Vaginal dryness is caused by a decline in estrogen levels in the blood. Estrogens (the "female" sex hormones) influence hundreds of functions in the body, including the menstrual cycle. These hormones also help maintain the tissue strength of the vagina, labia, clitoris, vulva, urethra, and bladder. Between premenopause and postmenopause, women experience a 95% reduction in their estradiol estrogen levels.

When estrogen levels decline, usually due to menopause, women can experience the following symptoms:

● Less vaginal lubrication

● Thinning of vaginal tissue due to reduced collagen production

● Loss of vaginal elasticity

● Increased vaginal pH

● Loss of pubic hair

Collectively, these symptoms make up a condition that healthcare providers call vaginal atrophy, vulvovaginal atrophy, atrophic vaginitis, or—since 2014—the genitourinary syndrome of menopause (GSM).

GSM can lead to discomfort, pain, sexual impairment, and distress. Research suggests that this treatable condition affects up to 85 percent of women over age 40.

Your clinician may prescribe a vaginal estrogen therapy like conjugated vaginal estrogen (Premarin) cream, or estradiol, which is available in cream, tablet, capsule, and ring form. They may also prescribe ospemifene (Osphena) tablets or Prasterone (Intrarosa) vaginal inserts.

Vaginal estrogen therapy can help increase vaginal secretions, restore normal vaginal pH and microflora, and strengthen vaginal tissue. These hormonal medications can also have urinary tract benefits.

For mild symptoms, your clinician may recommend one of the following over-the-counter (OTC) vaginal dryness treatments:

● Nonhormonal vaginal moisturizers (bioadhesives) include Replens, Vagisil Moisturizer, Feminease, Moist Again, K-Y Liquibeads, Hyalo GYN, and Revaree suppositories

● Vaginal lubricants can be water-based (Astroglide, Slippery Stuff, K-Y Jelly), silicone-based (Pjur, ID Millennium), and oil-based (Elegance Women's Lubricant, Simply Slick)

OTC vaginal moisturizers and lubricants can enhance comfort during sex and increase vaginal moisture, but, unlike hormone-based menopause treatments, they won't reverse vaginal atrophy.

Please note: This information is for general reference only. Your online doctor or nurse practitioner will review your symptoms and health history to determine which (if any) vaginal atrophy treatments are medically appropriate.

Vaginal atrophy, which many clinicians now call genitourinary syndrome of menopause (GSM), comprises far more than just vaginal dryness. GSM can have a wide range of symptoms, including the following:

● Vaginal burning, irritation, or itching

● Milky or yellow vaginal discharge

● Inflammation (swollen vulva or labia)

● Dryness during daily activities

● Dryness during sex

● Pain or discomfort during sex

● Sensitive vaginal tissue sometimes leading to small tears (fissures)

● Loss of vaginal elasticity (tightness)

● Recurring urinary tract infections (UTIs)

● Urinary urgency

● Pain or buring when urinating

● Levator spasm (sporadic pain in your rectum)

These symptoms often occur at the same time as other common menopause symptoms like hot flashes.

Menopause isn't the only cause of vaginal atrophy. Other possible reasons for low estrogen levels include the following:

● Childbirth (vaginal dryness postpartum)

● Breastfeeding

● Hypothalamus issues that lead to a period stopping (amenorrhea)

● Antiestrogenic medication

● Pelvic radiation

● Surgical removal of the ovaries

● Breast cancer

The median age of menopause is 51.4 years, but younger women can also experience the change. When someone 40 to 50 goes through menopause, it's called early menopause. When someone younger than 40 experiences it, it's called primary ovarian insufficiency.

There are no clinically-proven natural remedies for vaginal dryness that will increase estrogen levels in the body. But research shows that having sex can help preserve vaginal tissue, probably by increasing blood flow to the area.