Vaginal dryness: why you don’t need to suffer

This painful condition can have a big impact on your life and be linked to other symptoms during perimenopause and menopause, but treatments are available

Falling hormone levels can cause the tissues around your vulva and vagina to thin and become more sensitive
Applying local oestrogen is effective at relieving symptoms
Numerous preparations are available – your healthcare professional can help determine what’s best for you

Vaginal dryness is a well-recognised symptom of perimenopause and menopause but despite this, its impact has sometimes been underestimated. Oestrogen and testosterone are natural lubricants and cells that respond to these hormones are present in your vulva, vagina, urinary tract, pelvic floor muscles and surrounding tissues. Falling hormone levels during perimenopause and menopause can leave the tissues around your vulva and vagina more dry and less flexible.

While this used to be referred to as vaginal atrophy or atrophic vaginitis, this term only refers to vaginal and vulval changes. In fact, the lack of oestrogen and testosterone can also affect your bladder and the tube running from it (urethra) – they thin and become weaker, which can cause you to need the toilet more often and feel very desperate to go, without much notice. Oestrogen helps cells to fight off harmful bacteria, so a lack of this hormone can make you more prone to urinary tract infections, such as cystitis.

The term genitourinary syndrome of the menopause (GSM) now tends to be used to acknowledge that vaginal and vulval changes can also be associated with urinary symptoms.

What problems does vaginal dryness cause?

A lack of oestrogen to your vagina and vulva can cause symptoms that, although very common, are often not mentioned due to embarrassment. In a survey of women in the UK aged 55 and over, 33% did not seek professional advice for their symptoms of vaginal dryness and/or painful sex, while 36% resorted to an over-the-counter remedy [1].

Symptoms can present in the earlier years of perimenopause or may not occur at all until years after your last period. Around 65%-84% of women experience some of these symptoms after their menopause [2].

It is not just a problem for women who are sexually active – in more severe cases, discomfort can be present all the time and affect normal everyday activities, such as what clothing you wear or how long you can sit down for.

As mentioned, a common feature of vaginal dryness is for the tissue to thin and become more sensitive. This often feel sores and itchy, and can become red and inflamed. Scratching leads to more soreness, redness and inflammation, further exacerbating the problem. There may also be more frequent episodes of thrush.

You might experience intermittent, or even constant, pain at any time of the day, regardless of what you are doing. Or you may only feel discomfort when your vaginal tissue is stretched, such as during sex or when using tampons. This is because, as well as being drier, the tissue around your vagina has become less flexible and doesn’t expand as easily as it did before.

The good news is that there are effective treatments for vaginal dryness, which can be taken alongside HRT if necessary, and some remedies are available over the counter.

What are the treatments for vaginal dryness?

Local oestrogen

Because these symptoms are due to a lack of oestrogen, a very effective solution is to put oestrogen directly on the affected area. This is known as ‘local’ or ‘topical’ oestrogen. It is not the same as the oestrogen you take as part of your HRT.

Local oestrogen is available via a prescription and your healthcare professional can advise which type would be best for you. There are two types of oestrogen used – oestradiol and oestriol – and three main ways to absorb the oestrogen directly from the vagina and surrounding area:

Pessary

The most common choice of vaginal oestrogen is to use a pessary. This is a small tablet you insert into your vagina. Women usually insert the pessary at nighttime so it can stay in place for several hours. Your healthcare professional will advise you on how best to use it, but it’s commonly used daily for the first two or three weeks, then twice a week after that.

There is another type of pessary that is different to other preparations - Intrarosa contains DHEA (also known as prasterone), a hormone that your body naturally produces. Once positioned in the vagina, the DHEA is converted to both oestrogen and testosterone. It can be used with or without an applicator and the usual dose is one pessary every night.

Cream or Gel

Oestrogen creams are inserted inside your vagina, usually on a daily basis for the first fortnight, and then twice weekly after that. An applicator can be used to insert the cream in your vagina and it can be applied with your fingertips on and around your vulva area, which can be useful if you are experiencing itching or soreness of your external genitalia too.

Blissel gel is a newer product – it contains a lower dose of oestrogen and has an applicator to insert the gel inside your vagina. It is used every night for three weeks, then twice a week after that. Some women prefer the gel formula as it is less messy than cream.

Ring

This is a soft, flexible, silicon ring you insert inside your vagina, called an Estring. The ring’s centre releases a slow and steady dose of oestradiol over 90 days, and it needs to be replaced every three months. A health professional can insert the ring if you do not feel confident or able to do so. You can leave the ring in position to have sex, or you can remove and reinsert it yourself, if preferred.

Vaginal moisturisers and lubricants

As well as vaginal oestrogen treatments, there are non-hormonal moisturisers and lubricants that act to keep the tissues well hydrated and feeling less sore. Moisturisers such as YESTM VM, Sylk Intimate, and Regelle are longer lasting, so you might only need to use it every two or three days.

Lubricants are for using just before having sex. Sylk moisturiser can also be used as a lubricant and YES has lubricants known as YES OB or YES WB. If you are using condoms for contraception, and use a lubricant when having sex, make sure it is a water-based lubricant as this type will not dissolve the latex in the condom.

HRT

Many women find that using the right type and dose of HRT can really improve their symptoms. It is quite safe to take HRT with the other treatments mentioned in this article.

How long does it take to improve vaginal dryness?

Your symptoms of vaginal dryness and discomfort should improve after about three months of using vaginal hormone treatments or moisturisers. Some women see significant improvement using products containing oestradiol and not with oestriol – for other women, it is vice versa. Some women see good results with either type of oestrogen or with prasterone. Many women experience more improvements with prasterone as the cells in this area respond to oestrogen as well as testosterone with this preparation. It can also be very beneficial for women with recurrent UTIs and urinary symptoms [3].

It can be a case of trying a few preparations before finding the one most suitable for you. On occasion, it may be necessary to use one type inside your vagina and a different type for your external genitalia. While some symptoms of menopause become less severe as you get older, vaginal dryness is unlikely to resolve by itself – most women will benefit from continuing a maintenance dose of vaginal oestrogen or vaginal moisturisers.

If you have still not had an improvement after three months, you should see your doctor, as sometimes these symptoms can be due to other conditions or medications, for example the contraceptive pill and antidepressants. It is also very important to see your doctor if you have any unusual bleeding from your vagina.

These treatments are usually continued for ever as if they are stopped then symptoms usually return. It is quite safe to continue using them.

References

Barlow D.H., Cardozo L.D., Francis R.M. et al. (1997), ‘Urogenital ageing and its effect on sexual health in older British women’, Br J Obstet Gynaecol 104(1) pp87-91. Doi: 10.1111/j.1471-0528.1997.tb10655.x
Palma, F. et al. Vaginal atrophy of women in postmenopause. (2016), ‘Results from a multicentric observational study: The AGATA study’, Maturitas, 83, pp40-44. Doi: 10.1016/j.maturitas.2015.09.001
Rubin R., Sanaee M., Yee A., Moyneur E., Dea K., Dury A.Y. (2025), ‘Prevalence of urinary tract infections in women with vulvovaginal atrophy and the impact of vaginal prasterone on the rate of urinary tract infections’, Menopause, Jan 7, doi: 10.1097/GME.0000000000002485

Vaginal dryness: why you don’t need to suffer

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21 Feb 2025

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Vaginal dryness: why you don’t need to suffer

This painful condition can have a big impact on your life and be linked to other symptoms during perimenopause and menopause, but treatments are available

What problems does vaginal dryness cause?