Vaginal Dryness in Menopause

What is vaginal dryness in menopause?

Vaginal dryness, also called atrophic vaginitis or genitourinary syndrome of menopause (GSM), is pretty much what it sounds like—feeling less lubricated, itchy, irritated, or even “too tight” and is experienced by over 50% of women. 

Starting as early as your 40s, your vaginal wall becomes drier and, as a result, thinner and less pliable. Left untreated, it can lead to a number of side effects, from painful sex to general discomfort. 

What causes menopausal vaginal dryness? 

Vaginal dryness is caused by the decline of estrogen. Unlike other menopausal symptoms that typically go away over time, vaginal dryness tends to persist and often gets progressively worse. 

What is going on inside your body? 

Estrogen increases blood flow and the natural lubrication that keeps your vagina healthy, thick, and elastic. These secretions also create a slightly acidic environment that helps prevent urinary tract infections (UTIs), bacterial vaginosis, and yeast infections. 

During perimenopause, both the amount of estrogen and the number of estrogen receptors in your vagina begin to decline. This causes your vaginal walls to become thinner and less elastic leading to vaginal dryness. 

What are some medical-provider-prescribed treatments for vaginal dryness in menopause? 

The good news is that vaginal dryness is easily treated and can even be reversed.

Vaginal estradiol: This medication specifically targets only your vaginal tissue. It helps restore a normal vaginal pH, thickening your vaginal tissue and increasing vaginal secretions. It comes in cream, tablet, and ring forms. 

Estradiol: This medication replaces the exact form of estrogen that your ovaries are no longer producing. It comes in patch, oral, gel, and cream form. 

Selective estrogen receptor modulator (SERM): This medication mimics some functions of estrogen by stimulating estrogen receptors in your vagina to increase lubrication and lower your vaginal pH, which in turn will return it closer to its pre-menopausal state. 

Dehydroepiandosterone (DHEA): This is a steroid hormone that’s produced by your adrenal glands and can be converted into estrogen in your body. Intrarosa (a non-estrogen vaginal insert) is a prescription DHEA that’s FDA-approved for painful sex in post-menopausal women. 

What are some non-medical treatments for menopausal vaginal dryness you can do at home?

Lubricants: These products provide short-term relief when applied prior to sex. Water-based lubricants with osmolality are recommended. Never use body lotions or moisturizers because some ingredients can irritate your vagina. 

Moisturizers: A vaginal moisturizer or cream can be a more effective treatment than lubricant if you’re experiencing daily discomfort. Applied every one to three days, moisturizers rehydrate your vaginal tissue and lower your vaginal pH. The rehydration and lowering of vaginal pH allow moisturizers to last longer than lubricants. 

Supplements: There are many non-prescription oral DHEA supplements that may help with your vaginal dryness. However, there isn’t conclusive scientific evidence of their effectiveness. 

Lifestyle changes: Switching to cotton underwear can help reduce irritation and friction and can also lower the risk for potential infections. 

• Increased sexual activity: While this may seem counterintuitive, increased sexual activity can improve blood flow to your vagina and, over time, can help reduce GSM symptoms. 

What should you do next? 

Let’s get you prepared to be paired with your provider! 

Select and submit all of the symptoms you are currently experiencing so your doctor can assess and provide a tailored treatment plan for you.