How to treat vaginal dryness and urinary symptoms
Many women treat vaginal dryness with a lubricant for sex, a regular vaginal moisturizer and, when those are not enough, low-dose vaginal estrogen. It is common and treatable: genitourinary syndrome of menopause (GSM), the umbrella name for dryness and the urinary symptoms that travel with it, is estimated to affect 27–84% of postmenopausal women (NAMS, 2020), and it sits among the women's health conditions with established first-line treatments.
If this is happening to you, you are in good company, and it is nothing you have to quietly put up with. In plain words, vaginal dryness is too little natural moisture in and around the vagina, often with discomfort or pain during sex. It tends to arrive as part of a group: a sudden need to pass urine (urgency), leakage and repeated urinary tract infections (UTIs) often show up alongside it. In the US the group may also be called vulvovaginal atrophy; in the UK you may hear vaginal atrophy or urogenital atrophy.
When does vaginal dryness start, and what comes with it?
Vaginal dryness, urinary urgency and leakage become more common in perimenopause, the years leading up to the final period, and they carry on after it (The Menopause Society, 2022). After menopause, low estrogen keeps affecting vaginal health (NICE NG23, updated 2024).
Hot flashes usually ease with time. Vaginal and urinary symptoms follow a different course: dryness, discomfort, urgency and repeated UTIs tend not to fade on their own and can gradually increase without treatment (NICE NG23, updated 2024). The gentler way to read that is that it is never too late to mention them, and a symptom that has been there for years is still well worth bringing up.
Dryness, painful sex, urgency and repeated UTIs are listed side by side in the guidance, so a question about one is a fair moment to mention the others.
What helps to treat vaginal dryness?
For less severe symptoms, the first-line treatments are nonhormone lubricants and regular long-acting vaginal moisturizers, according to the 2020 position statement of The North American Menopause Society (NAMS, 2020). Nonhormone simply means the product contains no estrogen. The statement names lubricants for the vulva as well as the vagina, so lube for vaginal dryness is not only for the inside.
The NHS gives the same starting point in UK terms: water-based lubricants before sex and vaginal moisturisers, with oestrogen through a GP if those are not enough. So on both sides of the Atlantic, treating vaginal dryness that is on the milder side begins with products that carry no hormone, and hormone treatment is the next step.
When lubricants and moisturizers are not enough, low-dose vaginal estrogen treats dryness, painful sex and urinary symptoms. The products are named differently in each country: in the US the choice is usually described as a vaginal estrogen cream, ring or tablet, while the NHS describes oestrogen as a cream or pessary, arranged through a GP.
This is local treatment, placed where the symptoms are, and it is a different thing from whole-body HRT, known in the US as menopausal hormone therapy (MHT). According to The Menopause Society's 2022 hormone therapy position statement, very little of the estrogen reaches the bloodstream. Moisturizers and lubricants can stay in the routine alongside it.
Nonhormone products are first line for less severe symptoms, so women with more troublesome symptoms may wish to ask about estrogen at the first appointment.
How much treatment, and for how long?
The two nonhormone products work on different timetables. The NHS describes lubricant as something used before sex, while the NAMS statement describes moisturizer use as regular: a routine, not a one-off.
Vaginal estrogen has no fixed end date. NICE NG23 (updated 2024) describes it as safe long term at any age, so there is no birthday at which women are expected to stop.
For leakage and urgency, many women add pelvic floor exercises alongside local treatment, and the guidance pairs the two (NICE NG23, updated 2024).
How often to use a moisturizer or an estrogen product varies with the product and the prescription. In the US that schedule is something to settle with your provider, OB-GYN or pharmacist; in the UK, with your GP or pharmacist. It can be revisited whenever your symptoms change.
What do the studies show, and what is still unclear?
The studies support nonhormone products and low-dose vaginal estrogen, and they leave two questions open: whether vaginal laser works, and what long-term data on the womb lining will show.
On laser, the evidence on vaginal laser and other energy-based therapies is insufficient to support claims about benefit or safety, because placebo-controlled trials are lacking (NAMS, 2020). That is a statement about missing evidence, so a fair question for anyone offering a device is which trials sit behind it.
On the womb lining, long-term studies on the endometrial safety of vaginal estrogen are lacking (NAMS, 2020). This gap sits beside the long-term safety guidance above and does not cancel it. If you have questions about your own history, your provider in the US or your GP in the UK can talk them through with you.
Estimates of how many women are affected also vary widely between studies, which is why the NAMS figure is a range. The NHS simply calls dryness common and gives no figure.
