Vaginal Dryness in Perimenopause and Menopause: What’s Really Going On – and What You Can Do About It
Guest blog post by Dr Alice Duffy, from Health In Menopause
Let’s talk about something that doesn’t get nearly enough airtime: vaginal dryness.
It’s incredibly common during perimenopause and menopause, but many women feel embarrassed to bring it up – even with close friends or their GP. That silence often means it goes untreated, even though it can have a real impact on daily comfort, sex, and overall wellbeing.
And unlike things like hot flushes or night sweats, vaginal dryness doesn’t just fade away with time – it tends to stick around and often gets worse if nothing is done.
So, what actually causes vaginal dryness?
It all comes down to oestrogen – a hormone that plays a key role in keeping the vagina, vulva (opening of the vagina), bladder and pelvic floor healthy. When oestrogen levels drop (during perimenopause, menopause, breastfeeding, or if you’re on the contraceptive pill (the ‘Pill’), these tissues start to change:
• The vagina produces less natural lubrication and the walls become thinner and less stretchy, which can lead to discomfort or pain during sex – and even small tears.
• The bladder and urethra (the tube that empties it) can also thin, making urinary tract infections (UTIs) more likely.
• The labia (the lips around the vaginal entrance) can lose volume, become more sensitive, and even fuse together in some cases, which may cause itching, soreness, or difficulty sitting or wearing underwear comfortably.
• Scars from childbirth can become more painful due to the loss of collagen and elasticity.
These symptoms can pop up during perimenopause, or they might appear years later – just when you thought you were through it all. Once the ovaries stop producing oestrogen, you remain postmenopausal, and the lack of oestrogen can continue to cause changes to this part of the body.
Because many women don’t realise these changes are hormone-related, they miss out on simple, effective treatments that not only relieve symptoms but can also help prevent UTIs – a common cause of serious illness in older age.
The medical world used to call this “vaginal atrophy” – but that term’s now out of date. Instead, we use Genitourinary Syndrome of Menopause (GSM), which better describes what’s going on: changes to the vagina, vulva, bladder and urinary tract, all due to low oestrogen.
What can help?
- Self-Care Products
Just as we moisturise our face and body, we can also moisturise the vagina and vulva. It’s a simple, effective way to soothe and support these sensitive tissues.
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Care of the Vulva
The vulva refers to the external part of the female genitals, including the inner and outer lips (labia) and the clitoris. It does not include the vagina, although the vulva is the external part of the vagina.
The skin of the vulva is delicate and can be easily irritated by everyday products such as:
• Panty liners
• Soap, bubble baths, shower gels
• Talcum powder
• Cleansing wipes and feminine hygiene wipes
• Perfumes and deodorants
• Antiseptics
• Fragranced washing powders and fabric softeners
If your vulva feels sore, itchy, or dry, it’s best to avoid these products altogether — including those labelled as ‘intimate’ or ‘feminine’ washes.
Instead, rinse gently with water and consider using an emollient, such as Hydromol or Zerobase, to calm and protect the skin.
How to Use an Emollient for the Vulva:
• Gently pat the area dry with a soft, clean cloth.
• Apply the emollient to the skin of the vulva once a day, continuing daily until any soreness or itching settles — or for as long as you feel you benefit.
• Many women choose to use an emollient daily long-term.
If you’re unsure where to start, or if the emollient doesn’t help, do speak to your doctor for advice.
(For more information about emollients, see the website link below.)
Vaginal Moisturisers:
The vagina is the muscular canal that runs from the cervix (the opening to the uterus) to the vulva (the external opening). It’s lined with mucous membranes and nerve endings, and is usually a healthy pink colour.
Look for vaginal moisturisers that are specially formulated for this area and free from irritating ingredients or additives.
Good options include:
• Yes VM and Sylk Natural Intimate Moisturiser – both are pH-balanced and gentle.
• Sylk can also double up as a lubricant during sex.
• Yes WB (water-based) and Yes OB (oil-based) are good lubricants – they can be layered, starting with oil then water.
Just be aware: if you’re using condoms, skip the oil-based options during intercourse, as they can weaken latex.
Moisturisers can be used every 2–3 days, or more frequently if needed. And if you’re going for a smear test or vaginal exam, you can even bring your own lubricant along to make things more comfortable.
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2. Local Oestrogen Treatment
Using low-dose oestrogen directly in the vagina is one of the most effective ways to treat vaginal dryness. It usually starts working within about 3 months and can be safely used long term for most women. If you stop, the symptoms are likely to return – so it’s more of a long-term maintenance option.
There are two types of oestrogen used: estradiol and estriol, and lots of different ways to apply it. Here’s a quick guide to help you understand the options:
|
Type |
Product Names |
How it’s used |
Pros |
Cons |
|
Tablet |
Vagifem, Vagirux (estradiol) |
Inserted high into the vagina with an applicator – daily for 2 weeks, then twice weekly |
Easy, minimal mess. Vagirux is reusable and eco-friendly |
Vagifem creates plastic waste. Vagirux requires dexterity to load the tablet |
|
Pessary |
Imvaggis (estriol) |
Inserted with fingers – daily for 3 weeks, then twice weekly |
No applicator waste |
Can’t be used with latex condoms. Slight discharge possible |
|
Cream |
Ovestin (estriol) |
Inserted with an applicator – daily for 2 weeks, then twice weekly. Can also be applied to the vulva |
|
|
|
Blissel (estriol) |
Inserted with an applicator – daily for 3 weeks, then twice weekly |
Absorbs quickly |
May cause initial irritation |
|
|
Ring |
Estring (estradiol) |
Inserted and stays in place for 90 days |
|
|
There’s also Intrarosa, a non-oestrogen pessary that contains prasterone (converted in the body to oestrogen and testosterone). It’s easy to use and helpful for painful sex – but again, not compatible with latex condoms.
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Planning a Cervical Smear?
If you’ve had discomfort during a smear test before, using local oestrogen for 6 weeks beforehand can make it much easier and more comfortable.
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Not Feeling Better?
Everyone responds differently, and sometimes a different type or form of treatment will suit you better. If you’ve been using your treatment consistently for 3 months with no real improvement, it’s time to check in with your GP or menopause specialist.
There could be another condition at play, and it’s important to get the right diagnosis. Also, any unexpected vaginal bleeding should always be discussed with your doctor – don’t ignore it.
Final thoughts
Vaginal dryness is nothing to be embarrassed about – it’s incredibly common and completely treatable. The most important thing is knowing what’s going on, and that there are things you can do to feel more comfortable, confident, and like yourself again.
You’re not alone – and you don’t need to put up with this. Speak to your healthcare professional and find the treatment that works best for you
This blog post has been written by Dr Alice Duffy, from Health In Menopause. She has kindly let us use this on our website.
Any queries or if you’d like to book in to see Alice or another of the doctors in the Health In Menopause team, then click through here.
Vulva emollient information : https://www.bad.org.uk/pils/vulval-skincare/
