Vaginal Dryness After Menopause: Treatments That Help

Why does vaginal dryness happen after menopause?

As estrogen levels fall around menopause, the tissues of the vagina and vulva undergo changes collectively called genitourinary syndrome of menopause (GSM) — a term that replaced the older phrase 'vaginal atrophy.' GSM encompasses: - Vaginal dryness and reduced lubrication - Thinning and increased fragility of vaginal tissue - Loss of elasticity - A shift in vaginal pH (from acidic toward more neutral), which increases susceptibility to infections - Vulvar itching, burning, or irritation - Urinary symptoms including urgency, frequency, and recurrent UTIs [1, 3]

Unlike hot flashes, which often improve with time, GSM tends to persist and can worsen progressively without treatment 1Ref 1Faubion SS, Crandall CJ, Davis L, El Khoudary SR, Hodis HN, Lobo RA, Maki PM, Manson JE, Pinkerton JV, Santoro NF, Shifren JL, Shufelt CL, Thurston RC, Wolfman W (2022).The 2022 Hormone Therapy Position Statement of The North American Menopause Society.GSM definition, persistence of vaginal symptoms without treatment, local vaginal estrogen as first-line treatment, safety profile including consideration in breast cancer survivors, and systemic HRT risk-benefit framework. The symptoms are underreported — many people assume they are an unavoidable part of aging and do not mention them to a clinician.

What over-the-counter options are available?

Vaginal lubricants reduce friction during intercourse. They are water-based, silicone-based, or oil-based and are used at the time of sexual activity. Silicone-based lubricants last longer and are compatible with latex condoms. Oil-based products (including coconut oil) can degrade latex and increase infection risk, so they are best paired with non-latex barriers.

Vaginal moisturizers are used regularly (every two to three days), independent of sexual activity, to help maintain moisture in the vaginal tissue more consistently. Products containing hyaluronic acid or polycarbophil are commonly used 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM. They are not prescription and can be started at any time 2Ref 2American College of Obstetricians and Gynecologists (2014).Practice Bulletin No. 141: Management of Menopausal Symptoms.Vaginal estrogen forms, lubricants, and moisturizers as treatment options for genitourinary menopause symptoms; local estrogen as first-line prescription therapy.

The 2025 AUA/SUFU/AUGS guideline recommends vaginal moisturizers and lubricants as first-line or adjunctive therapy for GSM, noting they address symptoms without treating the underlying tissue changes 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM. Lubricants address the symptom in the moment; moisturizers work to improve tissue moisture over time. Using both is a reasonable strategy.

What prescription treatments are available?

Local (vaginal) estrogen is the most effective treatment for GSM and is the first-line prescription option for most people [1, 2]. Unlike systemic hormone therapy, low-dose vaginal estrogen is applied directly to the vaginal tissue and is absorbed minimally into the bloodstream. Forms include: - Estradiol cream — applied with an applicator - Estradiol vaginal tablet or insert (Vagifem, Yuvafem, Imvexxy) — inserted into the vagina - Estradiol vaginal ring (Estring) — placed by a clinician and replaced every three months

Because systemic absorption is very low, local vaginal estrogen does not increase the risk for endometrial or breast cancer at standard doses 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM. Many guidelines allow its consideration even in breast cancer survivors with significant GSM, in consultation with the patient's oncologist — though this should always be an individualized discussion [1, 2].

Ospemifene (Osphena) is a non-estrogen oral medication (selective estrogen receptor modulator) approved for moderate to severe dyspareunia due to GSM. The 2025 AUA/SUFU/AUGS guideline conditionally recommends it as an oral alternative to vaginal preparations 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM.

Prasterone (Intrarosa) is a vaginal insert that delivers DHEA (a precursor to estrogen and testosterone) locally to vaginal tissue. The guideline moderately recommends vaginal DHEA for dryness and dyspareunia as another non-estrogen alternative 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM.

Systemic hormone therapy (HRT) — oral, patch, gel, or spray — treats hot flashes and other systemic menopause symptoms and will also improve GSM, but carries a different risk-benefit profile than local vaginal treatment. The 2022 NAMS position statement provides detailed guidance on the appropriate use of systemic HRT 1Ref 1Faubion SS, Crandall CJ, Davis L, El Khoudary SR, Hodis HN, Lobo RA, Maki PM, Manson JE, Pinkerton JV, Santoro NF, Shifren JL, Shufelt CL, Thurston RC, Wolfman W (2022).The 2022 Hormone Therapy Position Statement of The North American Menopause Society.GSM definition, persistence of vaginal symptoms without treatment, local vaginal estrogen as first-line treatment, safety profile including consideration in breast cancer survivors, and systemic HRT risk-benefit framework.

Does regular sexual activity help?

Regular sexual activity — including intercourse or self-stimulation — promotes blood flow to vaginal tissue and may help preserve tissue moisture and elasticity. This is not a replacement for treatment in symptomatic GSM, but it is a factor that supports overall genital health during and after menopause.

Should I talk to a clinician, or just start with OTC products?

OTC lubricants and moisturizers are safe to start without a prescription. If symptoms are moderate to severe, persistent, or accompanied by urinary symptoms, a clinician visit is worthwhile — both to discuss prescription options and to rule out other causes (such as infection or skin conditions like lichen sclerosus). An OB-GYN, gynecologist, urologist, or clinician with menopause expertise can help match the right treatment to your symptoms and preferences 3Ref 3Kaufman MR, Ackerman LA, Amin KA, et al.; American Urological Association / SUFU / AUGS (2025).The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.Vaginal moisturizers and lubricants as first-line therapy; vaginal DHEA (prasterone) for dryness and dyspareunia; ospemifene as oral alternative; local vaginal estrogen does not increase endometrial or breast cancer risk; urinary symptoms including recurrent UTIs as part of GSM.