What's behind it
When oestrogen falls after menopause, the vagina, labia and urethra become thinner and drier. Experts call this the genitourinary syndrome of menopause. It includes dryness, burning, itching, pain during sex, needing to pee often and recurrent urinary tract infections.
How common it is
In a 2021 review of 27 studies, 13 to 87 percent of postmenopausal women had such symptoms, depending on the study. The authors also found that many women don't know the cause, it rarely comes up at medical appointments and most are dissatisfied with the treatment they have used.
What can help
- Water-based lubricants during sex and vaginal moisturisers used regularly (NHS).
- Unperfumed washes instead of scented products and douches (NHS).
- Low-dose oestrogen applied directly in the vagina, as a cream, pessary or ring. A 2024 review of 46 studies found it may improve dryness and pain during sex. The same applies to vaginal DHEA and ospemifene. Most studies lasted only twelve weeks; long-term data are lacking.
According to the North American Menopause Society's 2022 position statement, low-dose vaginal oestrogen is an option when over-the-counter products aren't enough. That's a medical decision, especially after breast cancer.
When to see a doctor
- The dryness lasts a few weeks and self-help isn't working.
- It affects your daily life or your sex life.
- You have unusual discharge or bleed after sex or after menopause.
Pain during sex has many causes. More in the article pain during sex.