symptoms affect roughly half of postmenopausal women and, unlike hot flashes, do not improve on their own. They respond extremely well to treatment — and they are dramatically undertreated.
The most undertreated problem in menopause medicine
The genitourinary syndrome of menopause — vaginal dryness, burning, painful intercourse, urinary urgency, recurrent urinary tract infections — affects roughly half of postmenopausal women. Unlike hot flashes, it does not improve on its own; ongoing estrogen deficiency in vaginal and urinary tissue makes it progressive without treatment. It is also dramatically undertreated, largely because neither patients nor clinicians bring it up. We bring it up.
Treatment that works
First-line for milder symptoms: non-hormonal vaginal moisturizers (hyaluronic-acid or polycarbophil based) used several times weekly, plus a quality lubricant. When that is not enough, low-dose vaginal estrogen — cream, tablet, insert, or ring — is highly effective, carries no measurable increase in breast cancer risk, and is often appropriate even for women who cannot use systemic hormones, with oncology input where relevant. Recurrent UTIs in postmenopausal women deserve the same evaluation; vaginal estrogen is one of the most effective preventive tools available.
Desire, plainly discussed
Low desire at midlife is common and multifactorial — hormonal, but also sleep, mood, medications, and relationship context. Where hypoactive sexual desire disorder is the diagnosis, carefully monitored transdermal testosterone has evidence of benefit. Where something else is driving it, we say so and treat that instead.