What Menopause Does to Your Vagina—and What You Can Do About It

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We often talk about the astonishingly dry skin and thinning hair, but, really, no body part is safe from the fallout of menopause—and that includes the vagina. “This area’s under-discussed changes often catch women off guard,” says Lauren Streicher, MD, an ob-gyn and the author of Slip Sliding Away. “The shifts can range from surprising to downright painful.”

It all stems from the natural dwindling of estrogen during midlife. From that hormonal slowdown, the mucosa, or vaginal lining, takes a dramatic hit, as does the entire vulva. “In premenopausal times, estrogen brings blood flow to the area, which provides oxygen and nutrients that build that tissue, plumping it up and keeping it moist,” explains Suzanne Gilberg-Lenz, MD, an ob-gyn and the author of Menopause Bootcamp. “Those nutrients also feed collagen and elastin production, which give your vaginal tissue elasticity and bounce.”

“Women tell me their vagina feels like it’s shrinking. They’re right; it actually is,” says Streicher. “The vaginal rugae, accordion-like folds that help the vagina expand, become flattened and less flexible. The labia may also diminish. As a result, sex can become painful. It may not just be stabbing and burning. Multiple studies show that, often, women also experience a loss of libido and have trouble orgasming.”

The technical term for what’s happening is GSM, genitourinary syndrome of menopause (an update to the terrifying term vaginal atrophy), which encompasses a range of symptoms. “Some women feel the dryness and rigidity only when it causes pain during intercourse. Others start having urinary tract sensitivity. And a number of women experience discomfort during daily activities, like sitting,” says Gilberg-Lenz. “Suddenly you may notice your vagina, and anybody who owns a vagina knows that you don’t notice it until something’s off.”

What to do about all this

“Now that that sounds terrible, please know there are many things you can do to help,” swears Gilberg-Lenz. With advancements in medical science and a better understanding of women’s health, experts have strategies that can bring enormous relief. “It’s important to find what makes you feel good again,” says Streicher, “because you don’t go through menopause; you enter menopause. These changes are forever.” Here’s what to do:

Get topical hormones

Topical vaginal estrogen therapy can be a life-changer. “Vaginal estrogen, or vaginal hormones, are safe for everybody. I repeat, they are safe for everybody, no matter what else is going on,” Gilberg-Lenz assures us, frustrated that the message is still slow to permeate the wider culture. You have options: Creams, tablets, and rings can all be prescribed to replenish local estrogen levels, significantly improving vaginal elasticity and moisture. You can use them whether or not you’re on HRT. “You’re putting those hormones back into the tissue, helping it behave as it did premenopause,” she explains.

One suppository Gilberg-Lenz particularly loves, called Prasterone, is actually DHEA (dehydroepiandrosterone), a hormone that converts into estrogen and testosterone. Talk to your doctor about getting an Rx that works best for you.

Start a skin regimen for your vulva

It begins with cleansing properly. “Warm water is all you need—seriously,” says Gilberg-Lenz. “No wipes, harsh washes, or soap, which will dry you out even more.” Next, if you want to turn to nonprescription products to keep the area moisturized, Gilberg-Lenz recommends ones containing hyaluronic acid (her favorite moisturizing ingredient) to support that delicate tissue. (Shop her picks below.) According to both experts, this alone can make a world of difference in your day-to-day.

Pop a daily probiotic

Decreased estrogen causes the vaginal pH to rise, altering which bacteria can thrive. This can lead to irritation, infections, a change in smell, and bleeding from small tears. “The world of probiotics [for the vaginal canal] is still mysterious and unfolding, but there’s decent clinical data that support trying them,” says Gilberg-Lenz. The options below are all specifically designed to boost the flora and promote an environment that is less susceptible to UTIs.

Consider tech

Although they’re an investment and you’ll have to get over the concept of a powerful device being pointed at your precious private parts, energy-based therapies may be a good option to reinvigorate your vagina, according to Gilberg-Lenz. There are lasers (like the MonaLisa Touch) and radio frequency devices with or without microneedling (like Viveve, Votiva, EMFemme 360, and ThermiVa). All of these options micro-damage the skin, which spurs the body to bump up collagen and repair the tissue in a stronger, more robust way, Gilberg-Lenz explains, adding that they work best in combination with topical hormones that further enhance healing. “Yes, the concept is a little scary, but these techniques can work to improve tissue integrity, lubrication, elasticity, and sexual function,” she says.

Lube up

With sex, experts say the use-it-or-lose-it principle is very real, and lubricant makes a huge impact in ensuring pleasure and eliminating agony. “Silicone-based lubes that decrease friction are best because they don’t absorb too quickly,” says Gilberg-Lenz. “In contrast, water-based products can actually pull moisture out of the tissue and cause more dryness.” She’s a big fan of Überlube; its gentle formulation is compatible with sensitive tissues, but it’s still durable. Another good option: Replens Silky Smooth Personal Lubricant. Our advice in picking one? You may want to play around.

VMagic Vulva Balm

Massage a bit of this organic, natural balm, made with olive, avocado, and sea buckthorn oils, on dry vulva skin. (It’s not meant to go inside the vagina.)

V Relief Serum

Formulated for skin that may be itchy, stinging, or burning, this gentle serum hydrates and soothes with hyaluronic acid and a peptide made to reduce sensitivity.

Revaree Vaginal Moisturizer

For deeper hydration and longer-lasting comfort, Gilberg-Lenz recommends this hyaluronic acid vaginal insert.

Vaginal Hydrating Gel

This hyaluronic acid-based vaginal moisturizer comes as a gel with 10 single-use applicators. It's more affordable but a bit messier (you squeeze the gel into the applicator and then insert).

Private Party

Besides lactobacillus, a probiotic to help support the vaginal microbiome, this oral pill contains a cranberry supplement for optimal urinary tract function.

Vaginal Health Probiotic

These probiotic strains help to balance vaginal and gut flora to reduce odor, itchiness, and discharge. Swallow one capsule daily with water.

Silicone Lube

Unscented and flavorless, this simple formula made of silicone and vitamin E is easy to apply and leaves skin feeling smooth, not sticky or dry.

Silky Smooth Personal Lubricant

This no-frills silicone formula provides the slip you need for an accessible price at most drugstores.

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