What Is Menopausal Vaginal Dryness And How Do We Treat It?

Menopausal vaginal dryness occurs when falling oestrogen levels make vaginal and vulval tissues thinner, drier and less elastic. It can cause soreness, itching, burning, urinary symptoms and pain during sex or smear tests. Treatment commonly involves local vaginal oestrogen tablets, while broader hormone replacement therapy may be considered when dryness occurs alongside symptoms such as hot flushes.

What Is Menopausal Vaginal Dryness And How Do We Treat It?
Medically reviewed

Dr. Chrysoula I. Liakou MD, PhD Google Scholar LinkedIn

Internal Medicine Specialist
Cancer Immunology Researcher

Why Menopausal Vaginal Dryness Happens and What Can Help


Many people experience vaginal dryness, but since it's not discussed much, it often doesn't get diagnosed or treated enough. This can make you uncomfortable and affect your daily life and overall well-being. Here, we'll discuss the usual signs of vaginal dryness, what makes it happen, and ways to treat it.



What Is Menopausal Vaginal Dryness? Who Does It Affect?


You might have heard that our hormones change as we grow older. For women, as they get older, their bodies make less estrogen, which leads to a bunch of changes. This decrease in estrogen is what causes a lot of the things we feel during menopause, like vaginal dryness.


The tissues in the vagina make natural fluids that keep it comfy and stretchy. These tissues are susceptible to estrogen levels, and when those levels are low, they can get drier. This might lead to feelings of soreness, itchiness, and burning in the vagina and vulva. Also, when estrogen goes down, the balance of bacteria in the vagina can get messed up. This could make it easier to get infections like bacterial vaginosis or thrush.


As we discussed, vaginal dryness usually happens during menopause and affects women who are 45 years or older. But it can happen at other times too. For example, after having a baby and while breastfeeding, you might feel vaginal dryness. Don't worry; this is usually a short-term thing. The dryness usually improves when you stop breastfeeding, and your estrogen levels return to normal.


Some medicines can affect how much estrogen your body makes, leading to vaginal dryness. But don't worry too much; this dryness might not last forever. When you stop taking those medicines, your estrogen levels usually return to normal, and things improve.


Vaginal dryness can happen after the ovaries are removed in surgery. It can also show up if someone has chemotherapy or radiation therapy in the pelvic area.



What Are The Most Common Vaginal Dryness Symptoms?


As we discussed, when estrogen levels are low, the vagina and vulva can feel sore, itchy, and not-so-great. So, if you're feeling these things around a certain age, it might mean you have menopausal vaginal dryness. But also, if you have thrush or bacterial vaginosis, you might feel these things too. The usual signs of a vaginal infection are:

  • Different discharge (it might feel different or smell different)

  • Itchy or sore skin around the vagina

  • The skin around the vagina that's red or swollen

  • Feeling a burning pain or discomfort


When estrogen levels go down, it can make the tissues in the pelvic floor get thinner and weaker. This means they don't support the bladder and urethra as well. This might lead to pee problems, which could also mean you have menopausal vaginal dryness. The main pee problems include:

  • Feeling like you need to go to the bathroom all of a sudden

  • Getting urinary tract infections often

  • Having to use the toilet more often than usual


Other vital signs include pain or discomfort during vaginal sex or smear tests. You might also experience some discomfort when you move or exercise. The skin around your vagina and vulva is susceptible. When it gets irritated and sore, it can become itchy. This might make you want to scratch, but scratching can worsen the irritation and cause more itching. This itching and scratching cycle can be bothersome and painful and might even affect your sleep.



How Can We Treat Menopausal Vaginal Dryness?


The good news is that vaginal dryness during menopause can be treated. Many women find relief by using extra estrogen for the vagina. Since these symptoms happen because of low estrogen, we can replace the hormone to improve the symptoms. Our doctors give out Vaginal Estrogen Tablets for this. These tablets go into the vagina and can help stop vaginal dryness.


Vaginal Estrogen Tablets are a kind of treatment that adds hormones to your body and are thought to be safe. These tablets only affect the tissues in your vagina, and they have a very tiny amount of hormones. It's important to know that Vagifem, the name of these tablets, only works on symptoms in the vagina. It doesn't help with other symptoms that happen all over your body during menopause.


When you use this treatment, the amount of estrogen in your blood is similar to what menopausal women who don't use vaginal estrogen have. So, there's a much smaller chance of having side effects like breast cancer, blood clots, and heart disease. This differs from other estrogen treatments like pills you take by mouth or the combination birth control pill, which carries a higher risk.


