Menopause and Vaginal Dryness
december 16, 2025 • Written by naturopathic doctor, hannah webb
The number one most frequent prescription I write in my practice is vaginal estrogen.
Why? Because many people in menopause experience vaginal dryness and discomfort or pain with intercourse. This happens because with the transition into menopause estrogen levels drop, which has a significant impact on the entire pelvic floor region.
Estrogen stimulates collagen production, which provides structural integrity. With less collagen, the epithelium of the vaginal canal becomes more friable, which is a medical term meaning the tissue becomes thinner and more easily irritated or injured with friction. Any kind of penetrative intercourse can cause microtears and bleeding, which is painful. This is extremely common during menopause.
And yet, I find many women and people with vaginas do NOT talk about this amongst themselves.
I make a point of asking about this with all of my patients in menopause, as well as sharing this information proactively with those entering the perimenopause transition, so they know what may be coming. Partners should also be offered this information, so there is shared understanding and the opportunity to anticipate and adapt together. I see how challenging this can be when it’s unexpected — it can negatively impact a person’s sense of self, confidence, and intimate relationships. Sexuality, for most people, is an important part of a vibrant, healthy life and relationship.
As a related aside, I believe it is so important we normalize conversations about sex. This is a healthy part of life, and when there are problems, naming them and talking about them openly reduces shame, and that in itself goes a long way.
We used to call this process “vaginal atrophy” but the current medical term is Genitourinary Syndrome of Menopause (GSM). This new term recognizes that the loss of estrogen affects a variety of tissues in different ways throughout the entire pelvic floor region including the vagina, vulva, bladder, and urethra.
These changes also cause reduced production of natural lubrication. In addition, unfortunately, estrogen loss can lead to decreased nerve sensitivity and sensation in the area. The lack of collagen and loss of structural integrity increases susceptibility to bladder infections, because the bladder and surrounding support tissues can shift slightly, meaning the distance through the urethra is shortened, which increases the risk of urinary tract infections.
What can you do?
The great news is, there are great treatments and strategies available. A visit to your primary care provider is an important first step to rule out anything else that could be going on (i.e. an infection or other vaginal issue beyond GSM).
Beyond that, there are a variety of effective topical options including non-hormonal topical treatments, as well as vaginal estrogen which is dramatically helpful for most, and has strong evidence for preventing recurrent UTIs. A good lubricant can be an important part of care.
But none of these treatments are available if you don’t first identify a concern and ask for support! I encourage you to talk about this, normalize it, and seek care as needed! It is absolutely possible to have a vibrant, pleasurable, sex life in middle age and beyond.
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Disclaimer: Information can be empowering, but we all have unique health profiles and needs. Health-related information contained in this article is intended to be general in nature and should not be taken as medical advice nor should it be used as a substitute for a visit with a licensed health care provider.