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Vaginal Dryness During Menopause

During menopause, as much as 60% of all women experience vaginal dryness, which is also called vaginal atrophy, atrophic vaginitis or genitourinary syndrome of menopause. Some women don’t realize the symptoms they’re experiencing are related to menopause. Fortunately, when women are willing to seek medical help, simple treatments are available. Learning how to fix vaginal dryness can be a life-changer for many women. Keep reading to learn more about what helps vaginal dryness.

Hormone Therapy Illustration

Symptoms of Vaginal Dryness

Vaginal dryness isn’t talked about much because many of its symptoms are so private. You may have experience any or all of these symptoms without wanting to discuss them with others, and you may have felt that they weren’t worth a visit to the doctor. However, the discomfort they bring is treatable, so seeking treatment is likely to bring the relief you need.

The most common symptoms of vaginal dryness include:

  • Pain during sex. Because the vagina becomes drier and smaller during menopause, and because of the decrease in natural lubrication, sex can become extremely painful. Many women find themselves avoiding sex, and possibly harming their relationships, as a result.
  • Urinary problems. As the vaginal lining thins with menopause, so do the tissues around the opening of the urethra. This weakening of tissues can result in repeated urinary tract infections with all the pain and discomfort they involve. Many women also experience more a frequent and urgent need to urinate or stress incontinence, as well as pain or a burning sensation during urination. In some cases, women also experience hematuria, or blood in the urine.
  • Vaginal discharge. Some women experience a yellowish discharge from the vagina during menopause. Often this is due to a vaginal infection, which is sometimes related to a simultaneous bladder or urinary tract infection, especially if the discharge has an unpleasant odor.
  • Vulvar pruritus. This symptom manifests as extreme itchiness around the vulva and vagina. As you give in to the need to scratch, you can then make the skin even more sensitive, exacerbating the itchiness even further.
  • Loss of sexual desire. The decreased sexual desire that some women experience during menopause can be in part a response to the pain associated with intercourse and the resulting loss of sexual confidence. The decrease in female sexual hormones that occurs during menopause may also lead some women to have difficulty reaching orgasm.

Hormonal Treatments for Vaginal Dryness

Several types of hormone-based treatments are available to treat vaginal dryness. These include topical treatments applied directly to vaginal tissues as well as hormone replacement therapy, which can treat other symptoms associated with menopause. In addition, a non-estrogen-based oral medication is available by prescription to treat the condition.

Estrogen Creams, Rings and Tablets

Topical treatments are applied directly to vaginal tissues. By delivering estrogen directly to the vagina, these treatments ease symptoms of vaginal dryness. Vaginal suppositories or pessaries are inserted like a tampon, delivering estrogen cream deep within the vagina. Applicators are also used to deposit vaginal tablets, which are essentially small pills that release estrogen.

A vaginal ring is a solution that delivers estrogen to the vagina over the long term. The ring is soft and flexible, about 2 inches in diameter. You can insert it yourself, or a health care provider can do so. Once inserted, the ring stays in place for up to 3 months, releasing estrogen steadily all the time. In addition, you can apply vaginal creams by hand.

Count on a few weeks for these topical estrogen treatments to start to work. You may need to start out applying creams or suppositories every day for a couple of weeks. After that, most women only need to apply them a couple of times per week. There’s no risk of heart disease or blood clots with any of these topical applications, since the estrogen isn’t delivered to the bloodstream.

Topical vaginal creams and suppositories shouldn’t be used as lubrication for sexual intercourse; additional lubrication is needed. They may also cause damage to diaphragms or latex condoms. Women who prefer these types of contraception may prefer vaginal tablets instead.

Systemic hormone therapy delivers estrogen to your entire body via any of several delivery systems. This type of hormone replacement therapy uses higher doses of estrogen and is effective against the most common (and most irritating) symptoms of menopause.

Most women choose to take their hormone replacement therapy in pill form, taking one estrogen pill a day. Also available is the estrogen patch, which is placed on your abdomen, with estrogen absorbed continually through the skin. Some patches can be worn for up to a week, while others must be replaced every few days. Low-dose estrogen patches are available for women who want to reduce their risk of osteoporosis but don’t need help with menopausal symptoms.

In addition, some women choose topical creams, sprays or gels to introduce estrogen into their bloodstream. These are applied to your arms or legs, depending on the dose and the method of delivery.

If you don’t want systemic hormone therapy, but prefer a topical approach to deal with symptoms affecting your vaginal area, you may want to choose low-dose preparations. These come in several forms as well. You can apply vaginal creams daily or several times a week or take vaginal tablets a couple of times per week. Vaginal rings are inserted for longer periods, with replacements needed every three months or so. These products limit estrogen to your vagina. They’re useful for treating vaginal dryness, vaginal itching and urinary issues, but don’t have any effect on the other symptoms of menopause.

Doctors typically start with the lowest effective dose to see how you respond. Dosages are individualized for each woman’s needs. If you start hormone replacement therapy around the beginning of menopause, you’re most likely to experience the greatest benefits at the lowest risk.

