Vaginal dryness in menopause: what's happening and what helps

Vaginal dryness is one of the most common symptoms of the menopausal transition, but it's often underreported. Around half of women in midlife experience it, and many don't mention it unless asked. The symptom is real, treatable, and worth discussing.

The underlying cause is the decline in estrogen that affects the vaginal and urinary tissues. These tissues rely on estrogen to maintain elasticity, lubrication, and a healthy microbiome. As estrogen declines, the lining can become thinner, drier, and less flexible. Some women also notice urinary urgency, recurrent urinary tract infections, or discomfort during intimacy. Clinicians call this collection of changes genitourinary syndrome of menopause (GSM).

Non-prescription strategies are the first-line self-care for many women. Vaginal moisturizers used regularly — not just during intimacy — can help restore tissue moisture over time. Lubricants used during intimacy reduce friction. Choosing fragrance-free, pH-balanced products and avoiding douching helps protect the vaginal microbiome. Pelvic floor exercises and staying sexually active, if comfortable, also support tissue health.

Prescription options exist for those whose symptoms persist. These are clinician-managed and include low-dose vaginal estrogen in several delivery forms, as well as non-estrogen alternatives. The right choice depends on symptoms, health history, and personal preference, and should be discussed with a provider.

When to see a provider: persistent dryness, pain with intimacy, recurrent UTIs, urinary urgency, or any bleeding. These symptoms are common, but they are not something to just accept — effective care is available.

Dot does not prescribe or recommend treatments. Dot can help you track these symptoms, prepare questions for a visit, and understand what's happening in your body.