What causes menopause vaginal dryness and itchiness?

Everyone is dealt a different hand in life, and this is no more apparent than when it comes to the menopause. As if the possibility of hot flashes, mood swings, and sleepless nights weren’t enough, mother nature sometimes decides to throw in something a little extra, just to keep you on your toes. Exhibit A: You may notice that during menopause, things feel a little (or a lot) different “down there.” Vaginal dryness can set off a chain reaction of unwelcome sensations — including burning, itching, or pain during sex. 

Continue reading to discover the common causes of vaginal dryness during menopause, the additional symptoms that can result from it, and ways to treat it to help with the discomfort. 

During perimenopause and post-menopause, a woman’s levels of estrogen fluctuate and ultimately take a dive. This results in a range of symptoms, including vaginal dryness and itchiness when the vulvovaginal and urinary tissues can become thin and irritated. This is a phenomenon often referred to as the genitourinary syndrome of menopause (GSM). Around 30% of perimenopausal and over 50% of postmenopausal women experience this symptom.

Other terms you might see

Genitourinary syndrome of menopause (GSM) is the current umbrella term that describes changes in the vaginal, vulvar, and urinary tissues due to declining levels of estrogen in a woman’s body during menopause. Older related terms like vulvovaginal atrophy or atrophic vaginitis can sound intimidating at first, but they’re just clinical labels for normal tissue changes, not a sign that something is “wrong.” All of these describe similar underlying changes, though GSM is now the widely accepted term.

The main cause of vaginal dryness and itchiness during menopause is the estrogen decline during the menopause transition. However, other potential contributors can include certain medications, medical treatments, and irritants. Vaginal itchiness can also have other causes like infections or skin conditions. Because of the other possible causes of vaginal dryness and itchiness, it’s recommended that you get a thorough evaluation from a clinician who can help identify the underlying reason and recommend the most appropriate treatment.

Factors that can worsen irritation

Certain everyday habits or products can exacerbate vaginal dryness and irritation during menopause. For example, very hot baths, fragranced soaps, perfumed personal care products, and harsh detergents could all cause your condition to worsen.

You should also try not to wear tight clothing or synthetic underwear, as they too can add to the discomfort caused by vaginal dryness and itchiness. 

Menopausal vaginal dryness usually comes with a host of other symptoms, such as: 

• Itching 

• Burning, especially on urination

• Irritation

• Light bleeding after intercourse

• Pain during sex

• Low vaginal lubrication

• Vaginal soreness

• Urinary urgency

• Urinary tract infections

If you’re experiencing any of these symptoms, bring it up with your health care provider. They’ll likely ask you about your symptoms, medical history, and any products or medications that might be contributing to your vaginal dryness and itchiness. They may also perform a pelvic exam to check the walls of your vagina and see if they’re thin, pale, or red. And they might test your vaginal discharge to rule out other causes for the condition.

It’s important to reach out to a clinician sooner rather than later if you notice certain red-flag vaginal symptoms, including vaginal bleeding after menopause, severe or worsening pain, new or unusual discharge or odor, and symptoms that begin much earlier than expected or don’t improve with basic care. These signs don’t necessarily mean something is seriously wrong, they just need professional evaluation to rule out more serious conditions and ensure you receive appropriate care and relief.

Other diagnoses 

There are a few things your clinician will seek to rule out during your appointment before identifying your dryness and itchiness as menopause-related. Other potential vaginal dryness and itching causes can include:

• Infections: This can include yeast infections, bacterial vaginosis (BV), and sexually transmitted diseases (STDs)
  

• Dermatological conditions: This includes skin conditions such as lichen sclerosus, eczema, or other inflammatory skin disorders
  

• Contact irritants or allergies: This can be brought on by anything from fragranced soaps, detergents, pads, and wipes to lubricants and fabrics that can irritate sensitive vulvar tissue

There are several treatment options available for vaginal dryness, itchiness, and discomfort linked to menopause. The right choice for you depends on your symptoms, preference, and medical history. 

When choosing any product to help with vaginal dryness, it’s important to always check ingredient labels carefully, especially if you have sensitive skin or a history of urinary or vaginal infections. Avoid products with strong fragrances or harsh additives, and don’t hesitate to discuss your options with a clinician to find the best option for you. 

Let’s take a look at the options available more closely:

Non-hormonal options

There are several non-hormonal choices for alleviating your symptoms.

Vaginal moisturizers

Vaginal moisturizers are used on a regular basis, rather than just during sex, and are created to help maintain hydration and support the elasticity and comfort of the vaginal tissues. They’re particularly useful for day-to-day dryness.

On-demand lubricants

If vaginal dryness in menopause is affecting your enjoyment of sex, as it does in over half (59%) of women, lubricants can be used to help reduce friction and increase comfort. They provide short-term relief to reduce irritation during sex.

Hormonal options

If the above options aren’t working, your provider may recommend and prescribe a hormonal treatment.

Local therapies

Prescription local vaginal estrogen products like creams, rings, and tablets deliver a small amount of estrogen directly to the vaginal tissues, helping to restore moisture, elasticity, and comfort. Unlike systemic estrogen, the hormone primarily stays local, and a minimal amount is absorbed into your bloodstream.

Non-estrogen options

For women who cannot use estrogen, or prefer not to, other local therapies such as non-estrogen prescription vaginal treatments could be considered. 