To help with common menopause problems like hot flashes, you might need to consider different HRT options like gel, patches, or pills you swallow. These kinds of treatments can work for overall menopause symptoms and can also stop vaginal dryness from happening.



Treatment Of Vaginal Dryness With Vaginal Oestrogen Tablets


Using this treatment is simple. Each packet has clear instructions and a tool to help you apply it. This tool lets you quickly put a tablet into your vagina every night for two weeks. After those first two weeks, you only need to do it twice a week.


If you haven't tried this treatment, your first prescription will have one pack with 24 tablets. After that, when you need more, you'll get a prescription with 48 tablets that should last you for six months. If this is your first time using this medicine, finish the first set of tablets and then set up a meeting with your doctor to talk about how it's going.


Because menopausal vaginal dryness varies for each person, the time you need to use this treatment will differ. It might take around 8 to 12 weeks of using it to get the most help. Some people might be able to stop taking the medicine if their symptoms get better, but sometimes the symptoms come back. If that happens, it's okay to keep using the medicine for a long time. It's a good idea to tell any doctor caring for you that you're using this medicine. That way, they can check if anything in your health history changes and if the treatment is still proper.


Some of the more common side effects include:

  • Bleeding or discharge from your vagina

  • Feeling uncomfortable or a stinging sensation in your vagina

  • Pain in your stomach

  • Having a headache


If you notice any side effects or your symptoms don't get better, worsen, or change, you should talk to a doctor. Also, if you start having unexpected or unexplained vaginal bleeding while using this medicine, see your doctor as soon as possible.


Getting Treatment For Menopausal Vaginal Dryness


If you're struggling with menopausal vaginal dryness and are looking for effective treatment, Mobi Doctor is here to support you. They offer a convenient solution through their online platform, allowing you to book consultations with healthcare professionals from the comfort of your own space.


By choosing Mobi Doctor, you can connect with experienced doctors online who can understand your situation and provide the appropriate treatment options.



Why Menopausal Vaginal Dryness Happens and What Can Help

Menopausal vaginal dryness is mainly caused by falling oestrogen levels. Oestrogen helps vaginal tissues produce natural moisture and remain supple; when levels decrease, the tissues become drier and more easily irritated. Reduced oestrogen can also disturb the vaginal bacterial balance, increasing susceptibility to problems such as thrush or bacterial vaginosis.

Common symptoms include vaginal or vulval dryness, soreness, itching, burning and irritation. Some people experience pain during vaginal sex, cervical smear tests, movement or exercise. Persistent scratching can worsen the irritation and create an itch–scratch cycle that affects daily comfort and sleep.

Lower oestrogen levels can contribute to urinary urgency, needing to urinate more frequently and recurrent urinary tract infections. This happens because the tissues supporting the bladder and urethra become thinner and weaker. Vaginal dryness accompanied by recurring urinary problems should be assessed so that other possible causes are not overlooked.

Vaginal dryness and infection can both cause soreness, itching and burning, so symptoms sometimes overlap. A noticeable change in discharge, an unusual smell, redness or swelling may point towards thrush, bacterial vaginosis or another infection. An assessment can clarify the cause before treatment is started.

Vaginal dryness can occur before menopause whenever oestrogen levels fall. It may develop after childbirth, during breastfeeding, after surgical removal of the ovaries or following pelvic chemotherapy or radiotherapy. Certain medicines can also reduce oestrogen. Breastfeeding-related dryness is usually temporary and often improves once hormone levels return to normal.

Menopausal vaginal dryness is often treated with low-dose vaginal oestrogen that acts directly on the affected tissues. Vaginal tablets target local dryness, soreness and discomfort but do not treat broader menopause symptoms such as hot flushes. When several menopause symptoms occur together, other forms of HRT, including gels, patches or oral tablets, may be considered.

Vaginal oestrogen tablets are inserted directly into the vagina using the applicator supplied. The schedule described in the article involves one tablet each night for the first two weeks, followed by one tablet twice weekly. The prescribed instructions should always be followed because the dose and review plan need to suit the individual.

Vaginal oestrogen may take approximately 8–12 weeks to provide its full benefit. Treatment length varies because menopausal vaginal dryness affects people differently. Symptoms sometimes return after the medicine is stopped, so continued treatment may be appropriate when regularly reviewed and the benefits still outweigh any risks.

Low-dose vaginal oestrogen is generally considered lower risk than systemic oestrogen because very little enters the bloodstream. Possible side effects include vaginal discomfort, stinging, discharge or bleeding, stomach pain and headaches. Unexpected vaginal bleeding, worsening symptoms or no improvement should be discussed with a doctor promptly.


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