Vaginal Dryness During Menopause: Treatment Options

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 have a real impact on your overall quality of life. It can affect your sex life by causing painful intercourse, and cause 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 in menopause.  

What is vaginal dryness during menopause?

Vaginal dryness (sometimes referred to as vaginal atrophy), is a common condition that affects many women, particularly during menopause.

Vaginal dryness occurs when there's a decrease in estrogen levels, which leads to the thinning and drying of the vaginal tissues. As a result, many women experience discomfort, pain, and even bleeding during sex. Additionally, vaginal dryness can increase the risk of urinary tract infections (UTIs) and other complications if left untreated.

The symptoms of vaginal dryness can vary from woman to woman, but some common signs to look out for include:

• A burning feeling and irritation in and around the vagina
• Lack of lubrication during sex
• Pain during sexual intercourse (called dyspareunia)
• Urinary tract infections
• Painful urination

Vaginal dryness is one of a range of genitourinary symptoms present during menopause, collectively the medical term for these symptoms is called genitourinary syndrome of menopause (GSM).

How many people experience vaginal dryness?

Research suggests 65-84% of menopausal women suffer from genitourinary syndrome in menopause, 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.

What causes vaginal dryness?

Hormonal changes, especially the decline in estrogen levels, play a significant role in the development of vaginal dryness. Estrogen is crucial for maintaining the health and thickness of vaginal tissues. When estrogen levels drop, the vaginal tissues become thinner, less elastic, and more prone to dryness. This can lead to a range of uncomfortable symptoms, including vaginal dryness, itching, and burning.

Other causes of vaginal dryness include:

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

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.

Diagnosing vaginal dryness typically involves a physical examination, a review of your medical history, and possibly some laboratory tests to rule out other conditions. Your healthcare provider may also perform a pelvic exam to assess the condition of your vaginal tissues and check for any abnormalities. If you notice any of these symptoms, it’s important to consult with your healthcare provider to get an accurate diagnosis and appropriate treatment.

They may recommend treatments such as vaginal estrogen cream or an over-the-counter vaginal moisturizer to help restore moisture and elasticity to the vaginal tissues.

Treatments for vaginal dryness

Vaginal dryness 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 effective treatments for vaginal dryness in menopause. One effective treatment option is vaginal estrogen cream, which can help restore moisture and elasticity to the vaginal tissues. 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 

Hormone replacement therapy (HRT) is a 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
• Breast cancer  

Vaginal estrogen

Vaginal estrogen therapy supplies a local, low dose 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 a few 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 hydrated. 

Moisturizers, like hyaluronic acid, are helpful for relieving daily discomfort. One option is Evvy’s Hyaluronic Acid Suppositories, specifically formulated to support vaginal hydration while maintaining a healthy pH and microbiome balance. These suppositories provide long-lasting moisture, easing discomfort during everyday activities and intimacy.

Vaginal lubricants are another effective tool used during intercourse to reduce friction, ease penetration, and make sex more pleasurable. Whether you’re choosing a lubricant or moisturizer, look for one with a pH similar to the vaginal pH (between 3.8-4.5) and free of harsh 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. 

FAQ

How do you treat menopausal dryness? 

There are several options to treat vaginal dryness caused by menopause. One common approach is hormone therapy, which can replenish declining hormone levels and relieve dryness. Another option is using estrogen directly in the vaginal area through creams, tablets, or a vaginal ring, providing localized relief without affecting the whole body as much as systemic hormone therapy. If you prefer non-hormonal options, you can try over-the-counter vaginal moisturizers and lubricants, which can also help ease dryness and discomfort during sex. And remember, staying hydrated and maintaining sexual activity, with or without a partner, can also help by increasing blood flow to the vaginal tissues. It's essential to consult a healthcare provider to find the best treatment approach for your specific needs and health considerations.

What are the symptoms of vaginal dryness?

Experiencing vaginal dryness can be uncomfortable and may cause symptoms like dryness, irritation, itching, discomfort during sex, a burning sensation, and reduced lubrication. Some women may experience light bleeding or spotting after intercourse due to the friction caused by the dryness. It's important to talk to a healthcare provider if you notice these symptoms, as they can help identify the cause and recommend appropriate treatment.