When we surveyed over a hundred women about their experience of menopause, 34% told us that their symptoms included vaginal dryness.
And the prevalence of vaginal dryness may even be on the low side among our community – some research suggests that as many as 50% of women over 60 experience this symptom of decreased oestrogen.
While women are increasingly talking about their experience of perimenopause and menopause, the conversation still tends to focus on symptoms like hot flushes and brain fog, as well as the mental impact of changing hormones.
These are important and necessary topics and anything that raises awareness of the realities of menopause is fantastic in our book.
But we also need to talk about some of the more “embarrassing” symptoms of menopause. Incontinence, period flooding, and vaginal dryness are all common symptoms that many women will experience.
So, in this blog post, we will look more closely at vaginal dryness – what causes it, how it can affect us, and what some of the options are for treatment.
Above all, we want to encourage women reading this to not just accept vaginal dryness as a natural part of aging. Yes, our bodies change as we get older, which includes our vaginas. But that doesn’t mean we need to just live with irritation, itching, and discomfort or pain during sex.
What causes vaginal dryness in menopause?
Like so many of the symptoms of perimenopause and menopause, vaginal dryness is caused by decreasing oestrogen.
Oestrogen plays many roles in our bodies, and one of them is keeping the tissues of the vagina healthy, moist, supple, and elastic. So, as oestrogen begins to drop, it can lead to changes in the vagina.
This is known as vulvovaginal atrophy (VVA). Often described as one of the genitourinary symptoms of menopause (GMS), vaginal atrophy leads to the thinning and weakening of the tissues of the vagina. For many of us, this translates to dryness, itching, irritation, difficulties with arousal and lubrication, and discomfort or pain during sex.
VVA also causes a change in vaginal pH, which may disrupt the natural microbiome of the vagina and leave us more vulnerable to yeast infections and bacterial vaginosis.
What are the treatments for vaginal dryness?
Although there aren’t currently any complete cures for vaginal dryness, there are various treatment options that can help to alleviate symptoms and reduce discomfort.
Many of these treatments are available without prescription, but you could also speak with your GP about treatment options.
If you are talking to your doctor already about menopause symptoms, it’s important to let them know if you are experiencing vaginal dryness or other genitourinary symptoms. Many of us don’t bring up vaginal dryness and the issues it causes when we consult medical professionals, but if we stay silent, the scale of the issue goes underestimated.
The more we can talk about our shared experiences with menopause, including symptoms like vaginal dryness, the more likely it is that better treatment options will be developed and that women will have a realistic idea of what to expect.
1. Lubricants
If you notice the effects of vaginal dryness mostly during sex, you could start simple by exploring different types of lube to use during intimate moments. There are various options available, so you could try a few different ones to see what you prefer.
It’s important to note that oil-based lubricants make condoms less effective, so opt for a water or silicone-based option if you use condoms. And you will want to steer away from flavoured or scented versions, as these can contain ingredients that contribute to vaginal dryness and irritation.
2. Moisturisers
Lubricants are typically used just during sex, while moisturisers can be used regularly regardless of sexual activity – at least twice a week, according to the British Menopause Society.
The tissues of the vagina are sensitive, so you need to choose a moisturiser that is specifically targeted to this area, not just whatever you use on your face or body. You might also want to look out for a vaginal moisturiser that contains hyaluronic acid, as research suggests this ingredient can be especially affective at relieving symptoms associated with vaginal atrophy.
3. Phytoestrogens
Phytoestrogens are plant-based compounds that weakly mimic the effects of oestrogen in our bodies, so many women opt to supplement their diet with plants that are high in these compounds when going through menopause.
Creams and oils containing phytoestrogens from plants can also be applied topically to the vagina itself. Some examples that show promise are fennel cream, red clover oil, and Pueraria mirifica cream.
4. Pelvic floor exercises
Hopefully you already know about the importance of pelvic floor exercises (also known as Kegel exercises) to keep the pelvic floor strong as you age.
Because pelvic floor exercises are linked to improved sexual function, they may also help to alleviate some of the symptoms associated with vaginal dryness, especially those around arousal and sexual satisfaction.
