Treatment options for menopause symptoms mean you don’t have to accept them as “part of aging.” For vaginal symptoms, your doctor can help.

Story by: David Steen Martin; Reviewed by Kris E. Barnsfather, M.D. on January 26, 2024

The loss of the hormone estrogen during menopause can cause your vagina to lose its elasticity and cause other changes in the vaginal tissue, resulting in vaginal atrophy.

Vaginal atrophy also means your vagina has less natural lubrication and can result in vaginal bleeding or spotting during sex, while sex itself can become painful.

“Vaginal atrophy can affect your quality of life, your self-esteem and intimacy with your partner,” said Kris E. Barnsfather, M.D., an OB/GYN with Norton Women’s Care. “There’s no reason you have to accept that as a part of aging.”

Unlike other symptoms of menopause such as hot flashes and night sweats, which are temporary, vaginal symptoms will increase over time.

Roughly half of all women will experience vaginal symptoms after menopause.

Your primary care provider or your gynecologist can diagnose vaginal atrophy and discuss possible treatments with you.  

One treatment option is hormone replacement therapy. This will raise estrogen throughout the body, which will address vaginal atrophy and other symptoms of menopause, such as hot flashes. Estrogen and progesterone replacement therapies come with risks, however. These include raising the risk for stroke, breast cancer and blood clots.

Alternatively, vaginal estrogen, which is available by prescription, will restore estrogen levels in your vagina. Vaginal estrogen is applied once or twice a day for a few weeks, followed by a maintenance dose of two or three times a week.

You should not use topical estrogen during nights you plan to have intercourse. Also, there’s no need to use vaginal estrogen until you are experiencing symptoms.

It’s unclear whether it is as safe as systemic hormone replacement therapy.

Water-based lubricants and long-acting vaginal moisturizers also can eliminate pain during intercourse. You should avoid alcohol-based lubricants, which will make symptoms of vaginal atrophy worse. You also should also avoid products with harsh chemicals or fragrances, because they may alter the vaginal pH and cause external irritation.

An oral medicine approved for painful intercourse, sold under the brand names Osphena and Senshio, has been shown to improve vaginal dryness, and other potential medications are being studied.

In addition to dryness and irritation, menopause also causes a loss of fat at the entrance of the vagina, called the vaginal introitus, which can become smaller over time. Physical therapy at home using mineral oil on the introitus helps keep the vaginal tissue healthy.  

Vaginal dryness can affect masturbation, arousal and physical and emotional pleasure. It also can cause pain during sex. Studies have found many patients attribute these symptoms to natural aging — rather than menopause — and don’t talk to their gynecologist or primary care provider about them.

If you are experiencing symptoms of vaginal atrophy, talk with your health care provider to determine the best treatment for you.