Vaginal atrophy is "incredibly common and underreported," says one OBGYN. From symptoms to treatments and prevention, here’s what experts want you to know.
About the experts
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Highlights
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Estrogen is most closely associated with sexual and reproductive development in women, but this hormone affects systems throughout the body. A woman’s estrogen levels peak during her reproductive years and typically begin to decline in her mid-forties—when perimenopause usually begins—though the Cleveland Clinic notes this drop can start earlier for some women. By menopause, estrogen levels fall sharply, with the National Institutes of Health (NIH) reporting a whopping 95% reduction on average.
This dramatic loss of estrogen drives many of the physical changes associated with menopause, from thinning hair and skin to weakening bones and blood vessels. But low estrogen is also linked to another extremely common—yet seldom talked about—condition called vaginal atrophy. It’s sometimes referred to as genitourinary syndrome of menopause (GSM), a broader term that includes vaginal changes as well as urinary symptoms related to low estrogen.
While vaginal atrophy is tied to natural aging processes, effective treatments are available. Yet in 2024, the NIH reported that 70% of women with signs and symptoms do not seek medical help, and fewer than half use treatments that could ease their discomfort.
What is vaginal atrophy?
“Atrophy literally means drying up or shrinking,” says Alan Lindemann, MD, an obstetrician and maternal mortality expert. He explains that estrogen plays a key role in keeping the vaginal tissue thick, robust, and elastic. “When estrogen is withdrawn, as in menopause, the skin of the vagina becomes thin, dried up, and not stretchy.”
Diminishing estrogen levels also reduce vaginal blood flow and lubrication, says Helai Hesham, MD, OBGYN, a female pelvic medicine specialist and reconstructive surgeon at Columbia University Irving Medical Center. “The decrease in estrogen also causes downstream events that change the bacterial profile of the vagina.” This age-related process, she says, allows for more inflammation-causing bacteria to take hold.
These physical changes can lead to symptoms such as dryness, irritation, soreness, and pain during sex, Dr. Hesham says. “Women can also experience urinary symptoms, including urinary frequency, urgency, urinary tract infections, and at times, incontinence.”
How common is vaginal atrophy?
Vaginal atrophy is extremely common—essentially every female who undergoes menopause will experience symptoms to some degree due to the body’s natural decline in estrogen levels, says Dr. Lindemann.
But even if it’s “normal,” vaginal atrophy can have serious effects. Research in Frontiers in Endocrinology shows that these changes can significantly impact a woman’s quality of life, contributing to pain and discomfort during daily activities, reduced emotional well-being, sexual dysfunction, and lower body image.
Despite this toll to a woman’s health and well-being, vaginal atrophy is “incredibly common and underreported,” Dr. Hesham says. According to the NIH, many women assume their symptoms are just a normal part of aging and feel reluctant or embarrassed to discuss them with their doctor.
In addition to post-menopausal women, an estimated 15% experience vaginal atrophy symptoms at a younger age. Women undergoing breast cancer treatment, who have recently given birth, or are breastfeeding are at a greater risk, explains Dr. Hesham. “Women who have had their ovaries removed are also at risk, and women who have decreased sexual activity.” Certain medications can contribute to vaginal atrophy as well, including those used to treat uterine fibroids or endometriosis.
How is vaginal atrophy treated?
There are two primary approaches to treating vaginal atrophy, Dr. Hesham says: hormonal and non-hormonal methods.
Non-hormonal vaginal atrophy treatments
Non-hormonal treatments are considered the first-line therapy for vaginal atrophy, according to the NIH. These include:
- Vaginal lubricants
- Vaginal moisturizers
- Vaginal laser therapy
“Vaginal lubricants are short-acting and used primarily by patients shortly before sexual activity,” Dr. Hesham says. “Vaginal moisturizers can be used to tackle dryness, itching, and pain with intercourse,” but she advises against using DIY remedies like Vaseline, vitamin E, or mineral oils. “Some use coconut oils [as a moisturizer], but patients do need to be careful with possible allergic reactions.”
The NIH adds that for women with vaginal atrophy, regular sexual activity—with or without a partner—can help maintain the integrity of the vaginal walls and support a healthy bacterial environment.
“Vaginal laser therapy is a newer technology that has also been used to localize therapy to the vagina, particularly for women who have either failed estrogen therapy or are not candidates for vaginal estrogen,” Dr. Hesham explains. According to the NIH, laser therapy aims to boost collagen production, potentially restoring vaginal moisture and elasticity.
Hormonal vaginal atrophy treatments
Localized vaginal estrogen therapy is the gold standard for hormone-based vaginal atrophy treatment because it delivers estrogen directly to the vaginal tissues. “These come in cream, ring, and pill forms and are placed in the vagina at different frequencies,” Dr. Hesham says.
Over time, this vaginal estrogen restores the natural thickness of the vaginal walls, a healthy pH, normal blood flow, and a balance of good bacteria. The NIH reports that most women notice symptom relief within two to four weeks—though it can take up to three months—and it’s effective in 80-90% of cases.
Oral hormone replacement therapy (HRT) may be prescribed for women experiencing more widespread menopausal symptoms—like hot flashes, mood changes, and sleep problems. Studies indicate that HRT alleviates vaginal atrophy symptoms in about 75% of women, according to the NIH. “But nearly 20% of patients will still need localized vaginal treatment, too,” Dr. Hesham says.
Localized vaginal treatment is generally considered safer, however. Oral HRT has previously been associated with a slightly increased risk of certain reproductive cancers—but in November 2025 the U.S. Food and Drug Administration (FDA) and U.S. Health and Human Services (HHS) announced their aim to remove “black box ” warnings from HRT products. “The agency is working with companies to update language in product labeling to remove references to risks of cardiovascular disease, breast cancer, and probable dementia. The FDA is not seeking to remove the boxed warning for endometrial cancer for systemic estrogen-alone products,” read the statement.
Can I prevent vaginal atrophy?
Research shows there are ways you can lower your risk for developing vaginal atrophy symptoms or reduce their severity. Studies consistently link cigarettes with poor vaginal health—and because smoking affects your circulation, it can reduce the flow of blood and oxygen to your vagina, compounding potential problems.
A healthy diet also plays a major role in vaginal health, as does maintaining an active sex life as you age, either with a partner or flying solo. Pelvic floor training—such as Kegel exercises—has been shown to reduce the severity of symptoms as well, especially in women who don’t get full relief from estrogen therapy alone, according to 2025 research published in Clinics and Practice.
The NIH also emphasizes that early recognition and treatment of vaginal atrophy can significantly reduce symptoms, prevent complications, and improve overall well-being. Vaginal dryness and pain during sex are the earliest signs, but it’s also important to see your doctor if you experience vaginal burning and itching, unusual discharge, spotting or bleeding, frequent UTIs, or changes in your urinary habits.
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Sources
- Alan Lindemann, MD, an obstetrician and maternal mortality expert
- Helai Hesham, MD, an OBGYN, female pelvic medicine specialist and reconstructive surgeon at Columbia University Irving Medical Center
- Cleveland Clinic: “Perimenopause”
- National Institutes of Health: “Genitourinary Syndrome of Menopause”
- Frontiers in Endocrinology: “Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women”
- Nature: "Cigarette smoking is associated with an altered vaginal tract metabolomic profile"
- Clinics and Practice: “Evaluating the Efficacy of Combined Intravaginal Estriol Therapy and Kegel Exercises in Managing Menopausal Atrophic Vulvovaginitis”
