Vaginal dryness during menopause: causes, treatments, and tips for relief

Vaginal dryness during perimenopause and menopause isn’t just a private frustration; it’s a sensation that can interrupt the most ordinary and intimate moments. Vaginal dryness happens when there is less natural moisture in and around the vagina. This can cause irritation, itching, and pain during activities like sex, exercise, or even sitting.

“Vaginal dryness is a normal part of the hormonal shifts that happen during midlife, especially as estrogen levels drop in perimenopause, menopause, or after a surgery like ovary removal,” says Brittney Sellers, PT, DPT, a physical therapist at Hinge Health. “But there are lots of ways to feel better, from simple lifestyle changes to medication options. You don’t have to just put up with discomfort.” 

Read on to learn about vaginal dryness during menopause, what causes it, common symptoms, and how to treat it — including advice and pelvic exercises for more comfortable intimacy from Hinge Health physical therapists. 

Menopause starts when you haven’t had a period for 12 months. The phase leading up to it, called perimenopause, usually begins in your 40s or 50s and can last several years.

What causes vaginal dryness in menopause?

Vaginal dryness during perimenopause and menopause is usually related to lower estrogen levels, but other factors — such as certain medications, medical treatments, stress, or changes in sexual activity — can also play a role. Here’s more on the main factors that can contribute to vaginal dryness in perimenopause and menopause:

Decline in estrogen levels 

Estrogen is a hormone that helps keep vaginal tissue healthy, thick, and well-lubricated. As estrogen levels drop, the vaginal lining becomes less able to hold moisture, resulting in dryness. Lower estrogen also affects collagen production, reducing the vaginal tissue’s ability to stay flexible and strong. Here’s more on how lower estrogen can affect vaginal tissues:

• Thinning of vaginal tissues. With less estrogen, the vaginal walls become thinner and more fragile — part of a collection of changes known as genitourinary syndrome of menopause (GSM) (see more on this below). GSM makes tissues more sensitive, so dryness, irritation, and discomfort are more likely during activities and sex.

• Reduced natural lubrication. Hormonal changes can decrease vaginal lubrication. Estrogen helps maintain the glands and vaginal lining that produce natural moisture, so when levels drop, the vagina can become drier and less able to respond to arousal or friction. In turn, this can make sexual activity and even day-to-day movement feel less comfortable.

• Decreased blood flow to the vaginal area. Declining estrogen levels also affect blood vessels in the pelvic region. Reduced blood flow can affect the health, elasticity, and resilience of vaginal tissues, making it harder to retain moisture and recover from irritation. 

Medications and medical treatments

Certain medications — such as allergy medicines (antihistamines), some antidepressants, and oral contraceptives — can contribute to vaginal dryness by affecting hormone balance or directly reducing moisture in the body. Cancer treatments like chemotherapy or anti-estrogen medications like tamoxifen (a commonly-used medication for estrogen receptor-positive cancers) can also lead to vaginal dryness. If you think your medications might be causing vaginal dryness or other side effects, talk to your provider about options.

Stress 

Chronic stress and anxiety can affect hormone levels, disrupt arousal, and ultimately reduce natural lubrication. Stress during midlife can mean being pulled in multiple directions — balancing parenting responsibilities, career demands, caring for aging parents, or coping with relationship changes. These ongoing pressures can impact not only your mood and energy but also your body’s capacity for relaxation and arousal, both of which are linked to vaginal moisture.

Changes in sexual activity

Less frequent sexual activity may also contribute to vaginal dryness. Sexual arousal naturally increases blood flow to the pelvic region and helps keep vaginal tissues flexible and healthy. When sex or other forms of intimacy become less frequent — whether due to relationship changes, time constraints, stress or mood issues, or a decrease in libido  — it can lead to further tissue dryness and discomfort. These changes are common during midlife when busy schedules and emotional shifts can make it harder to prioritize intimacy.