There hasn’t been much research into how effective pelvic floor exercises for vaginal dryness are as yet, but it is another reason to make sure you do them regularly!
5. Topical hormone treatments
For those who are comfortable taking hormone treatments, another option is creams, gels, and pessaries containing oestrogen or dehydroepiandrosterone (DHEA). These can often be suitable even for women who can’t usually take HRT because they have a higher risk of hormone-related cancers like breast cancer. However, you should consult your doctor first before trying these treatments.
6. Laser therapy
It might sound a little sci-fi, but there’s increasing evidence that laser therapy can be effective in reducing vaginal dryness. The treatment encourages increased blood flow to the vaginal tissues, encouraging collagen production and leading to improvements in lubrication and elasticity.
This is a newer treatment option, but one that seems to be showing some promise, especially for women who can’t take hormonal treatments or prefer to seek alternatives. Despite what the name might imply, it is minimally invasive and only takes a few minutes.
However, more research is needed to see if improvements after laser therapy continue long-term.
7. Lifestyle tweaks
Although lifestyle changes alone are unlikely to alleviate vaginal dryness entirely, there are some things that you can do to minimise symptoms, especially if you combine them with one of the treatment options listed above.
For example, the British Menopause Society recommend that women experiencing vaginal dryness try to quit smoking, which can exacerbate the issue. Getting regular exercise may also help, as genitourinary symptoms like VVA can be more common in people who are sedentary.
Similarly, maintaining an active sex life might help – sexual activity increases the blood flow to the vagina, which supports collagen production and helps to maintain elasticity.
Of course, if vaginal dryness is making sex painful or uncomfortable, this might not be a welcome bit of advice. Don’t forget though that sex can come in many different forms – it doesn’t need to include penetration, and it also doesn’t require a partner.
Finally, the NHS recommends avoiding perfumed soaps and body washes, which can contribute to vaginal dryness. Look instead for fragrance-free soaps and washes to use around your vulva and avoid washing inside your vagina at all – it is essentially self-cleaning and washing inside, even with water, can increase the risk of infections.
References
Survey data of 111 women collected by WOW Worthy Women CIC during March-April 2024
Lethaby, A., Ayeleke, R. O., & Roberts, H. (2016). Local oestrogen for vaginal atrophy in postmenopausal women. The Cochrane database of systematic reviews, 2016(8), CD001500. https://doi.org/10.1002/14651858.CD001500.pub3
Sarmento, A. C. A., Costa, A. P. F., Lírio, J., Eleutério, J., Jr, Baptista, P. V., & Gonçalves, A. K. (2022). Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review. Eficácia das abordagens hormonais e não hormonais para atrofia vaginal e disfunções sexuais em mulheres na pós-menopausa: Uma revisão sistemática. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 44(10), 986–994. https://doi.org/10.1055/s-0042-1756148
Briggs, P. (2024) BMS consensus statement: Urogenital atrophy, https://thebms.org.uk/publications/consensus-statements/urogenital-atrophy/
Dos Santos, C. C. M., Uggioni, M. L. R., Colonetti, T., Colonetti, L., Grande, A. J., & Da Rosa, M. I. (2021). Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. The journal of sexual medicine, 18(1), 156–166. https://doi.org/10.1016/j.jsxm.2020.10.016
Dizavandi, F. R., Ghazanfarpour, M., Roozbeh, N., Kargarfard, L., Khadivzadeh, T., & Dashti, S. (2019). An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women. Post reproductive health, 25(1), 11–20. https://doi.org/10.1177/2053369118823365
Nazarpour, S., Simbar, M., Majd, H. A., & Tehrani, F. R. (2018). Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial. Sexual health, 15(5), 396–402. https://doi.org/10.1071/SH17203
Mortensen, O. E., Christensen, S. E., & Løkkegaard, E. (2022). The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state-of-the-art review. Acta obstetricia et gynecologica Scandinavica, 101(6), 657–692. https://doi.org/10.1111/aogs.14353
Vaginal dryness, the NHS, https://www.nhs.uk/conditions/vaginal-dryness/, consulted 26/10/2024
Douching, Office of Women’s Health, https://www.womenshealth.gov/a-z-topics/douching, consulted 26/10/2024
