What helps vaginal dryness in menopause?
Start with a vaginal moisturiser and a water-based lube. If that’s not enough, ask about vaginal oestrogen, which NICE recommends. Some is sold in pharmacies. And if you’re itchy, it may not be thrush.
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What is the best treatment for vaginal dryness?
Try the shop shelf first. The NHS suggests a vaginal moisturiser you put inside to keep it moist, and a water-based lube before sex. You don’t need a prescription.
Still dry? Falling oestrogen in menopause can cause it.
NICE says to offer vaginal oestrogen, even if you already take HRT. It’s a low dose that works inside the vagina.
| Option | Where to get it | Good to know |
|---|---|---|
| Vaginal moisturiser and water-based lube | Pharmacy or shop | Fine alone or alongside vaginal oestrogen. |
| Vaginal oestrogen | Prescription, or a pharmacy for Gina tablets and Ovesse cream | Can take up to 3 months to work fully. |
| Prasterone pessaries | Prescription | An option if the first two didn’t work or didn’t suit you. |
| Ospemifene tablets | Prescription | A tablet by mouth, if putting something in the vagina is hard, for example due to disability. |
Sources: NICE NG23; NHS: vaginal oestrogen; NHS: vaginal dryness
Seen adverts for vaginal laser? NICE says don’t offer it except in a research trial.
Pick up a moisturiser this week. Give it a few weeks before you decide it isn’t working.
Is my itchy vulva dryness or thrush?
It can be either, so look at your discharge.
| What you notice | Possible cause |
|---|---|
| Dry, itchy vagina and pain during sex | Hormone changes from menopause, breastfeeding or some contraception |
| White, lumpy discharge like cottage cheese, with itching and soreness | Thrush |
| Yellow, green or smelly discharge, pain when peeing or during sex | A sexually transmitted infection |
| Itchy white patches on the vulva, smooth or crinkled | A skin condition called lichen sclerosus, much more common in women over 50 |
Sources: NHS: vaginitis; NHS: lichen sclerosus
That discharge is the clue. The NHS says don’t self diagnose.
You may hear this called vaginal atrophy or GSM (genitourinary syndrome of menopause). NICE lists dryness, pain during sex, irritation, and pain when peeing. The NHS adds needing to pee more often and repeat urine infections.
It can start in perimenopause and may carry on after menopause.
Dry at other times, such as after a period? The NHS also lists hormonal contraception, antidepressants, breastfeeding, a hysterectomy and cancer treatment. Perfumed washes, not feeling aroused, diabetes and Sjögren’s syndrome (a condition that dries the eyes and mouth) can cause it too.
Not sure what’s causing it? Ask a pharmacist or GP before treating it as thrush.
How do I use vaginal oestrogen?
It comes as a tablet, pessary (a small tablet-shaped plug), cream, gel or ring that you put in your vagina. Little reaches the rest of your body. So you don’t need progestogen (the second hormone most HRT adds to protect the womb lining), even if you still have a womb.
Vaginal tablets: what usually happens
- 1
Weeks 1 to 2
1 tablet a day.
- 2
After that
1 tablet twice a week.
- 3
Up to 3 months
Time to work fully. Not better by then? See your doctor.
- 4
Every year
Check with your doctor that it still suits you.
Sources: NHS: how to use vaginal oestrogen; NHS: common questions
It won’t help hot flushes, mood or sleep.
Buying Gina tablets from a pharmacy? They’re for women aged 50 or over with no period for at least 1 year, after a chat with the pharmacist.
Symptoms often return when you stop, but you can restart. Never stop or change a prescribed medicine without your prescriber.
Is vaginal oestrogen safe?
Its risks are lower than other HRT. NICE says serious side effects are very rare.
Some bleeding is common for the first 3 to 6 months. Some creams and gels can damage condoms and diaphragms, so ask which suits you.
Had breast cancer? NICE says to offer moisturisers or lubes first. Vaginal oestrogen may be considered if symptoms carry on.
If you take aromatase inhibitors (a breast cancer medicine), NICE says a breast cancer specialist should help choose your treatment.
Tell your doctor about breast cancer, clots or bleeding with no known cause.
What can I do at home, and do supplements help?
Five NHS steps for vaginal dryness at home
- Put a vaginal moisturiser inside your vagina to keep it moist.
- Use a water-based lube before sex.
- Wash with unperfumed soap, and skip perfumed washes and douches (rinsing inside the vagina).
- Don’t use creams or lotions that aren’t made for the vagina.
- Try different kinds of foreplay to help you feel more aroused.
Source: NHS: vaginal dryness
Supplements, vitamins and herbs aren’t on the NHS or NICE list for vaginal dryness. The NHS says herbal remedies for menopause have very little evidence on how well they work or how safe they are. Some can clash with other medicines.
NICE finds some evidence for black cohosh (a herb) and isoflavones (plant oestrogens, as in soy), but only for hot flushes. More in menopause supplements and natural alternatives to HRT.
Low desire as well as pain? See low libido.
When to speak to a GP
Book an appointment if:
- You’ve been dry for a few weeks and what you’ve tried isn’t working, or it’s affecting your daily life.
- You have unusual discharge, or bleeding after sex or between periods.
- You’ve had no period for 12 months and get any bleeding, even once or just spotting.
- You have an itchy white patch on your genitals.
- You’ve used vaginal oestrogen for 3 months and aren’t better, or have unexpected bleeding after 6 months on it.
On vaginal oestrogen, call 111 for pain, redness or swelling in one leg. Call 999 for chest pain and breathlessness, or trouble speaking, moving an arm or leg, or a drooping face. Also call 999 if your lips, mouth, throat or tongue suddenly swell, or you struggle to breathe or swallow.