Vaginal Dryiness  in Perimenopause and Menopause:

Causes, Diagnosis, and Treatment Options

Genitourinary Syndrome of Menopause (GSM).
GSM includes vaginal dryness, irritation, pain during sex (dyspareunia), urinary symptoms, and decreased sexual function—all due to declining estrogen and androgen levels.


 What Causes Vaginal Dryness?

Low Estrogen (primary cause), thinning of vaginal walls, reduced blood flow, lower glycogen and moisture, low Testosterone, decreased blood flow and sensitivity in vulvar and clitoral tissue

Postpartum, breastfeeding, natural drop in estrogen causing temporary vaginal atrophy

Cancer treatments (e.g., chemo, radiation, aromatase inhibitors) drastically reduce hormone levels

Certain medications - antihistamines, SSRIs, and anti-estrogens can worsen dryness

Lack of sexual activity, reduces local blood flow and elasticity


  Symptoms of GSM / Vaginal Atrophy

  • Vaginal dryness, itching, or burning
  • Painful intercourse (dyspareunia)
  • Decreased arousal and lubrication
  • Loss of elasticity or tightness
  • Urinary urgency, burning, or frequent UTIs
  • Clitoral sensitivity loss or discomfort


 Treatment Options for Vaginal Dryness

   Vaginal Estrogen Therapy (First-line Treatment)

Helps reverse tissue atrophy, restore moisture, and improve elasticity.
Very low dose—primarily local, not systemic.

FormExampleFrequencyCreamEstradiol 0.01% (e.g., Estrace)Daily x 2 weeks, then 2–3x/weekTabletVagifem (10 mcg estradiol)Daily x 2 weeks, then 2x/weekRingEstring (2 mg, 90-day release)Insert every 3 monthsSuppositoriesEstriol 0.5 mg or compounded blends3–5x/week as needed


Safe for most women—including many with a history of breast cancer (oncology supervision recommended).

   Vaginal DHEA (Prasterone, Intrarosa)

  • Converts locally to estrogen and testosterone
  • FDA-approved for dyspareunia due to menopause
  • Helps with dryness, tissue tone, and libido

 Clitoral or Vaginal PRP Injections (O-Shot®)

  • Platelet-Rich Plasma is injected near the clitoris and vaginal wall
  • Stimulates nerve growth, tissue repair, and collagen production
  • May improve arousal, sensitivity, lubrication, and orgasm
  • Often combined with laser vaginal rejuvenation (e.g., CO2 or Er:YAG laser)

   Vaginal Testosterone (Compounded)

Used for:

  • Persistent dryness or sensitivity loss despite estrogen use
  • Clitoral atrophy or decreased arousal

Often combined with estriol in balanced vaginal creams.

  Non-Hormonal Treatments

Hyaluronic acid suppositories - deep moisture and elasticity (e.g., Revaree)

Vitamin E suppositories - natural emollient, some anti-inflammatory effects

Coconut or olive oil - as-needed lubrication or gentle moisturizer

Lubricants (water/silicone-based) - short-term symptom relief during intimacy


Summary

Vaginal dryness, or Genitourinary Syndrome of Menopause, is a treatable condition most often caused by low estrogen and testosterone. Modern therapies—ranging from local hormones (estradiol, testosterone, DHEA) to advanced regenerative treatments like PRP injections—can restore tissue health, comfort, and intimacy. Early treatment prevents worsening atrophy and maintains quality of life.

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