From its causes to what not to do (& what to do instead)

The menopause is a natural part of life and the hormonal shifts that drive it can cause changes to your body. One common issue is vaginal dryness. Many women experience this during the menopause, as well as the perimenopause (the stage before the menopause), and postmenopause (the stage after). It can be uncomfortable and upsetting, but there are steps you can take to help alleviate vaginal dryness. Here we explore the causes, symptoms and treatments that could help…

The causes of vaginal dryness during the menopause

First up, let's look at why it happens. It comes down to changes in hormones, notably oestrogen. As stated by the NHS, the menopause is a natural part of ageing where women’s oestrogen levels decline, their periods stop and they are no longer able to get pregnant naturally. The menopause usually occurs between the ages of 44 and 55 with the average age for women in the UK to reach menopause as 51. For more information and advice on menopause, check out our useful guide

This decline in oestrogen impacts the lining of the vagina. "The vaginal lining is dependent on oestrogen and with declining ovarian function and reduced levels of oestrogen, the vaginal glands stop producing mucus fluid and moistness. As a result, the vaginal lining becomes dryer and more delicate," says Dr Narendra Pisal, a consultant gynaecologist at London Gynaecology.

The key symptoms 

The initial symptoms of vaginal dryness include feeling sore or itchy day-to-day and sex can become uncomfortable. However, Dr Pisal notes how vaginal dryness can lead to occasional bleeding or brownish/pink discharge. "This symptom is often caused by delicate vaginal lining and dryness resulting from lack of oestrogen," he clarifies.

Vaginal dryness is often linked to loss of libido. The change in hormones during the perimenopause, menopause and postmenopause can impact your sex drive, and vaginal dryness can further affect it. It’s normal to want to avoid sex during this time, but doing so might not necessarily help. "Keeping an active sex life where possible is much more likely to help with a healthy vaginal mucosa," Dr Pisal explains. Water-based lubricants can help in this area, and in daily life, too (see below for treatment recommendations).

Also, infections can be more common when you suffer from vaginal dryness. "With thinner vaginal mucosa, vaginal infections can occur as the mucosal barrier to infection becomes ineffective. Sexually transmitted infections are on the rise in this age group as use of barrier contraception is not common," says Dr Pisal.

Treatments for vaginal dryness

The good news is that vaginal dryness can often be treated easily at home. The first port of call is using a lubricant or vaginal moisturiser. These can be used daily or specifically when having sex. "Water-soluble lubricants are a good choice if vaginal irritation or sensitivity is a problem. Silicone-based lubricants last longer and tend to be more slippery than water-soluble ones," explains Dr Pisal.

Another option you might want to consider is the Boots Online Doctor Vaginal Dryness Treatment Service, which can give you access to convenient, discreet care and treatment (if appropriate) from the comfort of your own home*. Simply fill in the online consultation and a clinician will review it within 24 hours. If deemed appropriate, they’ll prescribe vaginal tablets to help settle your symptoms that can be picked up in store or delivered straight to your door, though any treatments suggested come at an additional cost.

Common mistakes 

There are some products that may make vaginal dryness worse. The NHS recommends steering clear of any perfumed products, petroleum jelly or products not designed for the vagina (for example, shower gel). "It’s best to avoid using soaps or douches while washing and instead use plain water," confirms Dr Pisal. 

Seeking medical help

If the problem persists, it’s best to book an appointment with your GP to discuss it further.

The most common treatment for symptoms of the menopause is hormone replacement therapy (HRT). "HRT replaces the hormones that the ovaries were producing so that the symptoms and effects of menopause are minimised," says Dr Pisal. HRT could help with vaginal dryness, alongside relieving other symptoms of the menopause, such as hot flushes, mood swings, night sweats and a reduced sex drive. 

However, it’s worth pointing out that HRT isn’t guaranteed to help with vaginal dryness. "HRT may not always resolve vaginal symptoms, and it may be necessary to use vaginal oestrogen pessaries or creams," says Dr Pisal. "A lot of doctors recommend a very small amount of local oestrogen gel or pessary, which is good at helping to rejuvenate the vaginal lining and maintaining a healthier vaginal mucosa. It will often help prevent vaginal dryness and bladder infections." 

A GP or specialist will review your symptoms and discuss with you suitable options. These may include using silicon-based moisturisers, which "are also useful for daily use to maintain vaginal mucosa", says Dr Pisal. "Symptoms of pain or discomfort can be managed by using local anaesthetic creams," he adds. 

Discomfort due to vagninal dryness can be managed, but if you’re experiencing non-period bleeding or smelly discharge, it’s always important to book an appointment with your GP to discuss it further.

Vaginal dryness is something many women will experience while going through the perimenopause, menopause and postmenopause. It’s totally normal, but seeking help can mean you avoid unnecessary discomfort. Whether you have success with at-home treatments or help from a clinician or doctor – or maybe a mix of both – rest assured that vaginal dryness doesn’t need to impact your day-to-day life. 

Products to help treat vaginal dryness:

Try: Balance Activ Menopause Moisturiser Gel (£11.99)

• Size: pack of seven

This hormone-free internal moisturiser contains hyaluronic acid, a hydrating substance found naturally in the body, and works to help supplement the body’s natural moisture. Use one tube daily for five days and then reduce usage to two or three times a week or as required.

Try: Sylk Intimate Lubricant (£9.99)

• Size: 40g

This plant-based and pH-friendly lubricant can be used daily for vaginal dryness or to make sex more comfortable.

Try: Boots Vaginal Moisturiser Gel (£9.99)

• Size: 30g

This colourless moisturising gel contains Hydeal-D, a derivative of hyaluronic acid that helps provide natural hydration. Apply every three days for 30 days.

Try: Durex Naturals Water Based Extra Sensitive Lubricant Gel (£9.99)

• Size: 100ml

Made with 100% natural ingredients, this pH-friendly formula helps soothe any soreness and is ideal for those who are sensitive to other types of lubricants.