Best Vaginal Moisturisers for Perimenopause: What Works and How to Use Them

Vaginal Dryness in Perimenopause: Why It Happens

Vaginal dryness and discomfort are among the most common symptoms of perimenopause, affecting around 50 percent of women during the transition, yet they remain significantly underreported and undertreated. Unlike hot flashes, which often improve once oestrogen stabilises after the final period, vaginal and vulval symptoms tend to worsen over time without treatment. The medical term is genitourinary syndrome of menopause (GSM), which encompasses vaginal dryness, irritation, burning, recurrent urinary tract infections, urinary urgency, and pain during intercourse. The underlying cause is the direct effect of oestrogen decline on the vaginal epithelium. Oestrogen maintains the thickness, elasticity, and lubrication of vaginal tissue by stimulating the production of glycogen, which feeds the lactobacilli bacteria that maintain the vaginal microbiome and acidic pH. Without adequate oestrogen, the vaginal walls become thinner and less elastic, glycogen production falls, the lactobacilli population decreases, the vaginal pH rises, and the tissue loses its natural moisture. Vaginal moisturisers address the symptoms directly by restoring moisture to the vaginal tissue on a regular basis. They are distinct from lubricants (which are applied immediately before or during sex for comfort) and from vaginal oestrogen (which addresses the root cause by restoring local oestrogenic stimulation). All three have a role and are complementary rather than interchangeable.

Replens: Long-Acting Vaginal Moisturiser

Replens Long-Lasting Vaginal Moisturiser is one of the most studied non-hormonal vaginal moisturisers available, with multiple randomised trials supporting its efficacy. It works through a polycarbophil-based formulation that bioadheres to the vaginal epithelium, drawing water into the cells and creating a sustained moisture reservoir that lasts for two to three days. The formulation also has a mild acidic pH (around 2.8 to 3.2) that helps restore the normal vaginal acid environment, supporting the lactobacilli-dominated microbiome that protects against infections. Clinical trials comparing Replens to vaginal oestrogen show broadly comparable improvements in vaginal dryness, pH, and epithelial maturation over 12 weeks, though vaginal oestrogen typically produces superior results over longer timeframes in women with more severe atrophy. Replens is applied internally using a pre-filled applicator, typically two to three times per week. It is available over the counter at pharmacies without a prescription and is relatively affordable. Some women find the pre-filled single-dose applicators more hygienic and easier to use than reusable applicators with a tube format. A small number of women find the polycarbophil formulation irritating if they have a sensitivity to its components. In this case, alternative formulations should be explored.

YES VM and Natural-Formulation Moisturisers

YES VM (Vaginal Moisturiser) by YES is a water-based alternative formulated from organic plant ingredients including aloe vera, flaxseed extract, and vitamin E. It is free from parabens, synthetic fragrances, and hormones, which makes it suitable for women who prefer natural formulations or who have sensitivities to conventional products. YES VM uses a hyaluronic acid and plant polysaccharide base that creates a moisture-retaining film on vaginal tissue without the bioadhesion mechanism of polycarbophil products. It is applied internally two to three times weekly using an applicator. In an independent randomised crossover trial published in the Journal of Lower Genital Tract Disease, YES VM performed comparably to Replens on measures of vaginal pH, moisture, and comfort over 12 weeks, making it a well-evidenced natural alternative. YES also produces an oil-based moisturiser (YES OB) that is suitable for external vulval dryness and irritation but should not be used with latex condoms (as oil degrades latex). For women with recurrent vulval irritation or lichen sclerosus (a skin condition that worsens without adequate vulval moisture), an oil-based external moisturiser applied daily provides sustained protection and comfort. Coconut oil and pure vitamin E oil are low-cost alternatives that some women find effective for external use, though clinical evidence is limited.

Hyaluronic Acid Vaginal Moisturisers: Emerging Evidence

Hyaluronic acid (HA) is a naturally occurring molecule in the body that holds up to 1,000 times its weight in water. It is well established as an ingredient in skincare, and its application to vaginal moisturisation is increasingly supported by clinical evidence. Vaginal hyaluronic acid gel formulations (typically 0.2 percent HA) are now available in several products in the UK, including from brands such as Bonafide, Revive, and various pharmacy own-label products. Randomised trials comparing vaginal HA gel applied two to three times weekly to vaginal oestrogen cream show broadly equivalent improvements in vaginal dryness, pH normalisation, and dyspareunia (pain during intercourse) over periods of eight to twelve weeks. This is a notable finding because it suggests HA is not simply a comfort measure but produces meaningful histological improvement in the vaginal epithelium. HA formulations tend to be very well tolerated with minimal side effects, making them an attractive option for women who cannot or prefer not to use vaginal oestrogen. They are also suitable for women who have had hormone-sensitive cancers and are advised to avoid all oestrogen-containing products, where they provide one of the only evidence-based alternatives to vaginal oestrogen. The main limitation is cost: HA vaginal gels are typically more expensive than polycarbophil-based products like Replens.

Vaginal Moisturisers vs Lubricants vs Vaginal Oestrogen

Understanding the distinction between vaginal moisturisers, lubricants, and vaginal oestrogen is important for choosing the right product for the right situation. Vaginal moisturisers (the focus of this article) are used regularly, typically two to three times per week regardless of sexual activity, to maintain baseline vaginal tissue moisture, restore pH, and support the vaginal microbiome. They provide cumulative benefit over weeks and months. Lubricants are used acutely, immediately before or during intercourse, to reduce friction and discomfort during sex. They do not treat the underlying tissue changes and provide no lasting benefit between uses. Water-based lubricants (such as YES WB or Sliquid H2O) are safe with condoms and suitable for most women. Silicone-based lubricants last longer and are water-resistant but should not be used with silicone toys. Oil-based lubricants are incompatible with latex condoms. Using both a regular moisturiser and a lubricant as needed is the most comprehensive non-hormonal approach. Vaginal oestrogen, available as cream, pessaries, ring, or tablet, addresses the root cause by restoring local oestrogenic stimulation to vaginal and urethral tissue. It has the strongest evidence for GSM and also significantly reduces recurrent UTI risk. The amount of oestrogen absorbed systemically from vaginal preparations is minimal, and the latest clinical guidance confirms it is safe for most women, including many cancer survivors, in discussion with their oncologist.

Frequency of Use, Practical Tips, and When to See a Doctor