“If you’re dealing with dryness, make sure to talk with your healthcare provider so you can find out what’s actually causing it,” says Dr. Sellers. “Getting to the root cause matters, because different factors — like hormones, medications, or lifestyle — might call for different treatments.”

Why is my vagina dry during sex?

It’s common for vaginal dryness to feel more noticeable during sex, especially in perimenopause and menopause. Most of the same factors that cause dryness daily — like declining estrogen, thinner tissues, less natural lubrication, and certain medications — can also make sex less comfortable. For many, dryness is more obvious with friction or if there’s less arousal or increased stress. Even if you feel desire for sex, dryness can still occur, and it’s not a reflection on your interest or relationship.

Vaginal dryness and genitourinary syndrome of menopause

Vaginal dryness is one of the main symptoms of genitourinary syndrome of menopause (GSM), a collection of symptoms that are related to hormone changes during the menopause transition. 

As estrogen levels drop, the tissues of the vagina and urinary tract become thinner, drier, and more sensitive. GSM can show up in several ways — vaginal dryness, needing to urinate urgently and frequently, leaking urine, more frequent urinary tract infections (UTIs), waking up more than once at night to pee, itching or burning, and increased sensitivity to clothing or pressure. It can also cause pelvic pain, pain or bleeding during or after sex, and even decreased arousal and desire. 

One of the most effective treatments for GSM is long-term, low-dose vaginal estrogen, available as creams, tablets, suppositories, or a flexible ring that slowly releases estrogen (see more on this and other treatments below). This medication can restore healthy tissue, improve lubrication and blood flow, reduce UTIs and nighttime bathroom trips, and make sex more comfortable. Other options include non-hormonal vaginal moisturizers and lubricants for temporary relief, and pelvic floor exercises to help with bladder and pelvic symptoms. Talk to your provider about which approach might work best for your pelvic and sexual health.

Symptoms of vaginal dryness in menopause

Menopause-related vaginal dryness can cause a range of symptoms, including itching or burning, pain or bleeding during sex or penetration, more frequent urinary tract infections, narrowing or discomfort in the vaginal opening, reduced interest in sex due to discomfort, and urinary symptoms like frequent urination or waking at night to pee. The following are some common vaginal dryness symptoms during perimenopause and menopause:

• Vaginal itching or burning. Dryness can cause persistent or occasional itching or a burning sensation, especially around the vulva and inside the vagina.

• Painful sex or penetration (dyspareunia). Less lubrication makes sex or insertion of anything into the vagina (like tampons) uncomfortable or even painful. 

• Light bleeding during or after intercourse. Fragile, dry vaginal tissues may bleed slightly during or after sex or a pelvic exam.

• Frequent urinary tract infections. Drier, thinner vaginal tissues are less able to resist infections, raising the risk of UTIs. Changes in vaginal pH can also impact the balance of bacteria.

• Narrowing (stenosis) of the vaginal opening. Tissue changes can cause the vagina to feel tighter (stenosis), less stretchy, or uncomfortable at rest, during movement, or with penetration.

• Decreased libido due to discomfort. If sex is uncomfortable or painful, your interest in sexual activity may decrease, even if desire remains.

Treatments for vaginal dryness during menopause

Vaginal dryness during perimenopause and menopause can be managed in several ways, often with a combination of treatments. These include prescription low-dose vaginal estrogen or hormone therapy for longer-term tissue health, over-the-counter lubricants and moisturizers for immediate relief, and pelvic floor exercises and movement to support circulation and comfort. Some people benefit from supplements or gentle products like coconut oil. Staying active and maintaining regular sexual activity can also play a role in restoring healthy tissue and improving symptoms.

Talk to your provider before using over-the-counter options or to explore prescription treatments for vaginal dryness. Here’s more on treatments for vaginal dryness during perimenopause and menopause:

Prescription low-dose vaginal estrogen

Topical vaginal estrogen treatments (estradiol) are considered the gold standard for supporting healthy vaginal tissues when estrogen levels are low. Vaginal estrogen can help restore tissue health, improve blood supply, relieve urinary urgency and frequency, preserve your vaginal microbiome, and reduce UTIs. It can decrease nighttime bathroom trips, minimize vulvovaginal sensitivity, increase lubrication, and make sex more comfortable.

