What Causes Vaginal Dryness in Postmenopause

Vaginal dryness is an uncomfortable and frustrating part of menopause for the majority of women. Luckily, there are effective options to help with vaginal dryness, painful sex, vaginal itching, and recurrent infections. 

Understanding Vaginal Dryness in Postmenopause

Estrogen plays a significant role in maintaining moist, healthy vaginal tissues. As estrogen begins to decline in perimenopause and decreases to very low levels when menopause is reached, the majority of women will experience changes in vaginal and urinary health and sexual wellness. These changes are called the Genitourinary Syndrome of Menopause (GSM). GSM tends to worsen after reaching menopause, with research suggesting that 75% to 93% of people in menopause experience GSM. 

Unlike hot flashes, which tend to reduce in frequency and severity over time, GSM is a progressive and chronic condition that worsens as time goes on and affects quality of life. GSM includes vaginal dryness, thinning of the vaginal tissue, inflammation of the vaginal walls, low libido, urinary incontinence, and more. People with GSM are more likely to get vaginal and urinary tract infections because of pH changes in the vaginal environment. With GSM, it’s common to experience painful intercourse (dyspareunia) and vaginal burning or itching. 

Other Contributors to Vaginal Dryness

GSM is the most common cause of vaginal dryness in menopause. There are other factors to consider when it comes to dryness, such as Sjogren’s syndrome, an autoimmune disorder that can worsen symptoms. Women undergoing breast cancer treatment and chemotherapy may also experience more severe symptoms of GSM.  

SSRI antidepressants and antihistamine medications can also contribute to vaginal dryness. Even if you’re taking over-the-counter medications for colds or allergies, you may be inadvertently making your symptoms worse. 

Non-Medical Strategies to Relieve Vaginal Dryness

Non-medical options to improve vaginal dryness are usually the first line of treatment that healthcare providers recommend. There are several lifestyle and inexpensive over-the-counter options you can try.

Quit Smoking

Research shows that smoking worsens vaginal dryness in menopause. 

Limit Alcohol Consumption

Experts have found excessive alcohol consumption impedes sexual function and worsens vaginal dryness. 

Let Your Vagina Self-Clean

Do your vagina a favor and avoid products purported to clean and freshen your vaginal area. Your vagina needs no help in maintaining a clean environment. Douches, soaps, or vaginal deodorant sprays should not be used. Perfumed soaps and lotions, bubble baths, bath salts, and even scented toilet paper and wipes can worsen GSM by disrupting your vaginal pH and irritating your skin.

Swap Your Clothing

Tight pants and synthetic underwear can irritate the vaginal area and prevent air from circulating down there. Change to underwear with a cotton crotch and wear loose-fitting clothing.

Keep Up Your Sex Life

Regular sexual activity—solo or partnered—has been shown to improve symptoms of vaginal atrophy in menopausal women. 

Make Friends with Lubricant 

Even external stimulation can feel uncomfortable if you’re dealing with GSM. Using a high-quality lubricant during sexual activity can decrease your discomfort and increase your enjoyment. Your options include water, silicone, and oil-based products. Some trial and error are usually required to find products you enjoy and that feels good on sensitive vaginal tissue. 

Try a Vaginal Moisturizer

Vaginal moisturizers used several times a week can relieve vaginal dryness, protect vaginal tissues, and increase sexual enjoyment. Think of a vaginal moisturizer like a lip balm that you apply to soothe tissues regardless of whether you’re engaging in sexual activity.

Medical Options for Vaginal Dryness

If you need more relief for vaginal dryness than over-the-counter strategies can provide, prescription medications can make a big difference. 

Local Low-Dose Estrogen can be applied in a topical cream or inserted via a suppository or a hormone-infused ring. The ring is inserted and left in place for about three months at a time. The other options are usually used daily for a week or two and then used one to three times a week thereafter. Because estrogen is applied locally, it is considered a safe and effective treatment for many people, even those who are not candidates for other forms of menopausal hormone therapy. 

Ospemifene (Osphena) is a daily non-hormonal medication that is effective for treating vaginal dryness and painful sex. It is appropriate for women with a history of estrogen-sensitive breast cancer. 

Menopausal hormone therapy (MHT) delivers estrogen or estrogen and progesterone throughout the body. It is effective at treating many symptoms of menopause, including vaginal dryness. MHT is considered a safe option for most healthy women, but MHT is not appropriate in all cases. Women with a history of estrogen-sensitive cancers are not good candidates for MHT. Talk to your healthcare provider about the potential risks and benefits. 

When to Talk to Your Provider

While discussing changes in your vagina might not be a comfortable conversation, it’s important to have it if vaginal dryness impacts your sex life and day-to-day well-being. Your provider can rule out causes of vaginal dryness that are not menopause-related and work with you to develop a plan to address your symptoms. 

For expert support regarding menopause, symptoms, and strategies for relief, download the Midday menopause app from the App Store or visit us at Midday Health.

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.