Vaginal Dryness & Menopause: What Actually Helps?
Learn about the changes that happen during menopause and the treatments that can improve comfort.
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This blog post takes a deeper dive into vaginal dryness during perimenopause and menopause, including symptoms, treatment options, and practical tips.
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Let's talk about something that affects so many people during perimenopause and menopause but doesn't get nearly enough attention: vaginal and vulvar dryness, irritation, and discomfort.
The hormonal changes that occur throughout the menopause transition can have a significant impact on the health of our vulvar and vaginal tissues.
As estrogen levels decline, these tissues may become thinner, less elastic, less lubricated, and more sensitive to irritation.
You might experience:
Vaginal or vulvar dryness
Itching, burning, or irritation
Discomfort with sitting, tight clothing, or exercise
Increased sensitivity to friction, including during cycling
Pain or discomfort with sexual activity
Urinary urgency, frequency, or burning
Recurrent urinary tract infections (UTIs)
These symptoms are often part of a condition called Genitourinary Syndrome of Menopause (GSM).
And here's something important: you don't have to be fully menopausal to experience these changes! Symptoms can begin during perimenopause, when hormone levels are fluctuating.
Unlike some other menopause symptoms, GSM often doesn't improve on its own. Without treatment, symptoms may persist or become more bothersome.
The good news? There are several effective treatment options!
First things first: Is menopause really the cause?
Before assuming your symptoms are related to hormonal changes, it's important to rule out other potential causes.
Vaginal and vulvar dryness, itching, and burning can also be caused by:
Yeast infections or bacterial vaginosis
Sexually transmitted infections
Contact dermatitis or reactions to soaps, detergents, pads, wipes, or other products
Vulvar skin conditions such as lichen sclerosus, lichen planus, or eczema
Vulvodynia or pelvic floor muscle dysfunction
Certain medications, including some antihistamines and hormonal medications
Other skin lesions or vulvar conditions
Starting with a visit to your healthcare provider is always a good idea!
A proper assessment can help identify what's contributing to your symptoms and guide you toward the most appropriate treatment.
New vulvar sores, unexplained vaginal bleeding, or persistent changes in skin appearance should be evaluated promptly.
Treatment option #1: Vaginal estrogen
One of my first recommendations is to talk with your healthcare provider about using low-dose vaginal estrogen.
Vaginal estrogen is a prescription treatment with extensive research supporting its effectiveness for GSM.
It helps restore and maintain the health of estrogen-responsive vaginal tissues, improving moisture, elasticity, and comfort.
It can help with:
Vaginal dryness and irritation
Pain during sexual activity
Certain urinary symptoms associated with GSM
Reducing the risk of recurrent UTIs
Vaginal estrogen comes in several forms, including creams, tablets, inserts, and rings.
How do you apply vaginal estrogen cream?
Cream can be applied using a vaginal applicator or, depending on the prescribed dose and treatment area, with a clean finger.
I frequently recommend discussing application to the external tissues around the vaginal opening, especially when those areas are particularly sensitive or dry.
When using an applicator, ask your prescriber whether a portion of the prescribed dose can be reserved for external application.
How often should you use it?
Many treatment regimens begin with daily application for approximately two weeks, followed by maintenance use, often two to three times per week.
The exact frequency depends on the product and your healthcare provider's instructions.
Because the hormonal changes associated with menopause are ongoing, many people benefit from continuing treatment long-term.
And yes, that may mean using vaginal estrogen for many years, potentially for the rest of your life!
Is vaginal estrogen safe?
For most people, low-dose vaginal estrogen is considered a safe and effective treatment.
Because it acts primarily on local tissues, absorption into the bloodstream is generally minimal.
However, it's important to discuss your individual medical history with your healthcare provider, particularly if you have a history of estrogen-sensitive cancer or unexplained vaginal bleeding.
What if vaginal estrogen cream causes irritation?
Occasionally, people experience burning, redness, or irritation when starting vaginal estrogen cream.
This doesn't necessarily mean you can't tolerate estrogen!
Sometimes the inactive ingredients in the cream can irritate sensitive tissues.
Existing inflammation, infection, or a vulvar skin condition may also contribute.
If you experience persistent or worsening irritation, talk with your prescriber.
You may benefit from a different formulation, such as a vaginal tablet or insert. In selected situations, a different cream base may be considered through a compounding pharmacy.
There are options, so don't give up after trying just one product!
Treatment option #2: Over-the-counter vaginal and vulvar moisturizers
We have so many options available today for managing vaginal and vulvar dryness without a prescription!
These products can be used on their own, particularly if you prefer a non-hormonal approach, or in addition to vaginal estrogen.
I often suggest using a vaginal moisturizer on the days you're not applying your estrogen cream, especially if you're still experiencing dryness.
There's no strict rule that they must be used on alternating days, but many people find this routine convenient.
What kinds of products are available?
There are several categories, and understanding the differences can help you choose what works best for your body.
Gels and vaginal moisturizers
These are typically water-based or formulated with ingredients that help attract and retain moisture.
Some are designed for external application, while others can be inserted into the vagina with an applicator.
Lotions and creams
These may be helpful for moisturizing external vulvar tissues. Always check whether a product is specifically intended for vulvar use, vaginal use, or both.
Balms and ointments
These are generally thicker products designed to protect the external vulvar skin, reduce friction, and help retain moisture.
