Vaginal Dryness in Perimenopause: What It Is, Why It Happens, and How to Treat It
Vaginal dryness is one of the most common perimenopause symptoms. This guide explains the causes, treatment options, and when to seek help.
Understanding Vaginal Dryness in Perimenopause
Vaginal dryness is common in perimenopause, yet rarely talked about openly. Unlike hot flashes, which tend to be the first change people associate with hormonal transition, vaginal dryness often creeps in gradually. The condition has a medical name, genitourinary syndrome of menopause, and it is both well understood and very treatable. The term covers dryness, irritation, burning, and tissue changes that make the vagina thinner, less lubricated, and more prone to discomfort. Oestrogen maintains the thickness, moisture, and elasticity of vaginal tissue. As oestrogen fluctuates and falls during perimenopause, these tissues begin to change, and the effects can be felt daily, not just during sex.
How Oestrogen Decline Changes Vaginal Tissue
Under the influence of oestrogen, the vaginal lining is thick, folded, well-lubricated, and maintained by a healthy bacterial balance. As oestrogen declines, the lining becomes thinner and smoother. Cells that produce natural lubrication become less active. The vaginal pH rises, disrupting the bacterial balance and making infections more likely. For many women the changes are subtle at first, a mild itching or intermittent dryness. Over time, without treatment, they tend to become more pronounced. Unlike hot flashes, which often ease as the body adapts, vaginal dryness may worsen after menopause if left untreated, making early attention worthwhile.
Symptoms Beyond Dryness Itself
Genitourinary syndrome of menopause involves a cluster of symptoms beyond dryness alone. Itching and burning in and around the vagina are common, easily mistaken for thrush. Irritation from clothing or exercise is frequently reported. Painful intercourse can occur because the tissues are less lubricated and more fragile. Some women notice light bleeding after sex. Urinary symptoms, including urgency, frequency, and recurrent infections, are also part of the syndrome because the same oestrogen decline affects urethral tissue. The range of symptoms varies considerably, but any of them warrant a conversation with a healthcare provider.
Non-Hormonal Approaches to Relieve Symptoms
Several effective non-hormonal options exist. Vaginal moisturisers are applied two to three times a week to restore moisture to tissues over time. Lubricants are used during sexual activity to reduce friction. Both have a role and can be used together. Look for pH-balanced products free from fragrances and parabens. Hyaluronic acid-based moisturisers have good evidence for symptom relief. Regular gentle sexual activity, including solo activity, supports blood flow and helps maintain tissue health. Avoiding harsh soaps and scented products around the vulval area also reduces irritation.
Local Oestrogen Therapy
Local oestrogen therapy is widely considered the most effective treatment when moisturisers and lubricants are insufficient. Applied directly to the vaginal area as a cream, pessary, tablet, or ring, it restores oestrogen to local tissues without significantly raising blood oestrogen levels. This makes it suitable for many women who cannot take systemic HRT, including some with a history of oestrogen-sensitive breast cancer, though this should always be discussed with an oncologist. Most women notice improvement within four to six weeks. Local oestrogen is generally recommended for long-term use and does not carry the same risks as systemic oestrogen.
When Systemic HRT Is Relevant
For women experiencing vaginal dryness alongside hot flashes, sleep disruption, or mood changes, systemic HRT may address everything simultaneously. Systemic HRT raises oestrogen levels throughout the body, which can improve vaginal health as well as broader symptoms. For women whose main concern is vaginal and bladder symptoms, local oestrogen alone is often preferable as it delivers oestrogen directly to the tissues that need it, with minimal systemic absorption. Some women use both approaches. The right combination depends on your symptom profile, medical history, and preferences, best worked out with a GP or menopause specialist.
Having the Conversation and Tracking Progress
Many women delay seeking help for vaginal dryness because they feel embarrassed or assume nothing can be done. Healthcare providers who work in this area are entirely accustomed to discussing it. Booking an appointment specifically to address this symptom, rather than hoping it comes up at the end of another consultation, gives the conversation the space it deserves. Tracking how symptoms change over time helps gauge whether a treatment is working. Apps like PeriPlan allow you to log symptoms regularly so you have a clear picture of your baseline and how things shift week to week. Many women find that with the right approach, vaginal dryness moves from a daily irritant to something they barely notice.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.