Vaginal estrogen comes in a few forms: creams, dissolving tablets, or suppositories for the vagina and vulva, used two or three times a week. Another convenient option is a vaginal estrogen ring: a small, flexible ring that releases estrogen gradually over 90 days. The amount of estrogen absorbed into your bloodstream from topical treatments is very low and does not increase the risk of cardiovascular disease or cancer, according to research. 

Many providers prescribe vaginal estrogen in addition to systemic menopause hormone therapy (MHT). The American College of Obstetricians & Gynecologists supports the use of vaginal estrogen in people treated for estrogen-dependent breast cancers. (Talk to your doctor about vaginal estrogen with menopause hormone therapy or after cancer treatment, or non-hormonal options.)

Other prescription medications

• Vaginal DHEA (dehydroepiandrosterone, or prasterone). Vaginal DHEA is a treatment you apply directly to the vaginal tissues. DHEA is sometimes thought of as an alternative to estrogen, but it’s actually an estrogen precursor —it helps your body make estrogen. When used in the vagina, DHEA may help boost local hormone levels to relieve dryness and discomfort. Studies show vaginal DHEA is safe and effective for treating vaginal symptoms during perimenopause and menopause. Because DHEA has hormonal effects, it may not be recommended if you need to avoid hormone-based therapies. (Oral DHEA supplements aren’t proven to help with vaginal dryness.)

• Ospemifene. Ospemifene is non-hormonal oral prescription medication used to treat moderate to severe vaginal dryness and pain with sex, especially in people who cannot or do not wish to use hormones. While it’s not a hormone itself, ospemifene acts on estrogen receptors in the vaginal tissues to help improve tissue health, increase lubrication, and make intimacy more comfortable.

Vaginal moisturizers

Non-prescription vaginal moisturizer creams or suppositories are designed for regular, everyday use to help retain hydration, soothe dryness, and maintain comfort. They often contain hyaluronic acid or vitamin E. Vaginal moisturizers are not the same as lubricants, which are used during or immediately before sex for short-term relief of vaginal dryness and discomfort during intercourse. 

Some people also find organic coconut oil effective for relieving dryness or soothing irritation. 

Moisturizers can ease discomfort and reduce dryness, but they don’t address the tissue changes caused by low estrogen. You can use both moisturizers and lubricants together — moisturizers provide ongoing comfort, while lubricants add extra comfort and relief during intimacy. 

Menopause hormone therapy

Systemic menopause hormone therapy (MHT) includes medications with forms of the hormones estrogen and progesterone, or a mix of both. Systemic treatments (like tablets, patches, sprays, or gels) enter your bloodstream and affect your whole body. 

This is different from topical  treatments, such as vaginal estradiol creams, rings, or tablets, which are designed to work locally in the vaginal and vulvar tissues.

Systemic hormone therapy (MHT) can help relieve a wide range of menopausal symptoms, including hot flashes, night sweats, and vaginal dryness. MHT can also help prevent osteoporosis, may reduce your risk of cardiovascular disease depending on when it’s started, and can improve joint and muscle health, support better sleep and mental health, and even lower your risk of colon cancer. 

Because systemic hormone therapy may not provide enough relief specifically for vaginal dryness symptoms in some people, they may use both systemic MHT and local (vaginal) treatments together. Your healthcare provider can help you determine the best treatment plan  based on your personal health and symptoms.

Supplements

Many plants, herbs, and foods have been used for centuries to treat perimenopause and menopause symptoms, including vaginal dryness. Supplements are not FDA-regulated for dosage, ingredients, effectiveness, or safety. Omega-3 supplements, which are anti-inflammatory, and vitamin E, which supports cell health, are both being studied for their role in tissue moisture and repair. Because more research is needed, evidence is mixed, and side effects can occur, check with your provider before taking them.

