In this article
Vaginal dryness is one of the most common changes after menopause, and one of the least talked about. It can make sex uncomfortable, but it can also make sitting, walking, wiping, or wearing certain clothes uncomfortable too [3]. The good news is that there are several effective treatments, from simple products you can buy at a pharmacy to prescription options [1]. Here is why dryness happens, why it rarely fixes itself, and how the treatment options fit together.
Why dryness shows up after menopause
Estrogen helps keep vaginal tissue lubricated and healthy [5]. When estrogen falls at menopause, the vaginal lining can become thin and dry, with less stretch and less natural lubrication [3]. Menopause is the most common reason for vaginal dryness, but it is not the only one. Certain breast cancer medicines, surgical removal of the ovaries, pelvic radiation, chemotherapy, and smoking can also play a part [5].
Doctors now call the cluster of changes genitourinary syndrome of menopause, or GSM. It covers changes to the labia, vagina, urethra, and bladder caused by low estrogen, and it includes what used to be called vaginal atrophy [2]. Symptoms can include [2, 3, 5]:
- Dryness, burning, itching, or irritation of the vagina or vulva
- Less natural lubrication and pain during sex
- Light bleeding after sex
- Burning when you urinate, or needing to go more often or more urgently
- More frequent urinary tract infections
Symptoms may be more severe for women whose menopause came from surgery to remove both ovaries or from chemotherapy, and for women taking aromatase inhibitors for breast cancer [3].
How common it is, and why it tends to stay
The Menopause Society's 2020 position statement on GSM estimates it affects roughly 27% to 84% of postmenopausal women and says it is likely underdiagnosed and undertreated [1]. A Mayo Clinic review points to two reasons: women are often embarrassed to bring it up, and clinicians do not always ask [8].
A long-running US study called SWAN (the Study of Women's Health Across the Nation) shows how the picture changes with time. Researchers followed 2,435 women for about 17 years, with 13 check-ins along the way [4]. The share who reported vaginal dryness nearly doubled over that time [4].
- Vaginal dryness ~19.4%
- No dryness reported ~80.6%
- Vaginal dryness ~34%
- No dryness reported ~66%
The share of SWAN participants reporting vaginal dryness rose from 19.4% at baseline to 34.0% at the 13th visit [4].
In SWAN, moving further through menopause and having surgical menopause were linked to developing dryness, and women not on hormone therapy who had higher natural estradiol levels were less likely to develop it [4]. Dryness was also linked to reporting pain during sex later on [4].
This is the key difference from hot flashes. Hot flashes typically improve with time, but GSM usually gets worse over time without treatment [3]. So waiting it out is rarely a plan that works.
Treatment, step by step
The Menopause Society says the right treatment depends on how severe your symptoms are, how effective and safe each option is for you, and what you prefer [1]. Over-the-counter products give enough relief for most women with mild symptoms, while low-dose vaginal estrogen, vaginal DHEA, systemic estrogen, and the oral medicine ospemifene are effective for moderate to severe symptoms [1].
| Option | What it does | How it's used | Usually for |
|---|---|---|---|
| Vaginal lubricant | Reduces friction and discomfort during sex [3] | As needed, during sexual activity [3] | Mild symptoms, mainly during sex [1, 3] |
| Vaginal moisturizer | Helps keep moisture in the vaginal tissue day to day [3] | Regularly, often several times a week [3] | Mild everyday dryness [1, 3] |
| Low-dose vaginal estrogen | Treats the tissue changes from low estrogen, with minimal absorption into the bloodstream [2] | Prescription cream, tablet or insert, or ring [2, 3] | Moderate to severe symptoms [1] |
| Other prescriptions | Vaginal DHEA inserts or oral ospemifene [1, 3] | As prescribed | Moderate to severe symptoms, when a clinician thinks they fit [1] |
Lubricants and moisturizers
These two are often confused. A lubricant is used during sex to cut friction. A moisturizer is used on a regular schedule, whether or not you are having sex, to keep tissue moist and ease daily symptoms [3]. MedlinePlus notes that these products can help for a few hours up to about a day [5].