They can be especially helpful when irritation occurs with sitting, clothing, exercise, or other daily activities.
Vaginal suppositories and inserts
These are designed to be inserted into the vagina, where they dissolve or release moisturizing ingredients.
For products that may leak after application, I generally recommend using them before bed to minimize messiness during the day.
Always follow the product's instructions.
What ingredients should you look for?
Hyaluronic acid: One of my favorites!
Hyaluronic acid is an ingredient that helps attract and retain moisture.
Research suggests that vaginal moisturizers containing hyaluronic acid can improve symptoms of vaginal dryness and discomfort.
Although the evidence for vaginal estrogen is more extensive, hyaluronic acid products are a promising non-hormonal option.
Several companies offer vaginal moisturizers, including Kindra, Good Clean Love, and YES (AH! YES).
Not every product from these brands contains hyaluronic acid, so it's important to look at the specific formulation.
What about herbal products?
Personally, I tend to be cautious about products containing multiple herbal extracts, essential oils, or other botanical ingredients.
Natural doesn't necessarily mean better or safer!
Many herbal formulations have limited clinical research supporting their effectiveness for GSM, and certain ingredients can irritate already sensitive tissues.
That doesn't mean every plant-derived ingredient is problematic, but I generally prefer products with simpler formulations and a clear purpose.
A vulvar balm I really like: Medicine Mama
One product that I love, and that many of my patients have reported positive experiences with, is Medicine Mama VMagic Vulva Balm.
It's a hormone-free balm made with ingredients including olive oil, beeswax, avocado oil, honey, and propolis.
It's designed for external vulvar use to help moisturize and protect sensitive skin.
I particularly like the idea of a protective balm for people experiencing irritation from friction, tight clothing, or daily activities.
Keep in mind that it contains bee-derived ingredients, which may not be appropriate for people with relevant allergies or sensitivities.
It's also oil-based, so it should not be used with latex condoms.
And remember: while a balm may improve comfort, it doesn't replace treatment for the underlying hormonal changes of GSM.
What about lubricants?
Sometimes the simplest products work surprisingly well!
Some people find that a gentle, water-based lubricant provides enough temporary moisture to make their vulvar or vaginal tissues feel more comfortable.
However, there is an important distinction:
Lubricants reduce friction. Moisturizers are designed to provide longer-lasting hydration.
If you're experiencing persistent dryness, a dedicated vaginal moisturizer may provide more sustained relief.
For sexual activity, both water-based and silicone-based lubricants can be excellent options.
Ingredients worth paying attention to
I generally encourage people with sensitive vulvar or vaginal tissues to choose products with simple formulations.
Consider avoiding:
Added fragrances and flavors
Warming, cooling, or tingling ingredients
Harsh antiseptics
Products containing high concentrations of glycerin or glycols that may contribute to irritation
Ingredients that have previously caused you irritation or an allergic reaction
Glycerin, propylene glycol, and certain preservatives can be problematic in some formulations, particularly for people with very sensitive tissues.
However, not every product containing these ingredients is automatically unsafe. The overall formulation, pH, osmolality, and your individual response matter.
When selecting a product for internal vaginal use, look for one specifically formulated for that purpose.
Finding what works for YOU
With the booming women's health industry, finding the right product can feel overwhelming.
And honestly, that's part of what inspired me to start Pelvic Shanti Boutique!
Over the years, I've tried a LOT of products 😅, researched ingredients, reviewed the available evidence, and listened to what my patients find helpful.
My goal is to help take some of the guesswork out of finding products that support pelvic and sexual health.
At Pelvic Shanti, we often have product samples available so patients can try certain products before committing to a purchase.
Because the truth is, what works wonderfully for one person may not work as well for someone else.
Finding the right moisturizer, balm, or lubricant may take a little trial and error.
And that's okay!
A few more tips for supporting your vulvar and vaginal health
Beyond moisturizers and prescription treatments, a few simple habits can help reduce irritation:
Avoid scented soaps, douches, and unnecessary vaginal cleansing products.
Choose gentle, fragrance-free products for external cleansing.
Reduce friction from clothing or exercise when possible.
Consider a protective external balm if friction contributes to discomfort.
Use lubrication during sexual activity when needed.
Address pelvic floor muscle tension if it contributes to pain with penetration, sitting, or other activities.
And for my fellow cyclists: don't overlook vulvar tissue health when addressing saddle discomfort!
Hormonal changes can increase tissue sensitivity, and managing GSM may be an important part of improving comfort on the bike, alongside proper bike fit and pressure management.
One final thought
Everyone's journey toward relief from GSM is different.
Some people do wonderfully with vaginal estrogen alone.
Others benefit from adding a moisturizer or protective balm. And some prefer or need non-hormonal options.
You may need to experiment a little, and you may benefit from support from a healthcare provider who understands pelvic and sexual health.
But please remember:
Vaginal dryness, burning, irritation, and painful sex are not things you simply have to accept as part of getting older.
There are effective options, and you deserve to feel comfortable in your body.
We've curated a selection of vaginal moisturizers, vulvar balms, lubricants, and other pelvic health products to help you find what works for your body.
With care,
Mieke Haeck, PT
Pelvic Shanti | Finding peace in your pelvis
This guide is intended for educational purposes and does not replace individualized medical advice, diagnosis, or treatment.
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