Vaginal dryness in menopause affects the majority of women who have gone through the menopause transition, yet it remains one of the most underreported and undertreated symptoms. Research suggests that seven out of ten women experience genitourinary symptoms after menopause.
Understanding vaginal dryness: it is more than just dryness
Vaginal dryness is the most commonly used term for a broader range of changes known as the genitourinary syndrome of menopause (GSM). Unlike hot flushes, GSM does not improve without treatment and typically worsens progressively over time.
Symptoms of genitourinary syndrome of menopause
Vaginal dryness, itching, and soreness. Pain during sexual intercourse (dyspareunia). Vulval thinning and sensitivity. Urinary urgency, frequency, and leakage. Recurrent urinary tract infections.
Treatment options: the evidence-based UK approach
| Treatment | What it does | How to access |
|---|---|---|
| Moisturisers | Relieve dryness and irritation but do not reverse GSM tissue changes | Pharmacy or supermarket |
| Vaginal oestrogen | Treats the underlying oestrogen-related tissue changes | GP prescription, or pharmacy for Gina/Ovesse where eligible |
| Prasterone | Local DHEA option for selected women | Prescription after clinical review |
| Ospemifene | Oral SERM option for selected women | Prescription after clinical review |
| Pelvic floor physiotherapy | Helps pain, urinary symptoms and pelvic floor function | Private or NHS referral depending on area |
Step 1: Vaginal moisturisers
Available over the counter. Recommended UK products include YES VM, Sylk Natural Intimate Moisturiser, and Regelle. Used regularly every two to three days. They manage symptoms but do not treat the underlying cause.
Step 2: Vaginal oestrogen
The most effective treatment for GSM. Restores thickness, elasticity, and lubrication of vaginal tissues. Has minimal systemic absorption. Does not require progesterone. Safe for long-term use. UK preparations include Vagifem and Vagirux pessaries, Ovestin cream, Blissel gel, and Estring ring. Gina oestradiol vaginal tablet is available over the counter from pharmacies for women aged 50+.
Step 3: Prasterone (Intrarosa)
A vaginal pessary containing DHEA, converted to oestrogen and testosterone locally. A prescription option for some women who cannot or prefer not to use oestrogen; local NHS availability may vary, so discuss suitability with a clinician.
Step 4: Ospemifene
A selective oestrogen receptor modulator taken as a once-daily tablet. Available on prescription in some circumstances for women who find local vaginal preparations difficult to use.
Vaginal oestrogen and breast cancer history
Many women with a history of breast cancer are incorrectly told they cannot use any oestrogen including vaginal preparations. Guidance and evidence are more reassuring for low-dose local vaginal oestrogen than for systemic HRT, but decisions after breast cancer should be individualised with oncology or menopause-specialist input. A specialist discussion is more appropriate than a blanket answer.
Who to see for vaginal dryness
Your GP is the first port of call and can prescribe vaginal oestrogen and other preparations. A menopause specialist provides more comprehensive assessment. A pelvic floor physiotherapist addresses urinary symptoms and pain with sex.
For related support, see HRT in the UK, menopause physiotherapists, and sex and relationships support.
Frequently Asked Questions
What causes vaginal dryness during menopause?
Declining oestrogen causes the vaginal walls to become thinner, drier, and less elastic, leading to the range of symptoms known as the genitourinary syndrome of menopause.
Will vaginal dryness get better on its own?
No. Unlike many other menopause symptoms, vaginal dryness does not improve without treatment and typically worsens progressively over time.
What is the most effective treatment for vaginal dryness?
Vaginal oestrogen is the most effective treatment for moderate to severe vaginal dryness. It restores tissue thickness, elasticity, and lubrication, and significantly reduces urinary symptoms and recurrent UTIs.
Is vaginal oestrogen safe?
For most women, yes. Vaginal oestrogen has minimal systemic absorption, is considered safe for most women for long-term use, does not require progesterone, and has no time limit on use under NICE guidelines.
Can I use vaginal oestrogen if I have had breast cancer?
This depends on your individual situation and should be discussed with your oncologist and a menopause specialist. The evidence on vaginal oestrogen in women with breast cancer history is more reassuring than for systemic HRT. A specialist discussion is more appropriate than a blanket answer.
Is the Gina vaginal tablet available over the counter in the UK?
Yes. Gina oestradiol vaginal tablet has been available without prescription from UK pharmacies since 2022 for women aged 50 and over after a pharmacist consultation.
Can vaginal oestrogen help with recurrent UTIs?
Yes. Vaginal oestrogen restores the vaginal microbiome and urethral tissues, significantly reducing UTI recurrence. Women experiencing more than two or three UTIs per year should ask their GP whether GSM may be contributing.
Do I need systemic HRT as well as vaginal oestrogen?
Not necessarily. For women whose main concern is genitourinary symptoms, vaginal oestrogen alone is effective. It can also be used safely alongside systemic HRT.
Author: The Menopause Directory
About this guide
This guide is published by The Menopause Directory editorial team to help UK readers understand menopause symptoms, support options and services. It is for general information only and should not replace advice from a GP, pharmacist or qualified menopause specialist.
Last reviewed by The Menopause Directory editorial team.