Vaginal dryness is one of the most common symptoms women experience during perimenopause and menopause, yet it often goes untreated. Many women assume discomfort is simply part of aging and something they must tolerate. According to Dr. Troy Robbin Hailparn, a board-certified OB-GYN specializing exclusively in cosmetic gynecology, that assumption keeps countless patients from getting the care they need.
With more than 30 years in practice and over 9,000 procedures performed, Dr. Hailparn has helped thousands of women address physical changes linked to hormonal shifts. Among those concerns, vaginal dryness remains one of the most frequent and misunderstood conditions.
© Getty ImagesWhat Causes Vaginal Dryness During Perimenopause and Menopause
The root cause of vaginal dryness during this stage of life is the drop in estrogen levels. Estrogen plays a key role in maintaining vaginal tissue health, helping keep the lining thick, elastic, and naturally lubricated.
As estrogen begins to decline during perimenopause and falls significantly after menopause, the vaginal tissue undergoes structural changes. The walls thin, elasticity decreases, and the body produces less natural moisture.
Dr. Hailparn explains that these changes are part of a broader medical condition. “The primary driver is estrogen loss. Estrogen keeps vaginal tissue thick, elastic, and well-lubricated,” she says. “As estrogen declines during perimenopause and drops significantly after menopause, the vaginal walls thin, become more fragile, and produce less natural moisture.”
© Getty ImagesThese changes are medically known as genitourinary syndrome of menopause (GSM), a condition that affects the vagina, vulva, and urinary tract. One important distinction many women do not realize is that vaginal dryness typically does not resolve over time without treatment. “One thing many women don’t understand is that it doesn't get better on its own,” Dr. Hailparn says. “In fact, unlike hot flashes, which often improve over time, vaginal dryness tends to worsen without treatment.”
The Gold Standard Treatment for Hormone-Related Dryness
For women experiencing vaginal dryness caused by estrogen loss, the most widely recommended treatment is low-dose vaginal estrogen therapy.
This therapy works directly in the vaginal tissue rather than affecting the entire body. By restoring estrogen locally, it helps rebuild healthy tissue, increase natural lubrication, and improve elasticity. “For most women, low-dose vaginal estrogen is the gold standard,” Dr. Hailparn explains. “It works locally, restoring moisture and tissue health right where it's needed.”
© Getty ImagesBoard-certified gynecologist and pelvic floor specialist Dr. Patricia Wallace, MD, told HOLA! that "Vaginal Estradiol is the gold standard treatment for GSM related to estrogen loss." According to Wallace, "this restores the skin integrity (epithelium), lowers pH, restores proper vaginal microbiome, which leads to proper lubrication, reduction in vaginitis, and urinary tract infections."
Dr. Wallace also said that "additional hormone therapies that help restore the health of tissue include Vaginal DHEA, which can be compounded or commercially available on a suppository called Intrarosa, or weaker estrogens like estriol."
Because the medication is applied directly to the vaginal area, only small amounts enter the bloodstream. Major medical organizations, including the American College of Obstetricians and Gynecologists and the North American Menopause Society, support its use for most women.
© Getty ImagesDr. Hailparn notes that fear of hormone therapy often prevents patients from exploring treatments that could significantly improve their symptoms. “Women deserve to know this, because fear of hormones keeps too many from getting relief they're entitled to,” he says.
Despite the fear, Dr. Wallace says people seeking treatment can rest easy as "the FDA has removed the Black Box warning on Vaginal Estrogen," because "there is very little systemic absorption. It is safe for breast cancer survivors also, as there have been no scientific studies showing vaginal estradiol increases the recurrence of breast cancer or other cancers."
Non-Hormonal Treatments That Improve Vaginal Tissue Health
Not every patient wants to use hormone therapy, and for some women, it may not be recommended. Fortunately, several non-hormonal treatments are available that focus on improving tissue quality and circulation.
Dr. Hailparn regularly uses energy-based technologies in her practice. “I also use energy-based treatments like ThermiVA and EmpowerRF (Morpheus8) in my practice,” she explains. “These radiofrequency devices stimulate collagen and improve vaginal tissue quality without hormones.”
