April 13, 2026, 2:34 am | Read time: 7 minutes

What is Vaginal Dryness During Menopause?

Medically, vaginal dryness during menopause is often attributed to the so-called Genitourinary Syndrome of Menopause (GSM). It is usually a hormone-related vaginal dryness, technically referred to as vaginal atrophy, which is a regression of the vaginal tissue caused by a lack of estrogen.

Also interesting: The longer women have to live without estrogen, the worse it is for the heart and brain

What Naturally Keeps the Vagina Moist?

Vaginal Wall

Vaginal moisture results from the interaction of several mechanisms. The largest contribution comes from the vaginal wall itself, as under the influence of estrogen, the mucous membrane is well supplied with blood, allowing tissue fluid to reach the surface. This process is called transudation and is the most important source of natural baseline moisture.

Bartholin’s Glands

The Bartholin’s glands are located on either side of the vaginal entrance and produce a mucous secretion that is released primarily during sexual arousal and serves as a natural lubricant.

Skene’s Glands (Paraurethral Glands)

These small glands are located near the urethral opening. Their contribution to vaginal lubrication is rather minor but can play a supplementary role.

Cervical Glands

“In perimenopause, the phase between regular menstruation and full menopause, the cervical glands still play an important role. They produce about 10 to 20 percent of the vaginal mucus, whose consistency changes throughout the cycle. Around ovulation, the mucus is particularly abundant, thin, and provides optimal conditions for sperm to ascend into the uterus. At the beginning and end of the cycle, it is sparser and thicker, sealing the cervix. Postmenopausally, cervical mucus largely loses its significance,” says Dr. Gößlinghoff.

How Does Vaginal Dryness Develop?

“The central cause is the declining estrogen levels during menopause. Estrogens play a key role in the health of the vaginal mucosa because they promote blood circulation, support mucus production, and ensure that enough glycogen is present in the mucosa. This glycogen serves as a nutrient for lactic acid bacteria and keeps the pH in the protective acidic range,” says Dr. Gößlinghoff. “When estrogen levels drop, a chain reaction occurs. The mucosa becomes thinner, natural lubrication decreases, and the vaginal environment becomes more susceptible to germs. It is crucial that these changes are measurable and medically relevant. It is not simply a temporary feeling of dryness but a structural change in the tissue,” explains Dr. Gößlinghoff. “The symptoms often develop slowly and are therefore usually not directly associated with menopause. Many women initially suspect an infection or a temporary irritation.”

Also interesting: Preventing bone loss! The right training for menopause

Symptoms of Vaginal Dryness

Irritation and Pain

Typical symptoms include a persistent feeling of dryness, burning, or itching (medically known as pruritus), as well as pain during intercourse (medically known as dyspareunia).

Skin Tears and Infections

Small mucosal tears or slight bleeding after sex can also occur. It is not uncommon for frequent bladder infections or increased urinary urgency to develop. Some women also notice recurring yeast infections, which are caused by hormone-related changes in the mucosa.

Friction Sensation

Less known but also typical is an uncomfortable friction sensation during sports or when wearing tight clothing, as well as a diffuse pressure feeling in the pelvic area.

Also interesting: Rebecca Barthel: “This is the training women should focus on during menopause”

Treatment Options

Local Estrogen Preparations

For pronounced hormone-related vaginal dryness, local estrogen preparations are considered the medical gold standard. These are applied directly into the vagina as creams, suppositories, vaginal tablets, or vaginal rings. They target the problem area and can demonstrably rebuild the mucosa. At the same time, the risk of infections decreases, and the systemic hormone load remains very low. However, women with hormone-dependent pre-existing conditions should always consult a doctor before use.

Hormone-Free Creams

Hormone-free moisturizing creams and lubricants can provide temporary relief by moisturizing the mucosa. However, it is important to know that they do not address the underlying cause. They do not rebuild the mucosa and usually need to be applied regularly. For more severe symptoms, they are often not sufficient but can be a useful addition.

Suppositories

Vaginal moisturizing suppositories, such as those containing hyaluronic acid, are also frequently used. They nourish the mucosa and can retain moisture longer than traditional gels. However, it is also true here: The underlying estrogen deficiency is not addressed.

Hormone Replacement Therapy

Systemic hormone replacement therapy is primarily considered when there are also severe menopausal symptoms such as hot flashes. It is not the first choice for treating vaginal dryness alone.

Laser Therapy

In laser therapy, targeted micro-injuries are created in the mucosa to stimulate collagen formation and improve blood circulation. However, the study situation on this is inconsistent, as Dr. Gößlinghoff emphasizes. Additionally, the treatment is costly and usually requires several sessions of the often-promoted “vaginal rejuvenation” method. For women with a contraindication to estrogens, it can still be a possible alternative.

Important for the Right Treatment: Medical Clarification of the Cause

Even if vaginal dryness during menopause is often hormone-related, the cause should always be clarified gynecologically. Similar symptoms can also arise from infections, skin diseases in the intimate area, medications, or other hormonal disorders. The gynecologist can usually recognize typical mucosal changes during the examination and, if necessary, order further tests. This clarification is important because the treatment can vary significantly depending on the cause.

Also interesting: Regular sex has health benefits for women over 40

Can Vaginal Dryness Be Prevented?

Gentle Intimate Care

Complete prevention is not possible, but you can actively do a lot for the health of the vaginal mucosa. Especially useful is mild, pH-balanced intimate care, while aggressive washing lotions should be avoided as much as possible, as they can further irritate the sensitive mucosa.

Sexual Activity

Regular sexual activity can also be supportive because it promotes blood circulation in the vaginal mucosa.

Quitting Smoking

Smoking worsens tissue blood circulation and can exacerbate symptoms.

Medication Check

Anti-hormone therapies, some antidepressants, and antihistamines can exacerbate vaginal dryness. If you are taking such medications and notice symptoms, consulting a doctor may be advisable.

Preventive Hormonal Treatment?

Routine preventive use of hormone-containing vaginal preparations without symptoms is generally discouraged. However, if initial symptoms appear, early local therapy can help maintain mucosal health.
Can hormone-related vaginal dryness disappear on its own?
Without treatment, hormone-related vaginal dryness usually does not regress. Since the hormonal change is permanent, the tendency toward mucosal atrophy also persists.

More on the topic

Advice From a Gynecologist How Menopause Changes the Vagina

Gynecologist Explains Vaginal Stenosis: A Little-Known Phenomenon During Menopause

What Happens If It Is Not Treated?

If vaginal dryness is left untreated, the mucosa can continue to regress. Symptoms often increase, infections occur more easily, and chronic irritations can develop. This can lead to a burdensome cycle of symptoms that can strain relationships and negatively affect one’s body image. The earlier treatment begins, the better the results usually are.

Don’t Ignore It, Don’t Accept It, Get Treatment

“Vaginal dryness during menopause is widespread and should be taken seriously medically. It affects not only the love life but can influence overall urogenital health,” says Dr. Gößlinghoff. “The most important message is: You do not have to simply accept these symptoms. Especially local estrogen therapy is considered an effective and well-tolerated standard treatment today. Hormone-free products can support but usually do not replace the causal therapy. If you notice the first signs, talk to your gynecologist early. The earlier action is taken, the better the mucosal health can be maintained–and thus your well-being in everyday life.”