Systemic treatments

Systemic hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), delivers estrogen throughout the whole body and is mostly used when vaginal dryness or itchiness occurs alongside other menopause symptoms, such as hot flashes or night sweats. If you’re considering systemic treatment for vaginal dryness during menopause, discuss your needs with your clinician to weigh the benefits and risks and ensure it’s a suitable prescription for you.

Emerging or energy-based therapies

Energy-based devices, such as vaginal laser or radiofrequency treatments, have been explored as potential treatments for vaginal dryness and itchiness during menopause. However, current evidence is still limited, and studies on long-term safety and effectiveness are ongoing. If you’re considering these options, it’s important to discuss them with a qualified clinician.

There are a few self-care strategies you can try to help ease your symptoms and make you feel more comfortable. Examples include: 

• Using gentle, fragrance-free soaps and skincare

• Wearing breathable underwear

• Supporting natural lubrication during intimacy with longer foreplay 

• Using additional water- or silicone-based lubricants

It can also be useful to track your symptoms to spot any triggers that are causing your vaginal dryness. That way you’ll know what to stop using.

Vaginal dryness caused by menopause can really impact your sex life. Lubrication is important during intimacy, and without it, sex can become painful and less enjoyable. This can be frustrating for both you and your partner, but it’s important to remember you’re going through a natural part of life. Vaginal dryness is not a reflection of your partner, your relationship, or your interest in sex.

There are a few things you can do to improve your sex life despite menopausal vaginal dryness. The first thing is open communication with your partner about what’s going on with your body, so they can better understand and support you. Taking time for adequate arousal and using water- or silicone-based lubricants can also help reduce friction. 

For some people, pelvic floor physical therapy can also be beneficial, particularly if tightness, tension, or pelvic pain is contributing to discomfort.

Pelvic floor and bladder changes

For some women, GSM not only affects vaginal tissues — it also impacts the bladder and pelvic floor. This can result in urinary urgency, frequency, or an increased risk of urinary tract infections (UTIs). Your clinician may suggest pelvic floor physical therapy to help support bladder function, improve pelvic muscle control, and reduce discomfort. Your healthcare professional will be able to recommend specific exercises to help with your symptoms as part of a holistic care plan for your individual needs.

For some women, perimenopause symptoms like vaginal dryness and itchiness can persist into postmenopause, though the intensity may vary. Tracking the changes that take place with your body throughout this time should help you better manage and understand your symptoms. You can then discuss your needs with a clinician to find out the best management plan. It’s worth noting that women on contraception are usually advised to continue taking it as normal (if desired) until menopause is confirmed. And if you aren’t on contraception, use other forms of birth control as you can still get pregnant until you’ve gone 12 months without a period.

When symptoms shift over time

Menopause symptoms can often change over time, and your individual comfort plan will need to evolve with it. What works for you during early perimenopause might not be effective for your symptoms after menopause — whether for vaginal dryness and itchiness or another issue. Because of this, it’s recommended that you have regular check-ins with your clinician and adjust your care plan as needed.

When trying to deal with vaginal dryness and itching during menopause, avoid the application of products like petroleum jelly internally, as they aren’t intended for such use. You should also be careful with fragranced products because they can cause further irritation. 

When discussing menopause care with your clinician, your personal health history should also be taken into consideration. Conditions influenced by hormones, a history of certain cancers, or menopause medications that affect hormone levels can all shape what treatments are suitable for you. 

Questions to bring to your appointment

Coming prepared to your appointment can help you get more from your visit and help your clinician better understand your needs. Here are some ideas of the questions you can bring up:

• Based on my menopause symptoms, what are the most effective options for me?

• Here’s what I’ve already tried — does that change what you recommend next?

• Which treatment options — moisturizers, lubricants, hormonal, or non-hormonal therapies — are the best fit for my symptoms?

• Are any of these products or ingredients likely to irritate me, given my sensitivities or allergies?

• How do my sexual health concerns fit into the treatment plan?

• How should I use the treatments you recommend, and how long should I wait before assessing whether they’re working?

• When should I schedule a follow-up if my symptoms don’t improve or if they shift over time?

Vaginal dryness and itchiness can be an awkward thing to talk about, even with a professional. But rest assured, there's nothing to be embarrassed about — it's a normal part of this stage in your life.

Consider the following for your appointment:

1. Start with discussing your menopause symptoms and highlight any changes that have taken place.

2. Let your clinician know what your main priorities are, whether this be general comfort, sex, or urinary issues.

3. From there, you can both review menopause care options together, considering combinations of a few treatments for menopause symptoms if possible.

4. Lastly, schedule another appointment to reassess how things progress.

Planning follow-up

Be sure to book a follow-up visit with your clinician so that you can assess together how well your comfort plan for your vaginal dryness and itchiness is working. During this appointment, you’ll check in on your symptoms, discuss any changes and side effects that have come up, and discuss your overall satisfaction with how things are going. 

With your provider’s guidance, you can adjust your menopause care as needed, whether by trying a new product, stopping something that isn’t working, or combining strategies. This all helps to ensure you have the best menopausal care plan for your needs.

Vaginal dryness and itchiness are common symptoms that come with menopause. They are brought on by the declining estrogen levels in your body. Take comfort in knowing that you’re not alone, lots of women experience this throughout the entire menopause transition. If, like many women, it’s causing you discomfort or affecting your sex life, there are a few things you can do to help. From lubricants to hormonal treatments, it’s all about finding a menopause care plan that works for you. Speaking with a qualified clinician will help you make sense of your options and adjust your plan as your needs evolve, helping you find relief in the most effective ways.