Vaginal dryness and urinary symptoms by life stage
| Stage | Figure | Why | Read more |
|---|---|---|---|
| Childhood | No figure given | The symptoms here are tied to the low estrogen of menopause, so the fact sheet has no childhood figure; this link is for parents reading about the early years. | What changes |
| Puberty | No figure given | No figure at this stage; this link is for girls and parents looking at the years when periods begin. | What changes |
| Reproductive years | No figure given | No figure at this stage; this link is for readers in the years of regular cycles, before perimenopause. | What changes |
| Perimenopause | No percentage given | Dryness, urinary urgency and leakage become more common in these years; pelvic floor training and local treatment are the options listed (The Menopause Society, 2022). | What changes |
| Menopause | Lubricants, moisturizers, vaginal estrogen | All three help with dryness and painful sex, and vaginal estrogen is often used alongside HRT (The Menopause Society, 2022). | What changes |
| Postmenopause | 27–84% | The estimated share of postmenopausal women affected by GSM (NAMS, 2020); vaginal estrogen is safe long term at any age (NICE NG23, updated 2024). | What changes |
Facts
Common questions
How to cure vaginal dryness?
Dryness linked to menopause is usually managed as ongoing care, because estrogen stays low after menopause. Care can continue for as long as it is useful, and it can sit beside other treatment: for women already taking HRT (menopausal hormone therapy in the US) who still notice dryness, vaginal estrogen is often used alongside it (The Menopause Society, 2022). A routine HRT review is a natural moment to raise it.
How to solve vaginal dryness?
It helps to match the treatment to the symptom that bothers you most. A lubricant eases discomfort during sex, a regular moisturizer works on day-to-day dryness, pelvic floor training is aimed at leakage and urgency, and vaginal estrogen is the option when those do not do enough. With a new partner, STI protection still matters at any age (NICE NG23, updated 2024).
How to treat vaginal dryness?
Treating vaginal dryness usually goes in steps. Step one is a water-based lubricant before sex. Step two is a vaginal moisturizer used on a regular schedule. Step three is low-dose vaginal estrogen, which is something to ask your provider or OB-GYN about in the US, or your GP in the UK. Many women find the first one or two steps are enough.
How to use coconut oil for vaginal dryness?
Coconut oil is not among the treatments the guidance names. The first-line products in the NAMS 2020 statement are nonhormone lubricants and long-acting moisturizers, and the NHS specifies water-based lubricants. The NHS also notes that creams not meant for the vagina can cause irritation or infection. If a natural remedy for vaginal dryness appeals to you, a pharmacist can suggest products made for the area.
What helps vaginal dryness?
After menopause, the NHS describes oestrogen as a cream or pessary for vaginal dryness, soreness or urinary symptoms, so one local treatment may help the vagina and the bladder together. If urgency or repeated UTIs bother you more than the dryness does, saying so at the appointment helps shape the plan around what matters most to you.
Can vaginal dryness cause itching?
Yes. The NHS lists itching, soreness and irritation among the symptoms of vaginal dryness, so itching can be part of the same picture and is nothing to feel awkward about mentioning. If itching does not settle once the dryness is being treated, a visit to your provider in the US, or your GP in the UK, lets the cause be checked.
What to use for vaginal dryness?
The NHS notes that perfumed products can cause irritation or infection, so plain, unperfumed products made for the vagina are a good place to start. A pharmacist can talk through the lubricant and moisturizer options on the shelf and help you compare them.
Next steps
A good place to start is whichever step feels most manageable today, whether that is trying a nonhormone product or booking a conversation with your provider in the US or your GP in the UK. It may help to note which symptoms bother you most and how long they have been there. Two things are worth a prompt doctor's visit: any vaginal bleeding or spotting after menopause, to rule out womb cancer (NICE NG23, updated 2024), and symptoms that keep getting worse. Some women stay with moisturizers, others move to local estrogen early, and both are reasonable choices. Treating vaginal dryness is not one size fits all, and what fits your body and your life is yours to decide.
See a doctor promptly if you have
- Any vaginal bleeding or spotting at any time: see a doctor promptly
- Symptoms that are getting worse
Sources
The guidelines and studies this page draws on.
- The 2020 GSM position statement of The North American Menopause Society (NAMS press release), EurekAlert (NAMS release) (2020)
- Vaginal dryness, NHS (n/d)
- Menopause: treatment, NHS (n/d)
- NICE NG23, updated 2024: Menopause: identification and management, NICE (2024)
- The Menopause Society, 2022: hormone therapy position statement, The Menopause Society (2022)