Greater Boston Urology Blog

Vaginal Health Tips for Menopausal Women

If you're in perimenopause or menopause, you might be experiencing vaginal dryness, which can make you feel irritation, pressure, discomfort, or rawness in the vaginal area. It can also make sexual intercourse uncomfortable or even painful.

But what causes vaginal dryness in the first place? And is there anything you can do about it?

We asked urogynecologist Dr. Dima Ezzedine to share vaginal health tips for people going through perimenopause and menopause.

As with all content on our blog, the following is educational only, not medical advice. Always consult your physician about your specific healthcare needs.

What causes vaginal dryness?

DR. EZZEDINE: Vaginal dryness is the most common symptom of vaginal atrophy, a condition caused by the lack of circulating estrogen (one of the female sexual hormones).

This usually results from natural menopause but also surgical menopause (surgical removal of both ovaries), premature ovarian insufficiency (menopause occurring at a very early age [earlier than 40 years old]), or temporarily when exclusively breastfeeding or when on antiestrogenic drugs (for breast cancer recurrence prevention). 

The vagina is very rich in estrogen receptors. Estrogen stimulates the growth of the vaginal lining—vaginal epithelium—making it thicker and fuller. It increases collagen production, which gives the vagina its elasticity. It also maintains good blood flow and an adequate level of vaginal secretions, which keeps its surfaces moist.

During the menopausal transition and later in menopause, the ovaries stop producing estrogen. The vagina responds by becoming thin (fewer cell layers) and loses its elasticity and moisture. This can cause the sensation of vaginal dryness, burning, and sometimes dyspareunia (pain with vaginal intercourse).

Will all or most women experience vaginal dryness by the time they hit menopause? Or is it just some women?

DR. EZZEDINE: All women entering menopause will eventually develop vaginal atrophy, but not everyone will be symptomatic. In one study, vaginal dryness was reported in 4% of women in early menopausal transition, 21% in the later years of the menopausal transition, and 47% of women three years after menopause.

Should I use vaginal moisturizers or lubricants to help alleviate vaginal dryness? (Is there a difference between the two?)

DR. EZZEDINE: Vaginal lubricants and moisturizers are, in fact, first-line treatments for women with vaginal dryness, discomfort, and dyspareunia in the context of vaginal atrophy.

Women should, however, know when to use a vaginal lubricant and when to use a moisturizer, as they are not interchangeable.

  • A vaginal moisturizer is meant to maintain (lock in) vaginal moisture. It usually contains hyaluronic acid. It should be applied regularly into the vagina to allow a continuous moisturizing effect. Different formulations are available (gel, cream, or a suppository), and each brand/product has its own application recommendations.


  • By contrast, a vaginal lubricant is only used at the time of vaginal intercourse to reduce friction and discomfort caused by vaginal dryness. Water-based, silicone-based, and oil-based lubricants are available as well as natural lubricants (such as olive, coconut, or avocado oil).

Both vaginal lubricants and moisturizers are available without a prescription over the counter and online. They do not contain hormones and have essentially no systemic side effects. However, they must be used continuously because symptoms will return when a patient stops using them.

If yes to using lubes and moisturizers, what should I look for on the label?

DR. EZZEDINE: There is no one universal brand or option that works well for all women. I do advise my patients to try different brands/products until they find the right vaginal moisturizer and/or lubricant for them. They should always make sure they are not allergic to any particular ingredient in a product before they use it. However, I also warn them that some products may cause irritation or a burning feeling after application due to the severity of the dryness, and that does not necessarily mean an allergic reaction.

Generally speaking, skin lotions and moisturizers should NOT be used for vaginal dryness as they are not formulated for the vaginal lining.

And finally, if patients are using latex condoms during intercourse, they should avoid oil-based lubricants (natural or synthetic) since they can damage latex condoms and make them less effective.

What about hormone treatments? Are things like vaginal estrogen safe?

DR. EZZEDINE: If lubricants and moisturizers are not doing enough to relieve vaginal dryness and pain with intercourse, then women should certainly consider using local, low-dose vaginal estrogen.

Vaginal estrogen is the most effective treatment for vaginal dryness. It does, however, require a prescription. It comes in the form of a vaginal cream or insertable tablet, capsule, or ring.

I only prescribe the lowest effective dose possible to maximize benefits and decrease potential risks.

A very small amount of estrogen is absorbed through the vagina into the bloodstream. Studies have shown that the blood level of estrogen with the use of low-dose, local vaginal estrogen is in the same range as in postmenopausal females who are not using vaginal estrogen. So there is a much lower risk of side effects, such as breast cancer, blood clots, stroke, or heart attack, compared with birth control pills or systemic (by mouth, high dose) menopausal hormone replacement therapy. There is, however, still a black box warning on all estrogen-containing prescription medications, including vaginal local, low-dose formulations, which I always discuss with my patients.

For the majority of women, low-dose vaginal estrogen is absolutely safe. For women with breast cancer or other hormone-sensitive cancers, low-dose vaginal estrogen may also be an option for those who fail non-hormone treatments. But it does require a discussion of risks and benefits with the patient and involvement of the patient's cancer provider.

Local side effects are rare. Some patients may complain of vaginal irritation or itching, vaginal bleeding, or breast tenderness, which mostly occur due to improper application or use of higher than recommended doses of vaginal estrogen.

Are there any foods that I should make sure I include in my diet to help boost my vaginal health?

DR. EZZEDINE: Nothing that I would particularly recommend for vaginal health. Generally speaking, like any other organ in your body, your vagina also benefits from a healthy, diversified diet, rich in protein, healthy fat, and nutritious vitamins and minerals.

What about supplements, like probiotics or cranberry?

DR. EZZEDINE: Data and evidence are lacking to support the use of probiotics (by mouth or vaginally) to boost vaginal health. Cranberry supplements may play a role in preventing recurrent UTIs but not so much for vaginal dryness per se.

What are your thoughts on products like Lume deodorant to reduce odor down there?

DR. EZZEDINE: I have no recommendations concerning products like Lume deodorant. Some women may find it useful. However, from my clinical experience, I have seen so many women develop vulvar irritation/dermatitis from the use of body deodorants/perfumes and synthetic products that I always recommend avoiding anything but gentle soap and water to gently cleanse the vulva.

When should I see a doctor about my vaginal dryness?

DR. EZZEDINE: Whenever it is bothersome! Women do not have to endure the discomfort since many treatment options are available. I will be more than happy to help my patients find the right treatment option for them.

What other vaginal health tips do you have for pre- and post-menopausal women?

DR. EZZEDINE: Not all vaginal issues or complaints are due to vaginal atrophy. Menopausal women can develop vaginal infections, pelvic muscles spasm (high-tone pelvic floor dysfunction), vaginal lesions, or vulvar skin disorders (e.g., lichen planus), among other conditions. When a vaginal health issue arises, I encourage all women to seek medical care from a women’s health provider, such as a urogynecologist, to get properly evaluated and treated.

If you're experiencing vaginal dryness due to menopause, we can help.

Schedule an appointment with one of our urogynecologists.

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