- Lubricants come in water-, silicone-, and oil-based versions. Oil-based ones may damage condoms and may raise the risk of vaginal infections [3].
- The Menopause Society suggests avoiding lubricants with flavors or sugar, warming ingredients, or preservatives such as propylene glycol and parabens, which can irritate some women [3].
- Skip scented soaps, lotions, perfumes, and douches, which can make dryness worse [5].
- Regular sexual stimulation, with a partner, alone, or with a device, promotes blood flow and natural secretions in the vagina [3].
Low-dose vaginal estrogen
When over-the-counter products are not enough, and you do not need hormone therapy for other reasons such as hot flashes, the Menopause Society recommends low-dose vaginal estrogen or one of the other prescription therapies [2]. When estrogen is used only for vaginal and urinary symptoms, low-dose vaginal products are preferred over pills or patches [2]. The Society's patient guide stresses consistent use, and how quickly symptoms ease differs from woman to woman [3].
A Cochrane review pooled 30 randomized trials with 6,235 postmenopausal women. It found low-quality evidence that vaginal estrogen improves symptoms compared with placebo, and no evidence that creams, tablets, and rings differ from each other in how well they work [6]. You can read how the cream is used in our guide to vaginal estrogen cream.
Not every study has shown a clear advantage. In a 12-week trial of 302 women with an average age of 61, a low-dose vaginal estradiol tablet, a vaginal moisturizer, and a placebo gel all eased women's most bothersome symptom by a similar amount, and neither treatment beat placebo [7]. Expert reviewers have pointed out the study's short length, and that the placebo gel itself may have helped [10]. Taken together, the evidence supports what guidelines already say: start with simple products for mild symptoms, and step up if they are not enough [1].
If you already take estrogen for hot flashes
Estrogen taken as a pill, patch, or skin cream for hot flashes also treats vaginal dryness, but some women still need a low-dose vaginal product as well [3, 5]. If dryness is your only symptom, the Menopause Society recommends low-dose vaginal treatment rather than systemic estrogen [3].
Already on systemic hormone therapy and still dry or sore? Tell your clinician. Adding a vaginal product is common, and it is a different decision from changing your main dose [3, 5].
When to see a clinician
Dryness after menopause is common, but that does not mean you should assume every symptom is menopause. Check in with a clinician if:
- Dryness, soreness, burning, itching, or painful sex continues even when you use a water-based lubricant [5]
- You have any vaginal bleeding after menopause, which always needs a thorough evaluation [2]
- Your symptoms do not improve with treatment, since yeast infections, allergic reactions, and some skin conditions can look similar [3]
- You have burning with urination, a frequent urge to go, or repeat urinary infections [2, 3]
If you have had breast cancer, the Menopause Society says low-dose vaginal estrogen should be prescribed in consultation with your oncologist [2]. Its 2020 statement adds that there are not yet enough data to confirm the safety of vaginal estrogen in women with breast cancer [1]. Start that conversation with your cancer team.
What about lasers and compounded products?
You may see vaginal laser or radiofrequency treatments advertised for dryness. The Menopause Society notes these devices are FDA-cleared for vaginal use but not specifically for GSM, and that the evidence does not support using them for dryness, irritation, or pain with sex [3]. Its 2020 statement found too few placebo-controlled trials to recommend them [1].
Compounded hormones are made by a pharmacy for an individual prescription. Compounded drugs are not FDA-approved, and the FDA does not review them for safety, effectiveness, or quality before they reach patients [9]. The Menopause Society's patient guide says compounded vaginal estrogen is not government regulated and is not recommended for GSM in most cases [3]. That matters here, because the vaginal cream offered through WarriorBabe Health is compounded. Ask your clinician why a particular product is the right fit for you, and what the alternatives are.
