Menopause and Vaginal Dryness: What Treatments are Available?

Highlights from this article

• Vaginal dryness is a common symptom of menopause caused by declining levels of estrogen in the body
• Estrogen keeps vaginal tissue thick, elastic, and lubricated
• Aside from affecting your sex life, vaginal dryness can also have an impact on your overall quality of life
• Vaginal dryness can be treated with a range of solutions, from prescription hormonal therapies to over-the-counter lubricants and moisturizers

Along with hot flashes and mood swings, vaginal dryness is a hallmark symptom of menopause.  Although you can experience vaginal dryness at any stage in your life, it’s more common in the years leading up to menopause (perimenopause) and after menopause.

Vaginal dryness can impact one’s sex life by causing painful intercourse. It also can impact overall quality of life through discomfort from other activities such as walking, exercising, or using a tampon. 

Menopause may be inevitable, but its symptoms don’t have to be! Luckily, there are several treatment options for vaginal dryness during menopause.  

What causes vaginal dryness in menopause?

Menopausal vaginal dryness is caused by a decrease in estrogen levels. Estrogen plays a crucial role in vaginal health. It keeps your vaginal mucosa thick, lubricated, and elastic. 

As estrogen levels drop during perimenopause and menopause, the vagina, vulva, and urinary tract can become thinner and drier. This is referred to as vaginal atrophy. When vaginal atrophy occurs, it can lead to symptoms such as vaginal dryness, burning and irritation, lack of lubrication, and pain with intercourse and peeing. The medical term for this condition is called genitourinary syndrome in menopause (GSM).

Other causes of vaginal dryness during menopause include:

• Not being aroused during sex (although being “wet” and arousal aren’t always mutually exclusive!)
• Douching or using perfumed vaginal soaps 
• Underlying conditions, like diabetes 
• Some medications, like antidepressants
• Chemotherapy 
• Surgical removal of the ovaries 

How many people experience vaginal dryness?

Research suggests 65-84% of menopausal women suffer from genitourinary syndrome in menopause (GSM) however, many don’t receive adequate treatment. 

According to the 2012 Vaginal Health: Insights, Views & Attitudes (VIVA) survey of 3,520 postmenopausal women, 75% of respondents said that vaginal atrophy negatively impacted their lives, 32% said it affected their overall quality of life, and 21% said it affected how attractive they felt.

How do I know whether I have vaginal dryness? 

Wondering if you’re experiencing vaginal dryness or not? Given the lack of education on these topics, that’s unfortunately pretty common. Only you know how your vagina is supposed to feel (it should feel good!), and everyone will experience vaginal dryness differently. However, these may be a few indicators that you are experiencing this vaginal symptom:

• Soreness or itchiness in and around your vagina
• Redness and inflammation of the vulva 
• Pain or discomfort during and after sex
• Painful sex
• Bleeding after sex

These symptoms can often be caused by other factors or conditions, but if you notice one or more of them in addition to other menopausal symptoms, reach out to your OB-GYN or healthcare provider. 

Treatments for vaginal dryness

Vaginal dryness during menopause can feel like the icing on top of the cake when you’re experiencing other uncomfortable symptoms (ahem, hot flashes). The good news is, there are several treatment options for vaginal dryness in menopause. The best way to figure out which treatment option works best for your body, symptoms, and lifestyle is to speak with your OBGYN or healthcare provider. That being said, we put together a list of treatments below so you can feel well-informed when you have that conversation with your doctor. 

Systemic hormone replacement therapy  (HRT)

Hormone replacement therapy (HRT) is prescription medication that contains either synthetic or bioidentical versions of the reproductive hormones estrogen and progesterone. HRT can be taken in the form of pills, gels, or patches.

Systemic HRT supplies hormones to the entire body, so it’s most likely you’ll be prescribed HRT to also treat other menopause symptoms, such as hot flashes. Not everyone can take HRT, so it may not be the best option for you. HRT isn’t recommended if you have a history of:

• Heart disease
• Blood clots
• Stroke
• Estrogen-dependent cancers  

Vaginal estrogen

Vaginal estrogen treatments supply low, local levels of synthetic estrogen. They can come in the form of vaginal suppositories, vaginal creams, or vaginal rings. You typically start by applying vaginal estrogen every day for two weeks then transition to twice weekly, but it can sometimes take a few months to see results. 

Vaginal estrogen causes fewer side effects than HRT because it only releases estrogen locally to the vaginal tissue, as opposed to your systemic circulation (aka your whole body). 

Non-hormonal vaginal moisturizers and lubricants 

In addition to vaginal estrogen, there is a range of vaginal moisturizers and lubricants that don’t contain estrogen but can keep your vagina lubricated. 

Moisturizers are used to relieve daily discomfort, while lubricants are used during intercourse to ease penetration and make sex more pleasurable (that’s true even if you don’t experience vaginal dryness, BTW!) 

Moisturizers and lubricants are a great alternative if you can’t (or don’t want to) take HRT. Just make sure you’re opting for a moisturizer or lubricant that has a pH similar to the vagina (between 3.8-4.5) and doesn’t contain ingredients that can disrupt the vaginal microbiome. 

Ospemifene 

Ospemifene is a selective estrogen receptor modulator (SERM), an oral medication used to treat painful intercourse and vaginal atrophy. It works by acting like estrogen in some parts of your body, but has anti-estrogen effects in others. 

In short:

Many women don’t speak up about vaginal dryness because they believe it’s just an unavoidable byproduct of aging. Although menopause is a normal part of life, there are many options you can explore with your doctor to alleviate uncomfortable symptoms!