© Getty ImagesRadiofrequency treatments work by heating tissue to stimulate collagen production and increase blood flow. Over time, this can improve vaginal elasticity and natural lubrication.
Dr. Wallace also warns that there is more pain and some downtime associated with these treatments. "Laser-based treatments came on the market for feminine rejuvenation about the same time, utilizing CO2 laser technology to gently resurface and stimulate collagen internally," she suggests.
Another option is the O-Shot, a treatment that uses platelet-rich plasma derived from the patient’s own blood to promote tissue repair and regeneration. “For women who want a biological boost, the O-Shot can also help restore sensitivity and lubrication,” Dr. Hailparn says.
These treatments offer alternatives for women who prefer hormone-free solutions or who are seeking additional ways to support vaginal health.
Lifestyle Habits That Can Support Vaginal Moisture
While medical treatments often play the largest role in addressing vaginal dryness, certain daily habits can support tissue health. Dr. Hailparn explains that regular sexual activity helps maintain circulation and elasticity in vaginal tissue. “Staying sexually active, with a partner or solo, increases blood flow to vaginal tissue and helps maintain elasticity,” she says.
Hydration also supports tissue health throughout the body, including the vaginal lining. Diet may play a small supportive role as well. Foods rich in phytoestrogens, such as flaxseed, soy, and legumes, contain plant compounds that mimic mild estrogen activity.
© GettyOther helpful practices include avoiding harsh soaps around the genital area and wearing breathable cotton underwear to reduce irritation. However, lifestyle changes alone usually do not resolve dryness caused by estrogen loss. “I always tell my patients that lifestyle habits are the complement, not the cure,” Dr. Hailparn explains. “If the underlying estrogen deficiency isn't addressed, dryness will persist.”
"Having proper vaginal hygiene and pH will help keep the tissue healthy."
"There are over-the-counter (OTC) treatments that can support lubrication, but won't really restore the tissue," Dr. Wallace explains. "Vaginal moisturizers with minimal preservatives are preferred, as preservatives like polypropylene glycol can be irritating, and glycerin-containing moisturizers and lubricants can lead to yeast infections. I do like a coconut-based or cocoa butter natural insert for moisture as needed."
When Vaginal Dryness Should Be Evaluated by a Doctor
Many women initially try over-the-counter moisturizers or lubricants to manage symptoms. While these products can provide temporary relief, persistent dryness should be evaluated by a healthcare professional. “If dryness is causing pain during sex, recurring irritation, urinary symptoms like urgency or frequent infections, or is affecting your quality of life, that's not something to manage alone with an over-the-counter moisturizer,” Dr. Hailparn says.
Vaginal dryness can occasionally signal other medical conditions that require diagnosis and treatment. “I also want women to know that vaginal dryness can sometimes signal other conditions, such as lichen sclerosus or an infection, that need proper diagnosis,” she adds.
© Getty ImagesDr. Patricia Wallace, who is also the owner and director of the Center for Pelvic Health and Wellness in Orange County, says that "women should not live with dryness or pain. GSM can be progressive, and women can have more chronic, irreversible changes in the vulva and vagina, leading to pain and permanent damage to tissue, loss of intimacy, recurrent infections, cracking, fissures, and difficulty with complete recovery."
For many women, the biggest barrier to treatment is simply the hesitation to bring up the issue. “My honest advice is don't wait,” Dr. Hailparn says. “So many women suffer in silence for years because they think this is just something they have to live with. It isn't. There are effective treatments, and you deserve to feel comfortable in your own body.”
Why Treating Vaginal Dryness Matters
Perimenopause and menopause bring many changes, but persistent discomfort should never be considered inevitable. Vaginal dryness can affect intimacy, urinary health, and everyday comfort, yet effective treatments are widely available.
© Getty ImagesFrom localized estrogen therapy to radiofrequency treatments and regenerative procedures, modern gynecology offers several options that can help restore vaginal health.
For many women, the most important step toward relief is recognizing that the condition is common, treatable, and worth discussing with a healthcare provider.
