Understand this symptom
Vaginal dryness in menopause
Written by
Uma Health
Medically verified by
Dr. William Declerck
Physician
Insight
The essentials
This symptom is caused by the hormonal shifts your body is going through. Understanding what's happening helps you better cope with what you're feeling.
The cause
Around menopause your oestrogen falls, and oestrogen is what keeps the tissue of your vagina and vulva supple, well supplied with blood and naturally moist. Without it, the lining becomes thinner and drier. Urinary symptoms often come with it, such as needing to go more often or recurrent bladder infections. Doctors call the whole picture the genitourinary syndrome of menopause (GSM).
What helps
A lubricant makes sex more comfortable, a vaginal moisturiser keeps the tissue suppler day to day. If symptoms persist, local oestrogen is safe and effective according to the guidelines, including for most women who cannot take systemic hormone therapy. A care provider who knows menopause well can help you find what fits.
Honest and transparent
The most frequently asked questions
It often feels like something you are dealing with alone, and yet it is very common. Estimates suggest up to half of women experience vaginal dryness or related symptoms after menopause. It happens because your oestrogen drops, not because there is anything wrong with you.
Honest answer: usually not. Unlike hot flushes, which ease off for many women over time, vaginal dryness tends to persist or slowly worsen as long as your oestrogen stays low. That sounds discouraging, but it is exactly why it is worth treating: treatment works, and waiting rarely helps.
They look similar but do different jobs. A lubricant is used in the moment, to reduce friction and pain during sex. A vaginal moisturiser is a hydrating gel you use regularly, a few times a week, to keep the tissue moister and more comfortable outside of sex too. Many women benefit from both.
An understandable question, because the word oestrogen worries a lot of women. Local oestrogen works mainly where you apply it and barely enters your bloodstream. That is why the guidelines consider it safe and effective, including for most women who cannot take tablets or patches. If you have had breast cancer, it is worth deciding together with your doctor or oncologist.
Yes, and this link is often missed. The same lack of oestrogen that dries the vagina also affects the urethra and the neck of the bladder. That can mean needing to go more often, burning when you pass urine, or recurrent bladder infections. Bladder infections that keep coming back are worth mentioning.
For comfort symptoms you can try something yourself first, but some signs should not wait. Any bleeding after menopause should be discussed with a doctor and checked, even a single spot. The same goes for persistent pain, sores that do not heal, or bladder infections that keep returning.
It is a symptom few women bring up on their own. Yet you may have lived with it for months: a burning feeling, itching, or pain during sex that was not there before. Vaginal dryness is among the most common menopause symptoms, and among the least talked about. Here is why it happens, why it rarely clears up on its own, and what genuinely helps.
How women describe it
"It feels raw and tender, all day long."
"Sex hurts, so I have started avoiding it."
"I get one bladder infection after another."
"I thought it was just me."
Sound familiar? You are in good company. Many women carry this symptom in silence, often because no one ever told them the menopause has anything to do with it.
What happens in your body
Oestrogen does far more than regulate your cycle. It also keeps the tissue of your vagina and vulva supple, well supplied with blood and naturally moist. When oestrogen starts to fluctuate in perimenopause and then falls, that tissue changes: it becomes thinner, less elastic and drier, and natural lubrication drops.1 That is why friction starts to hurt more quickly.
For many women it does not stop at the vagina. The urethra and the bladder neck also carry oestrogen receptors, so the same shortfall can cause needing to go more often, burning when you pass urine, or recurrent bladder infections. Doctors group these vaginal and urinary symptoms under one name: the genitourinary syndrome of menopause, or GSM.2 It helps to know the term, because it explains why symptoms that seem separate share the same cause.
Does it go away on its own?
This is where vaginal dryness differs from most other menopause symptoms, and it is worth knowing. Hot flushes and night sweats ease off for many women over time. Vaginal dryness usually does not. As long as your oestrogen stays low, the symptoms tend to persist or slowly increase.2
That is not bad news so much as a reason not to wait. Treatment works well, and the earlier you start, the easier it is to keep the tissue comfortable.
Lubricant or vaginal moisturiser: what is the difference?
For many women this is the first step, and the two are easily confused.
A lubricant is used in the moment, during sex, to reduce friction and pain. Choose a water-based or silicone-based lubricant.
A vaginal moisturiser is different. It is a hydrating gel you use regularly, a few times a week, to keep the tissue moister and suppler outside of sex too. Regular use works better here than the occasional attempt: many women only notice a real difference after a few weeks of consistent use.
If you react easily, choose mild products, avoid harsh soap and skip perfume in that area. Breathable cotton underwear helps some women too.
Local oestrogen: safe and effective
If a lubricant and moisturiser are not enough, there is a treatment with strong evidence behind it: local oestrogen. This is a low-dose oestrogen cream, pessary or tablet you place in the vagina. It makes the lining thicker, moister and more elastic again, and often eases the urinary symptoms too.
The word oestrogen makes a lot of women hesitate, which is understandable. But local oestrogen works mainly where you apply it and barely reaches your bloodstream. That is why Belgian and international guidelines consider it safe and effective, including for most women who cannot take systemic hormone therapy for other reasons.3,4,5 A typical schedule is more frequent use for the first couple of weeks, then a maintenance dose of a few times a week.
One situation calls for a separate conversation: a history of breast cancer. Even then the guidelines do not rule local oestrogen out, but the decision is one you make together with your doctor or oncologist, tailored to your treatment.6 Do not wait on that if the symptoms are weighing on you: there are options.
Sex, pain and desire
Let us be honest about intimacy, because that is often where it hurts most. Pain during sex is not a sign that something is wrong with you, and it is certainly not something to push through. Pushing through usually makes it worse: your body tenses, and that feeds a cycle of pain and tension.
The effect reaches beyond the physical. When sex hurts, desire often fades along with it, and that has nothing to do with how you feel about your partner. If you notice your desire changing, read our page on libido in menopause too. The two are connected, and both are easy to raise with a care provider.
Talking to your partner helps too. Explaining that the pain has a physical cause takes the pressure off the moment and makes room to find what does feel good together. Intimacy is more than penetration, and taking a pause until the symptoms are dealt with is a sensible choice rather than a setback.
Where to find help
Do the symptoms keep coming back, or weigh on your daily comfort or your relationship? You do not have to figure this out alone.
Your GP (huisarts) is a good first stop. They can assess the symptoms, rule out other causes and prescribe local oestrogen, or refer you to a gynaecologist. Some Belgian hospitals also run a dedicated menopause clinic.
Want to talk directly to someone who works on menopause every day? On Uma you will find care providers who specialise in (peri)menopause. Your consultation takes place online, you discuss all your symptoms together, including the ones you had not yet connected, and you leave with a concrete plan. Uma is active mainly in Belgium, the Netherlands, Luxembourg and France, but any woman in Europe can consult a care provider on Uma. Prescriptions are valid across Europe.
Sources
- NHS (2024). Vaginal dryness.
- The North American Menopause Society (2020). The 2020 genitourinary syndrome of menopause position statement. Menopause, 27(9), 976–992.
- Rozenberg, S. et al. (2026). Guidelines Menopause. Belgian Menopause Society.
- National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE Guideline NG23.
- BCFI (2025). Hormone therapy during perimenopause: benefits and drawbacks.
- Agrawal, P. et al. (2025). Vaginal estrogen therapy for genitourinary syndrome of menopause among breast cancer survivors: a systematic review and meta-analysis.
The content on this page is intended for informational purposes and does not replace medical advice. Please consult a physician for a personal assessment.