Physical therapy and targeted exercises

Targeted exercises can improve pelvic muscle health and coordination, increase blood flow to the vaginal and pelvic tissues, and support tissue healing. These benefits can indirectly help ease vaginal dryness while also supporting sexual function and addressing related symptoms like urinary leakage. 

You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

Stay active

Regular physical activity improves blood flow throughout your body, including to the pelvic region, which can support the health of vaginal and pelvic tissues. Staying sexually active can also help maintain blood flow and tissue flexibility. Improved circulation from movement and intimacy helps deliver nutrients and promotes tissue repair, which may indirectly help ease perimenopause and menopause symptoms like vaginal dryness.

Physical therapy for perimenopause and menopause symptoms

Physical therapy (PT) is a key treatment for menopause symptoms such as painful sex, pelvic pain, joint discomfort, urinary incontinence, and musculoskeletal changes. PT focuses on safe movement, targeted exercises, and stretches designed to relieve discomfort and support your changing body. 

The goal of physical therapy is to target the areas that need the most support — whether that means strengthening, stretching, improving mobility, or increasing coordination. Physical therapy can also support bladder and bowel function and reduce pain associated with hormonal and tissue changes, while improving mobility and functional strength.

A physical therapist (PT) can assess your movement patterns to customize an exercise program that’s right for you. They can also suggest ways to modify your everyday activities to minimize symptoms and empower you with tools and tips to help reduce pain, improve posture, and support pelvic floor, joint, muscle, and bone health. Recommendations may include strategies like bladder training, relaxation techniques for pelvic muscles, ergonomic adjustments, and advice on movement routines that enhance bone and muscle health.

If you’re dealing with painful sex due to vaginal stenosis or tightness, your pelvic floor physical therapist may also recommend tools like vaginal dilators. “These toolscan gently expand the vaginal canal and reduce discomfort with vaginal penetration,” says Dr. Sellers.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found below.

“Medications like hormone therapy can address some menopause symptoms, but physical therapy can still play a big role in your well-being,” says Dr. Sellers. PT isn’t just about improving pelvic symptoms — it’s also about helping you stay strong, support your bones and joints, manage stress, and boost your mood, she explains. “Physical therapy offers practical tools to help you feel better and stay active in daily life during the menopause transition.”

These exercises target key muscles and movement patterns that play an important role in comfort during menopause, including making sex less painful. Diaphragmatic breathing and reverse Kegels work together to promote relaxation and coordination of the pelvic floor, easing tension that can cause discomfort or pain with penetration. Bridge pose and butterfly stretch build strength and flexibility in the hips and pelvic floor muscles, making it easier to move and maintain comfortable positions during intimacy. Child’s pose adds gentle relaxation, relieves pressure in the pelvis, and supports spinal flexibility — factors that can help accommodate different positions and reduce tension or irritation from vaginal dryness. Practicing these moves regularly can improve pelvic muscle health, support flexibility and relaxation, and help make sex more comfortable and enjoyable during perimenopause and menopause.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

Vaginal dryness often improves with the right treatment. Talk to a healthcare provider if your vaginal dryness is severe, getting worse, or causing difficulty with activities, including painful sex. It’s also a good idea to get care if you have:

• Bleeding after sex or between periods

• New or increasing pelvic or vaginal pain

• Symptoms of a possible UTI (pain with urination, frequent or urgent need to pee, fever, chills)

• Unexplained vaginal discharge, odor, or burning

• Symptoms that don’t improve with at-home treatments

PT tip: Use movement to boost your pelvic health

“Your pelvis is like the anchor of your body — so much connects right there, from blood flow to nerves to movement,” says Dr. Sellers. Gentle exercises for your pelvic floor, hips, and core can really help nourish and support all those tissues, and can make a difference in your comfort and confidence, she explains. “If you’re dealing with dryness, discomfort, or any changes in your sexual health, a physical therapist can help you find the right strategies for your body and your goals.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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