Vaginal Dryness During Menopause: Causes and Effective Treatments

Vaginal dryness is a common result of falling estrogen around and after menopause. The tissues of the vagina and vulva become thinner, drier and less elastic, causing dryness, itching, burning and painful sex. It usually doesn’t improve on its own, but responds well to moisturizers, lubricants and low-dose vaginal estrogen, which NICE says can be used long-term.

What does vaginal dryness feel like?

• Dryness, soreness or a feeling of rawness
• Itching or burning in or around the vagina
• Pain, discomfort or light bleeding during or after sex
• Less natural lubrication during arousal
• Changes in discharge
• Discomfort when wearing tight clothing, cycling or sitting for long periods

Vaginal dryness often comes with bladder symptoms, such as urgency or recurrent infections. See urinary changes. Together, these are called genitourinary syndrome of menopause. See vaginal and urinary health after menopause.

Why does menopause cause vaginal dryness?

Estrogen keeps the vaginal and vulval tissues thick, moist and elastic, and supports healthy vaginal bacteria. When estrogen falls, NICE describes the tissues of the vulva, vagina, urethra and bladder thinning and shrinking. This causes dryness, irritation, a frequent need to urinate and urinary infections.

Because these tissues depend on estrogen continuously, symptoms tend to persist or gradually worsen after menopause, unlike hot flashes, which usually fade. See do menopause symptoms stop after menopause?.

How common is it?

Very common, though often under-reported. A systematic review found genitourinary symptoms affect about 55% of postmenopausal women, compared with about 32% in perimenopause. Many people don’t raise these symptoms with a clinician, even though they’re very treatable.

What else can cause vaginal dryness or irritation?

• Some medicines, including some breast cancer treatments, antihistamines, some antidepressants and hormonal contraception
• Breastfeeding, which also lowers estrogen
• Infections, such as thrush or bacterial vaginosis
• Skin conditions of the vulva, such as lichen sclerosus, which causes persistent itching and white, thin skin and needs treatment
• Irritants, such as perfumed soaps, bubble baths, douches and some laundry products
• Diabetes, which can increase infection risk
• Stress and low arousal, which reduce natural lubrication

What will a clinician assess?

A clinician will usually ask about your symptoms, sex life, bladder symptoms, periods and medicines. They may offer an examination to check the tissues and rule out infection or skin conditions. Blood tests aren’t needed to diagnose menopause-related vaginal dryness.

What treatments help?

Moisturizers and lubricants

• Vaginal moisturizers are used regularly, every few days, to keep tissues hydrated.
• Lubricants are used during sex to reduce friction and pain.

NICE advises that moisturizers and lubricants can be used on their own or together with vaginal estrogen. It recommends considering them for people who can’t or prefer not to use vaginal estrogen. For people with a history of breast cancer, NICE recommends offering them first.

Low-dose vaginal estrogen

Vaginal estrogen comes as a cream, gel, tablet, pessary or ring. NICE recommends offering it for genitourinary symptoms of menopause, including to people already using systemic HRT. When discussing it, NICE says to explain that:

• Serious side effects are very rare.
• It’s absorbed locally, with only a minimal amount reaching the bloodstream compared with systemic HRT.
• Symptoms often return when it’s stopped, but treatment can be restarted.
• Treatment should be reviewed regularly.

NICE notes that, because absorption is minimal, vaginal estrogen doesn’t need to be combined with a progestogen to protect the womb lining.

After breast cancer: NICE recommends considering vaginal estrogen if symptoms continue despite non-hormonal treatments, with specialist input, especially for people taking aromatase inhibitors.

Other prescription options

• Vaginal prasterone (DHEA): NICE suggests considering it if vaginal estrogen, moisturizers or lubricants haven’t worked or aren’t tolerated.
• Ospemifene: an oral tablet that NICE suggests considering when locally applied treatments are impractical, for example because of disability.

Treatments without strong evidence

NICE advises not offering vaginal laser treatment for these symptoms except as part of a clinical trial.

Systemic HRT

Systemic hormone therapy can help vaginal symptoms, but some people also need vaginal estrogen alongside it.

Practical steps that may help

• Avoid irritants: use plain water or an unperfumed emollient instead of soap on the vulva, and avoid douches and scented products.
• Choose products carefully: fragrance-free moisturizers and lubricants. Water-based lubricants suit most condoms and toys, silicone-based ones last longer, and oil-based products can damage latex condoms.
• Wear breathable underwear, such as cotton, and avoid very tight clothing.
• Take time with arousal, and communicate with your partner about comfort.
• Stay sexually active if you wish, with or without a partner, which may help maintain blood flow and elasticity.
• Consider pelvic floor physiotherapy if muscle tension makes sex painful.

Choosing a form of vaginal estrogen

NICE recommends making a shared decision about which form to use. The main types are:

Treatment is usually used more often at first, then reduced to a maintenance dose. Improvement typically takes several weeks, so give it time.

Talking to a partner

• Explain that dryness is a physical, treatable change, not a lack of attraction.
• Agree to go slowly, use lubricant, and stop if it hurts.
• Explore other forms of intimacy while you’re treating symptoms.

When should you get help?

Book an appointment if dryness, discomfort or painful sex affects your comfort, relationships or quality of life. There’s no need to put up with it.

See a clinician promptly if you have:

• Bleeding after sex, or any bleeding 12 months or more after your last period
• A lump, sore, ulcer or thickened patch on the vulva
• Persistent itching, or white, shiny or thin skin on the vulva
• Unusual discharge, especially if it’s bloodstained or smells offensive
• Pain that doesn’t improve with treatment

Questions to ask at your appointment

1. Could my symptoms be caused by menopause, or something else?
2. Would vaginal estrogen suit me, and which form would be best?
3. Can I use it alongside HRT, or after breast cancer?
4. Which moisturizers and lubricants do you recommend?
5. Should I see a pelvic floor physiotherapist?

See your first menopause appointment.

Related symptoms

Urinary changes · Low libido

Frequently asked questions

Does vaginal dryness go away after menopause?

Usually not. It tends to persist or worsen, but responds well to treatment.

Is vaginal estrogen safe?

NICE says serious side effects are very rare and only a minimal amount is absorbed into the bloodstream. It can be used for as long as needed, with regular reviews.

Can I use vaginal estrogen and HRT together?

Yes. NICE recommends offering vaginal estrogen to people with genitourinary symptoms, including those using systemic HRT.

What’s the difference between a moisturizer and a lubricant?

Moisturizers are used regularly to keep tissues hydrated. Lubricants are used during sex to reduce friction.

Does vaginal laser treatment work?

NICE doesn’t recommend vaginal laser for menopause-related genitourinary symptoms except as part of a clinical trial, because the evidence isn’t strong enough.

How long does vaginal estrogen take to work?

Many people notice improvement within a few weeks, with further improvement over two to three months. Keep using it as advised, and discuss it with your clinician if it isn’t helping.

References

1. NICE guideline NG23: Menopause, identification and management (2024 update: genitourinary symptoms)
2. NICE NG23 recommendations (definition of urogenital atrophy)
3. NHS: Symptoms of menopause and perimenopause
4. Prevalence of psychosomatic and genitourinary syndrome among menopausal women: systematic review
5. The Menopause Charity: 2024 NICE menopause guideline (genitourinary symptoms)
6. Harvard Health: FDA removes menopause hormone therapy black box warnings (vaginal estrogen)
7. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024 (moisturizers, lubricants, laser)

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.