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‘I remember working on the pharmacy counter in Boots as a student and a customer asked for KY jelly. I directed her to the food and drinks area. Now, 40 years later it’s me seeking advice from my GP and praying for a miracle lubricant so that sex is not so painful’. This patient was relieved when it was explained that vaginal dryness is a natural symptom of the menopause, but one that could be relieved using HRT, either in the form of patches, pills or topical cream.

Painful sex can occur when the hormone estrogen is completely depleted during the menopause. Estrogen has been working hard all a woman’s reproductive life: periods, pregnancy, childbirth and lactation. It is this vital hormone that ensures our ligaments and body tissues retain elasticity and strength. As it depletes during the menopause elasticity is lost, hence our skin, everywhere, can feel drier and have less bounce and springback. The same process happens within our vaginal passage, which creates the perfect environment for discomfort and even repeated urinary tract infections.

Topical estrogens that are biodentical and come in various strengths can be used effectively and safely to combat these issues. In a prescribed dosage it is highly effective in a local area only and licensed for indefinite use.

It may seem unfair that the male hormonal programme runs differently to women’s, with final depletion of testosterone happening well into their 70s. Understanding and reacting positively to our body’s natural rhythms allows us to embrace the changes, including vaginal dryness and choose to give ourselves the best menopause experience possible. It’s no longer the case that couples fall out of synch sexually as they grow older. If you can’t beat them join them!