How to manage vaginal dryness during menopause

Menopause causes many changes to your body. One common change is vaginal dryness, which can cause pain or discomfort during intercourse. Vaginal dryness may affect your sex life, but certain treatments can help.

Learn more about the causes, symptoms, and how to treat vaginal dryness during menopause.

What Causes Vaginal Dryness During Menopause?

Vaginal dryness can happen at any age. It’s most common during menopause because your body stops making estrogen, the hormone that regulates your menstrual periods.

Menopause is when your periods permanently stop, and you can no longer get pregnant. It usually happens between the ages of 48 and 52.

Besides regulating your periods, estrogen also helps maintain healthy vaginal tissue and promotes vaginal lubrication. Without estrogen, your vaginal tissues become thin, dry, and less elastic. Doctors call this vaginal atrophy.

About 60% of women experience some degree of vaginal dryness during menopause. But it can also start in the years leading up to menopause, as estrogen levels naturally begin to decline.

In addition to natural menopause, estrogen levels can also drop permanently or temporarily from:

  • Having your ovaries removed.
  • Recently giving birth or breastfeeding.
  • Taking anti-estrogen medications.
  • Undergoing certain types of cancer treatment.

Unlike other menopause symptoms, like hot flashes, vaginal dryness due to menopause doesn’t improve with time. If you don’t treat it, it may worsen.

While estrogen loss is the most common cause of vaginal dryness, these other factors can also contribute to it:

  • Dehydration.
  • Having Sjögren’s syndrome, an autoimmune disease that causes your glands to make less moisture throughout your body.
  • Smoking.
  • Taking certain cold or allergy medicines.
  • Using certain antidepressant medications.

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Symptoms of Vaginal Dryness

Vaginal dryness causes some or all of these symptoms:

  • Dryness, itching, or irritation around your vulva, the outside area of your genital area.
  • A feeling of vaginal tightness during sex or a pelvic exam.
  • Pain, burning, or discomfort during sex due to vaginal dryness.
  • Vaginal tissue irritation with sex that causes bleeding or can lead to an infection.

Besides these symptoms, some people also experience burning with urination, bladder leakage, or more frequent urinary tract infections. Although different from vaginal dryness, these urinary tract problems also happen because of low estrogen.

Having vaginal dryness symptoms along with urinary tract symptoms is also common during menopause. Doctors refer to this as the genitourinary syndrome of menopause (GSM).

Some people who go through menopause have only mild or no symptoms of vaginal dryness. For others, the symptoms are more intense. Having both of your ovaries removed, known as surgical menopause, usually causes more severe symptoms.

It’s important to talk to your doctor about vaginal dryness or GSM if your symptoms are severe. These can worsen over time and affect your sexual function and quality of life.

How to Treat Vaginal Dryness During Menopause

If your symptoms are mild or occasional, you may find relief with these non-hormonal treatments:

  • Hydration. Dehydration reduces fluids and moisture throughout your entire body. Drinking at least eight cups of water daily may help.
  • Vaginal lubricants. Use these before sexual intercourse to ease discomfort. These are available over the counter at a pharmacy. Coconut or olive oil are other home remedies, but note that oil-based lubricants can damage condoms.
  • Vaginal moisturizers. You apply these to the inside of your vagina several times a week to keep your vaginal tissue healthy and moist. These are available over the counter.
  • Vaginal dilators. These can gently stretch and dilate your vagina if it feels uncomfortably tight. Ask your health care provider for an appropriate recommendation.
  • Pelvic floor exercises. These may help if you have pain during sex or bladder leakage related to low estrogen. A trained therapist can teach you home exercises to relax tight pelvic floor muscles and tighten loose muscles. Your doctor can refer you to a trained pelvic floor therapist.

Medications for Vaginal Dryness

Talk to your doctor if your symptoms don’t improve with natural or over-the-counter treatments. Tell them about your symptoms, especially if vaginal dryness causes pain or bleeding during intercourse. They may do a pelvic exam to check your vaginal tissue.

Your health care provider may recommend using a prescription hormone medication alone or with non-hormone treatments. These medications can help:

  • DHEA vaginal suppositories. These go into your vagina each night and help reduce dryness.
  • Hormone (estrogen) replacement therapy. Your doctor may recommend this if you have other bothersome menopause symptoms like hot flashes or sleep problems. Hormone replacement therapy comes in the form of a pill, patch, or cream. It reduces vaginal dryness and menopause symptoms by increasing estrogen levels; it’s especially helpful for anyone with surgical menopause.
  • Low-dose estrogen cream or tablets applied in your vagina as directed. It replaces estrogen in your vaginal tissue to relieve dryness.
  • Low-dose estrogen ring. This also adds estrogen to your vagina, but you only replace it every three months.
  • Selective estrogen receptor modulator (SERM) medication. This is a pill that helps boost estrogen levels in your body.

You might have heard about bioidentical hormones as a treatment for menopause-related vaginal dryness. These use hormones that come from plants.

Some bioidentical hormones are FDA-approved, but they may still carry the same risks as low-dose estrogen or hormone replacement therapy. They may increase the risk of blood clots, stroke, or cancer in some people. Compounded bioidentical hormones are not FDA-approved.

There are pros and cons to using any hormonal treatments — even if they come from plants, so discuss them with your doctor. And make sure to tell your doctor if you have a personal or family history of uterine, ovarian, or breast cancer. They may advise sticking with non-hormonal or low-dose vaginal estrogen.

Vaginal dryness is often a natural part of aging, but you shouldn’t have significant pain or discomfort. If you find that it’s affecting your sex life or overall quality of life, reach out to your health care team. They’ll work with you to find a solution.

The North American Menopause Society. Vaginal Dryness. LINK

Frontiers in Reproductive Health. Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. LINK

American College of Obstetricians and Gynecologists. Experiencing Vaginal Dryness? Here's What You Need to Know. LINK

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