Vaginal dryness after menopause is very common and very treatable. It happens because falling hormone levels make the tissues of the vagina, vulva and bladder thinner, drier and less elastic. Unlike hot flushes, it tends not to settle on its own, but simple moisturisers, lubricants and prescription treatments applied locally help most women, so it is worth raising with a doctor rather than putting up with it.
Many women never mention it, often out of embarrassment or because they assume it is just part of getting older. This guide, part of our women’s health series, explains what is going on and what you can talk to a doctor about.
Why does menopause cause vaginal dryness?
Oestrogen helps keep the lining of the vagina thick, moist and stretchy, and supports healthy bacteria that protect against infection. As levels fall around menopause, the tissues become thinner and more fragile. Doctors call this group of changes genitourinary syndrome of menopause, because it often affects the bladder and urethra too.
It can start during perimenopause or years after your last period. It can also follow breastfeeding, some cancer treatments, or surgery that removes the ovaries.
What symptoms can it cause?
- dryness, itching, burning or soreness in or around the vagina
- pain or discomfort during sex, sometimes with light spotting afterwards
- discomfort when sitting, exercising or wearing tight clothing
- needing to pass urine more often or more urgently
- more frequent urine infections
Symptoms are easily mistaken for thrush or a urine infection, and some women are treated for these repeatedly without the underlying cause being addressed. If you keep getting urine infections, our guide to recurrent UTIs may help.
Related readingPerimenopause when your blood tests come back normalRead the article →What can help, and what can you ask a doctor about?
Things you can start yourself
- Vaginal moisturisers used regularly, a few times a week, help the tissues hold moisture day to day.
- Lubricants used during sex reduce friction and discomfort. Water-based or oil-based options both work; oil-based products can weaken condoms.
- Gentle care: wash the vulva with plain water or an emollient, and avoid perfumed soaps, bubble baths, wipes and douches, which can irritate.
A pharmacist can help you choose products. Some women find these alone are enough.
Prescription treatments applied locally
If symptoms continue, the NHS and NICE recognise local hormone treatment, applied directly into the vagina as a cream, gel, pessary or ring, as an effective option. The amount of hormone is small and very little is absorbed into the rest of the body. Most women can use it, including many who cannot or prefer not to take hormone therapy tablets, patches or gels, and it can be used alongside them. Some low-dose options are now available from pharmacies after a pharmacist consultation.
Symptoms often return if treatment stops, so many women use it long term, with a review with their doctor. If you have had breast cancer or another hormone-sensitive condition, local treatment is still sometimes possible, but it should be discussed with your doctor and cancer team first.
There are also non-hormonal prescription options that may suit some women. We can go through these at your appointment.
Wider hormone therapy
If you also have other menopause symptoms, such as hot flushes, poor sleep or low mood, broader hormone therapy options may be worth discussing. Some women still need local treatment as well to fully settle vaginal symptoms.
Pain during sex and pelvic floor support
If sex has been painful for a while, the pelvic floor muscles can tighten in anticipation, which adds to discomfort. A specialist pelvic health physiotherapist can help, alongside treating the dryness itself.
What about energy-based treatments?
Some women ask about laser or radiofrequency treatments for vaginal dryness. The research is still developing, and these are not a first-line treatment in NHS or NICE guidance. We would only discuss them once medical causes have been assessed and the options above considered, and we will be honest about what the evidence does and does not show. You can read more on our vaginal dryness page.
When to see a doctor sooner
Please see a doctor promptly, rather than treating symptoms yourself, if you have:
- any vaginal bleeding after menopause, meaning more than a year after your last period, including spotting or bleeding after sex. This always needs checking, even if it is light or happens once.
- a lump, ulcer or sore on the vulva that does not heal
- persistent itching with white, shiny or thickened patches of skin
- unusual discharge, especially if it smells or is bloodstained
- blood in your urine
If you have symptoms of a urine infection with a high temperature, shivering, pain in your back or side, or you feel very unwell, contact your GP the same day or call NHS 111. Call 999 if you are confused, very drowsy or struggling to breathe.
This list is not exhaustive. If you are not sure about something, see a doctor.
How we approach this at Aarva
Appointments are with Dr Shivani Malhotra, a GP who leads our women’s health care. We know this can be hard to talk about, so we give you time and let you lead. We ask about your symptoms, periods, bladder, sex life if relevant, medical history and any treatments you have tried. An examination is offered only if it would help, with a chaperone available, and you can say no.
Your doctor explains your options, what we recommend and why there and then, along with the price of anything suggested. There is no pressure to book on the day, and if a treatment is unlikely to help you, we will say so. With your consent we can update your NHS GP. You can read more about what to expect at your first appointment, or see our wider women’s health care.
Questions patients ask
Will vaginal dryness after menopause go away on its own?
Usually not. Unlike hot flushes, vaginal and bladder symptoms tend to continue or gradually worsen without treatment, so it is worth speaking to a doctor.
Is local hormone treatment safe?
For most women, yes. The dose is small and very little is absorbed into the body. If you have had breast cancer or another hormone-sensitive condition, discuss it with your doctor and cancer team first.
Can I use local treatment if I already take hormone therapy?
Yes. Some women find that wider hormone therapy does not fully settle vaginal symptoms, and local treatment can be used alongside it.
Is bleeding after sex normal after menopause?
No. Any bleeding after menopause, including after sex, should be checked promptly by a doctor, even if it is light or only happened once.
You do not need to put up with discomfort. You can book a consultation with our doctor, or use find your starting point if you would like help choosing the right appointment.
This article is general information and does not replace a consultation with a doctor.
