Vaginal dryness in menopause (GSM): causes and treatments

Name: Vaginal dryness in menopause (GSM): causes and treatments
Creator: MenoWoman

Vaginal dryness is a common effect of lower estrogen. It is part of genitourinary syndrome of menopause (GSM), which tends to get worse without treatment. Moisturizers and lubricants are the first step, and low-dose vaginal estrogen is an effective prescription treatment.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if you have any vaginal bleeding or spotting after menopause, unusual discharge, burning or soreness. Also go if pain with sex does not improve with a moisturizer or lubricant. Urinary symptoms or repeated urinary infections are also worth raising.

What it is and how common it is

Vaginal dryness is one part of genitourinary syndrome of menopause (GSM). GSM covers vulvar, vaginal and urinary symptoms caused by lower estrogen. It used to be called vaginal atrophy.³

Symptoms can include dryness, burning, itching, pain during sex and light bleeding after sex. Some women also have urgency, burning when passing urine or repeated urinary tract infections.^1,3

Studies estimate that 27% to 84% of postmenopausal women are affected.¹ Most never seek or receive treatment.^1,2

Why it happens in menopause

Estrogen keeps the tissues of the vagina and vulva thick, elastic and moist, and supports blood flow. As estrogen falls, the vaginal walls become thinner, stiffer and drier.⁵

Hot flashes usually ease over time, but GSM generally gets worse without treatment. Symptoms often return when treatment stops.^1,5

Smoking makes it more likely, because it reduces blood flow to the vagina.³

What else can cause it

Low estrogen at other times of life can cause the same changes. Examples include breastfeeding, surgery to remove both ovaries, chemotherapy or pelvic radiation, hormone treatment for breast cancer and some birth control pills.³

Before diagnosing GSM, a doctor rules out conditions with similar symptoms, such as:¹

yeast and other infections
skin conditions such as lichen sclerosus or lichen planus
contact dermatitis from soaps or other products
vulvodynia (long-lasting vulvar pain) and pelvic floor muscle tension

Symptoms that started before menopause suggest a different cause.¹

Everyday measures

Know the difference. Vaginal moisturizers are used regularly to keep tissue hydrated. Lubricants are used during sex to reduce friction.^1,5
Choose products with care. Some water-based products are very concentrated and may irritate. Silicone-based or body-balanced (iso-osmolar) products suit some women better.¹ Oil-based products and petroleum jelly can damage latex condoms.³
Avoid irritants. Skip perfumed or antibacterial soaps, bubble baths, bath oils, scented toilet paper, douches and flavored or warming lubricants.⁵
Stay sexually active if you wish. Regular sex or self-stimulation supports blood flow and keeps tissue more elastic.^3,4 Allow plenty of time for arousal.⁵
Ask about dilators. Vaginal dilators, sometimes with pelvic floor physical therapy, can help if the vagina has become tight.³

What helps: options rated

Option	Evidence	What the research shows
Low-dose vaginal estrogen	Strong evidence	Effective for moderate to severe symptoms, with creams, tablets, inserts and rings working similarly. Very little reaches the bloodstream.¹ It is prescription-only. Women with a history of breast cancer should decide with their oncologist.^1,3
Vaginal DHEA (prasterone)	Strong evidence	A prescription vaginal insert approved for moderate to severe pain with sex. In 12-week trials it improved pain and dryness.¹ Availability differs by country.
Ospemifene	Strong evidence	A prescription pill approved for menopausal vaginal symptoms in the US and the EU, where it is sold as Senshio. It is not available in some countries, such as Canada.^1,6 Two large placebo-controlled trials found it eased dryness and pain with sex.⁶ It is not recommended for women with known or suspected breast cancer.¹
Systemic hormone therapy (HRT)	Strong evidence	Usually considered when hot flashes are also a problem.^2,3 It often helps vaginal symptoms, but some women on HRT still need vaginal treatment as well.¹
Vaginal moisturizers	Some evidence	Recommended as a first step in guidelines, but evidence for specific products is limited.¹
Lubricants during sex	Some evidence	A guideline-recommended first step for painful sex, though few trials compare products.¹
Vaginal laser and energy devices	Weak evidence	Trials lack proper sham comparisons, the devices are not FDA-approved for GSM, and side effects include scarring. The Menopause Society does not recommend them.^1,2

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.