Hormone Replacement Therapy

Hormone replacement therapy involves systemic replacement of the estrogen that declines sharply during menopause. The small risks involved with hormone replacement therapy are well worth the relief that the treatment provides, not just for vaginal dryness but also for other menopause symptoms, including hot flashes, mood swings and night sweats.

Hormone replacement therapy improves vaginal dryness drastically, restoring the elasticity and moisture of the vagina. It thickens the skin of the vaginal wall, and it restores the vaginal pH balance to its premenopausal levels. In addition, it improves bone density, providing a pushback against the development of osteoporosis, and it typically improves mood and sleep as well.

Women who only experience vaginal dryness, with no other menopausal symptoms, may be best served by using topical hormone treatments. If you’re experiencing other menopausal symptoms, however, hormone replacement therapy may very well be your best choice.

You can discuss with your doctor the best way to take your estrogen. Available methods of delivery include tablets, patches (similar to nicotine patches) and gels. The best approach will be the one that pairs well with your lifestyle and medical history.


This prescription medication is a selective estrogen receptor modulator that’s designed to treat pain during sexual intercourse caused by vaginal dryness. While this fairly new treatment doesn’t actually contain estrogen, its effects are similar. Ospemifine, which is sold under the brand name Osphena, is taken orally every day. However, while it does help with vaginal dryness, it doesn’t help with other menopause symptoms and may prompt hot flashes.

What Help is Available to Women With Vaginal Dryness in Massachusetts?

Vaginal dryness is far more than a mildly irritating condition. It can affect your relationship with your partner because of the discomfort it causes during sex. It also typically diminishes your overall quality of life, thanks to the burning sensation, urinary tract infections and discomfort that accompany it.

Fortunately, treatment is straightforward and effective. At Hormonally Balanced, we can help you choose the best option to treat your vaginal dryness and other symptoms of menopause. Contact us today to schedule a consultation with our team so you start to end the discomfort of vaginal dryness.

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Feel free to call us or take our short women's health questionnaire.

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Questions about Vaginal Dryness?

We have answers

As women go through perimenopause and menopause, their bodies stop producing as much estrogen as they did when they were younger. As a result, the secretions that kept the vagina lubricated start to dry up, and the lining of the vagina starts to become dry and thin. Many women experience burning and itching sensations and pain during sex due to vaginal dryness. Other symptoms associated with atrophic vaginitis are increased urinary tract infections, vaginal infections and frequent urination.

Vaginal dryness typically sets in during menopause. That means women may start to experience it in their late 40s and over age 50. Other factors can increase the likelihood of this symptom showing up.

One of the key factors contributing to atrophic vaginitis is lack of sexual intercourse. Women who stay sexually active during perimenopause and menopause are much less likely to experience vaginal dryness.

In addition, various medical conditions, including some immune disorders, can help to trigger vaginal dryness. Women whose ovaries have been removed or who have decreased ovarian function because of cancer treatments, including radiation and chemo, also typically experience the condition. Some breastfeeding mothers may also experience temporary vaginal dryness.

Some medications also have vaginal dryness as a side effect. These include tamoxifen, nafarelin and medroxyprogesterone, also known by their brand names Nolvadex, Synarel and Provera, respectively.

Before menopause begins, estrogen helps the lining of the vagina to stay moist, supple and elastic. It also protects the vagina against infection by stimulating the production of glycogen in the vaginal lining.

At menopause, the ovaries stop producing the same amount of estrogen. Without that hormone, the lining of the vagina starts to thin and become less elastic. At the same time, the glands that produce mucus decrease their production, which also contributes to vaginal dryness. The acid balance of the vagina also changes, which can increase the chances of infection, and the vaginal canal can become narrower and even shorter than it was pre-menopause.

Because vaginal dryness is caused by lack of estrogen, the best way to treat it is usually to replace the missing estrogen. There are other ways you can help treat the condition as well. These include:

  • Vaginal moisturizers. Over-the-counter moisturizers, such as Replens or K-Y Liquibeads and Bonafide Revaree, can help keep the vaginal lining healthy and moist. They must be applied every few days.
  • Vaginal lubricants. K-Y Jelly, Astroglide, Sliquid and other over-the-counter lubricants can help alleviate pain during intercourse. Use water-based lubricants to avoid irritation, and apply them just before intercourse.
  • Vaginal dilators. When used in conjunction with local hormone therapy, vaginal dilators can help widen the vagina to prepare it for sex without any pain.
  • Regular sexual activity. Whether you treat yourself to solo vaginal stimulation or sexual intercourse with a partner, regular sexual activity helps the vaginal lining remain healthy, thick and moist.
  • Avoidance of irritants. Bubble baths and scented lotions can add to the irritation that comes with vaginal dryness, making your condition worse. In addition, synthetic fabrics can exacerbate itchiness and irritation, so it’s best to stick with cotton underwear.

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