Vaginal Dryness During Perimenopause and Menopause

Vaginal dryness is one of the symptoms women are least likely to mention to their doctor, despite the fact that it is extremely common and very treatable. Research suggests it affects around 50 percent of postmenopausal women, and many notice the first changes during perimenopause. If this is something you are experiencing, you are far from alone.

Why It Happens

The vaginal lining depends on estrogen to stay thick, elastic, and well-lubricated. During perimenopause, as estrogen levels fluctuate and gradually decline, the vaginal tissue begins to change. The medical term for this is vulvovaginal atrophy, though more recently the broader term genitourinary syndrome of menopause (GSM) has been adopted because the effects extend beyond the vagina to include the vulva and urinary tract.

Research from the REVIVE (Real Women's Views of Treatment Options for Menopausal Vaginal Changes) survey, which gathered data from over 3,000 postmenopausal women, found that vaginal dryness was the most commonly reported GSM symptom. A 2013 study in Menopause found that tissue changes can begin in early perimenopause, sometimes before a woman notices any other symptoms (Portman and Gass, 2014).

Unlike hot flashes, which tend to improve over time, vaginal dryness typically gets worse without treatment because the underlying tissue changes are progressive.

What It Feels Like

Women describe vaginal dryness in different ways:

A general feeling of dryness, tightness, or irritation
Discomfort or burning during daily activities
Pain during sex (known medically as dyspareunia)
Light bleeding or spotting after intercourse
Increased urinary frequency or urgency
Recurrent urinary tract infections

The REVIVE survey found that 85 percent of women with vaginal dryness said it negatively affected their lives, yet only 56 percent had discussed it with a healthcare provider. Many women assumed it was something they simply had to put up with. That is not the case.

How It Affects Intimacy

Changes to sexual comfort are often the most distressing aspect. Research published in the Journal of Sexual Medicine found that vaginal dryness is one of the primary contributors to reduced sexual desire and satisfaction during the menopause transition.

Pain during sex creates a cycle that can be difficult to break. Anticipating discomfort reduces desire, which reduces arousal, which makes dryness worse. This is a physiological problem, not a psychological one, and it responds well to treatment.

Treatments That Work

Vaginal Moisturisers

Over-the-counter vaginal moisturisers are applied regularly (not just before sex) to help maintain moisture in the vaginal tissue. A randomised trial published in Obstetrics and Gynecology found that regular use of vaginal moisturisers improved dryness, itching, and discomfort scores significantly compared to placebo.

Products containing hyaluronic acid have shown particular promise. A 2016 study in the European Journal of Obstetrics and Gynecology found that hyaluronic acid vaginal gel was comparable to low-dose vaginal estrogen for relieving symptoms.

Vaginal Lubricants

Lubricants are used during sex to reduce friction and discomfort. Water-based and silicone-based options are both effective. Oil-based lubricants should be avoided with latex condoms.

Vaginal Estrogen

This is the most effective treatment for vaginal dryness. Vaginal estrogen comes in creams, tablets, and rings that deliver a low dose of estrogen directly to the tissue. It restores thickness, elasticity, and lubrication.

The critical point: vaginal estrogen is a local treatment. Research consistently shows that very little estrogen is absorbed into the bloodstream, making it significantly different from systemic hormone therapy in terms of risk profile. The American College of Obstetricians and Gynecologists states that vaginal estrogen is appropriate for most women, including many who cannot use systemic HRT.

A Cochrane Review of 30 trials found that all forms of vaginal estrogen (cream, tablet, and ring) are equally effective and significantly better than placebo.

Ospemifene

Ospemifene is an oral medication that acts like estrogen on vaginal tissue without being a hormone. Clinical trials published in the New England Journal of Medicine showed it significantly improved vaginal dryness and pain during sex. It is an option for women who prefer an oral treatment over vaginal application.

Vaginal Laser and Radiofrequency Treatments

Some clinics offer laser or radiofrequency treatments for vaginal dryness. While early studies show promise, the evidence base is still developing. A 2023 review in Menopause noted that more large-scale, long-term randomised trials are needed before these can be recommended as first-line treatments.

What Does Not Help

Some commonly suggested remedies lack evidence or can make things worse:

Soap, douches, and fragranced products: these disrupt vaginal pH and can worsen irritation
Cranberry supplements for UTIs: while popular, a Cochrane Review found limited evidence that cranberry products prevent UTIs in postmenopausal women
Waiting it out: unlike hot flashes, vaginal dryness does not resolve on its own and tends to worsen over time without treatment

The Link to Urinary Symptoms

The same tissue changes that cause vaginal dryness can affect your urinary tract. Research from the SWAN study found that urinary symptoms increase significantly during the menopause transition. You may notice:

Needing to urinate more frequently
A sense of urgency
Discomfort or burning when urinating
More frequent urinary tract infections

Vaginal estrogen has been shown to reduce the frequency of recurrent UTIs by up to 50 percent in postmenopausal women, according to a systematic review in the British Medical Journal.

Starting the Conversation

If vaginal dryness is affecting your comfort or your relationships, it is worth bringing up with your doctor. Many women feel awkward raising the topic, but healthcare providers deal with this regularly and have effective treatments available.

If you are not sure how to start, our article on talking to your doctor about perimenopause has practical suggestions for making these conversations easier.

You can also try over-the-counter moisturisers and lubricants as a first step while you decide whether to pursue medical treatment.

Tracking Your Symptoms

Keeping a record of your symptoms can help you assess whether treatments are working and give your healthcare provider useful information. Note:

When symptoms are most noticeable
Any triggers (such as certain activities or products)
Whether symptoms are getting better, worse, or staying the same over time
How treatments are working for you

If you are experiencing other perimenopause symptoms alongside vaginal dryness, tracking everything together gives a more complete picture of your overall experience.

Sources:

Portman, D.J. and Gass, M.L.S. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy. Menopause, 21(10), 1063-1068
Kingsberg, S.A. et al. (2013). The Women's EMPOWER Survey: Identifying women's perceptions on vulvar and vaginal atrophy and its treatment. Journal of Sexual Medicine, 10, 1790-1799
REVIVE (Real Women's Views of Treatment Options for Menopausal Vaginal Changes) Survey. Menopause, 2014
Lethaby, A. et al. (2016). Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews
Portman, D.J. et al. (2013). Ospemifene, a novel SERM for treating vulvar and vaginal atrophy. New England Journal of Medicine, 368, 2111-2121