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Vaginal dryness, itching and painful sex are common around menopause and rarely improve alone. Learn the causes and treatments, from moisturizers to estrogen.
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.
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.
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?.
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.
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.
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.
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:
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.
NICE advises not offering vaginal laser treatment for these symptoms except as part of a clinical trial.
Systemic hormone therapy can help vaginal symptoms, but some people also need vaginal estrogen alongside it.
NICE recommends making a shared decision about which form to use. The main types are:
| Form | How it’s used | Might suit you if… |
|---|---|---|
| Cream or gel | Applied with an applicator or finger | You also have vulval dryness or soreness |
| Tablet or pessary | Small tablet inserted into the vagina | You prefer something less messy |
| Ring | Soft ring placed in the vagina and replaced every few months | You prefer not to use something frequently |
Treatment is usually used more often at first, then reduced to a maintenance dose. Improvement typically takes several weeks, so give it time.
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
See your first menopause appointment.
Usually not. It tends to persist or worsen, but responds well to treatment.
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.
Yes. NICE recommends offering vaginal estrogen to people with genitourinary symptoms, including those using systemic HRT.
Moisturizers are used regularly to keep tissues hydrated. Lubricants are used during sex to reduce friction.
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.
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.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
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