Getting help through WarriorBabe Health
WarriorBabe Health offers a low-dose estradiol vaginal cream for vaginal dryness and related symptoms after menopause. It is compounded by a licensed pharmacy under your provider's prescription and is not FDA-approved. A licensed provider reviews your health history and decides whether it is appropriate for you, and not everyone will be a candidate.
If you also have hot flashes or night sweats, ask about systemic options on our hormone treatments page. Not sure where to start? Take the 2-minute quiz.
Frequently asked questions
Does vaginal dryness after menopause go away on its own?
Usually not. The Menopause Society says that unlike hot flashes, which typically improve with time, GSM usually gets worse over time without treatment [3]. In the SWAN study, the share of women reporting vaginal dryness rose from 19.4% in their 40s and early 50s to 34.0% about 17 years later [4]. Treatment can help, so it is worth raising.
What is the difference between a vaginal lubricant and a vaginal moisturizer?
A lubricant is used during sexual activity to reduce friction and discomfort. A moisturizer is used regularly, often several times a week, to keep vaginal tissue moist and ease daily symptoms [3]. Many women use both. Water-based lubricants are a good default, since oil-based products may damage condoms and may raise the risk of vaginal infections [3, 5].
Is low-dose vaginal estrogen safe?
The Menopause Society calls low-dose vaginal estrogen effective and generally safe for GSM, with minimal absorption into the bloodstream [2]. It says a progestogen is not required with low-dose vaginal estrogen, though trial data beyond one year are lacking [2]. Any vaginal bleeding after menopause needs to be checked [2]. If you have had breast cancer, involve your oncologist [2].
Will my estrogen pill or patch fix vaginal dryness?
It may help. Systemic estrogen taken for hot flashes also treats vaginal dryness, but some women still benefit from adding a low-dose vaginal product [3, 5]. If dryness is your only symptom, low-dose vaginal treatment is recommended over systemic estrogen [3]. Talk to your clinician if you are on hormone therapy and still have symptoms.
Can vaginal dryness affect my bladder?
The same low-estrogen changes can. GSM includes urinary symptoms such as burning with urination, urgency, frequency, and repeat urinary tract infections [2, 3]. Low-dose vaginal estrogen may help with some urinary symptoms, including preventing repeat infections, though hormone therapy is not FDA-approved for any urinary use [2]. Any new urinary symptoms are worth checking with a clinician.
References
- The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. pubmed.ncbi.nlm.nih.gov/32852449/
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
- The Menopause Society. MenoNote: Genitourinary syndrome of menopause. Patient education. 2025. menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf
- Waetjen LE, Crawford SL, Chang PY, et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018;25(10):1094-1104. pubmed.ncbi.nlm.nih.gov/29916947/
- Vaginal dryness. MedlinePlus Medical Encyclopedia. National Library of Medicine. medlineplus.gov/ency/article/000892.htm
- Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016;(8):CD001500. pubmed.ncbi.nlm.nih.gov/27577677/
- Mitchell CM, Reed SD, Diem S, et al. Efficacy of vaginal estradiol or vaginal moisturizer vs placebo for treating postmenopausal vulvovaginal symptoms: a randomized clinical trial. JAMA Intern Med. 2018;178(5):681-690. pubmed.ncbi.nlm.nih.gov/29554173/
- Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. Mayo Clin Proc. 2017;92(12):1842-1849. pubmed.ncbi.nlm.nih.gov/29202940/
- U.S. Food and Drug Administration. Human drug compounding laws. www.fda.gov/drugs/human-drug-compounding/human-drug-compounding-laws
- Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health. Menopause. 2018;25(6):596-608. menopause.org/wp-content/uploads/2024/09/Management_of_genitourinary_syndrome_of_menopause.97565-2.pdf
This article is for general information. It is not medical advice and does not replace a visit with a licensed clinician who knows your history. Do not start, stop or change a medication without talking to your clinician. If you think you are having a medical emergency, call 911.
