Vaginal dryness after menopause: common, rarely discussed
In short
First, water-based lubricants and vaginal moisturisers used regularly, plus fragrance-free washes. If that isn't enough, low-dose oestrogen applied directly in the vagina may be an option, as a medical decision. Unlike hot flushes, the dryness usually doesn't go away on its own. Depending on the study, 13 to 87 per cent of women after menopause have such symptoms.
Everyone knows about hot flushes; hardly anyone talks about vaginal dryness. Yet unlike hot flushes, it usually doesn't go away on its own.
When oestrogen falls after menopause, the vagina, labia and urethra become thinner and drier. Experts call this the genitourinary syndrome of menopause. It includes dryness, burning, itching, pain during sex, needing to pee often and recurrent urinary tract infections.
How common it is
In a 2021 review of 27 studies, 13 to 87 percent of postmenopausal women had such symptoms, depending on the study. The authors also found that many women don't know the cause, it rarely comes up at medical appointments and most are dissatisfied with the treatment they have used.
What can help
Water-based lubricants during sex and vaginal moisturisers used regularly (NHS).
Unperfumed washes instead of scented products and douches (NHS).
Low-dose oestrogen applied directly in the vagina, as a cream, pessary or ring. A 2024 review of 46 studies found it may improve dryness and pain during sex. The same applies to vaginal DHEA and ospemifene. Most studies lasted only twelve weeks; long-term data are lacking.
According to the North American Menopause Society's 2022 position statement, low-dose vaginal oestrogen is an option when over-the-counter products aren't enough. That's a medical decision, especially after breast cancer.
When to see a doctor
The dryness lasts a few weeks and self-help isn't working.
It affects your daily life or your sex life.
You have unusual discharge or bleed after sex or after menopause.
Pain during sex has many causes. More in the article pain during sex.
Sources
Mili, N., Paschou, S. A., Armeni, A. et al. (2021): Genitourinary syndrome of menopause: a systematic review on prevalence and treatment. Menopause 28(6), 706–716. View source
Danan, E. R., Sowerby, C., Ullman, K. E. et al. (2024): Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review. Annals of Internal Medicine 177(10), 1400–1414. View source
The North American Menopause Society (2022): The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 29(7), 767–794. View source
The complete list of sources is in the app under Help & FAQ.
