Dryness & Discomfort - Come Sit With Me | A Perimenopause Resource

Let’s talk about something that doesn’t get talked about enough.

The changes to vaginal and urinary tissues that occur during perimenopause and beyond are among the most common symptoms—affecting about 45% of postmenopausal women—and among the most undertreated. Wrapped in silence. Wrapped in stigma. When they shouldn’t be wrapped in anything but honest conversation and effective treatment.

What Happens

Vaginal and urinary tissues are particularly sensitive to estrogen. When estrogen levels change, these tissues respond:

Dryness and thinning: The vaginal walls become thinner, drier, less elastic
Changed pH: The vaginal environment becomes less acidic, which can alter the microbiome and increase infection risk
Irritation and discomfort: Daily discomfort, not just during intimacy
Painful intercourse: What used to be pleasurable becomes painful—or impossible
Urinary changes: Urgency, frequency, burning, or a constant feeling of needing to go
Recurrent UTIs: The changed vaginal environment makes infections more likely

This constellation of symptoms has a clinical name: Genitourinary Syndrome of Menopause (GSM). The name isn’t important. What matters is that it’s real, it’s common, and it’s treatable.

Why This Is Different

Here’s something crucial to understand: unlike hot flashes, these symptoms typically don’t improve on their own.

Hot flashes, for many women, eventually ease as the body adapts to stable postmenopausal hormone levels. Urogenital symptoms tend to do the opposite—they progressively worsen without intervention. The tissues become thinner and less resilient over time, not more.

This isn’t something to “wait out.” If you have these symptoms, they deserve attention now, not later.

The Silence Around This

Many women don’t mention these symptoms to their doctors. Embarrassment. The sense that it’s just part of aging. Not wanting to seem like they’re complaining about sex. Not realizing that urinary symptoms are connected to the same hormonal changes.

And many doctors don’t ask. They might ask about hot flashes, but not about vaginal health. This is a failure of the medical system, not a reflection of what matters.

If your provider doesn’t ask, bring it up yourself. These symptoms affect quality of life, relationship satisfaction, urinary health, and comfort in your own body. They matter.

What Actually Helps

The good news: this is one of the most treatable symptoms of menopause.

Vaginal estrogen is the most effective treatment for most women. It comes in creams, tablets, rings, and suppositories. Here’s what’s important to know:

It works locally—the estrogen stays in the vaginal tissues and doesn’t significantly raise blood levels
Because absorption is minimal, it’s safe for many women who can’t take systemic hormone therapy—including many breast cancer survivors
It takes time to work (weeks to months for full effect), but it works
It can be used long-term

Vaginal DHEA (prasterone) is another option that converts to estrogen locally.

Ospemifene is an oral medication that acts like estrogen on vaginal tissue without being estrogen—an option for women who can’t use local estrogen.

Moisturizers and lubricants help manage symptoms but don’t address the underlying tissue changes:

Vaginal moisturizers (used regularly, not just during sex) help maintain moisture
Lubricants (used during sexual activity) reduce friction and discomfort
Look for products designed for sensitive tissues, without irritating fragrances

What probably won’t help:

Waiting for it to get better on its own
Avoiding the conversation with your doctor
Assuming nothing can be done

For Partners

If your partner is experiencing these symptoms, understand:

This isn’t about desire for you (though desire itself may be affected separately)
Pushing for intercourse when it’s painful will only create aversion
There are solutions, but they take time
Your patience and willingness to explore other forms of intimacy matter

Permission to Address This

You deserve comfort in your own body. You deserve to not have chronic irritation or pain. You deserve sexual experiences that feel good rather than something to endure.

This isn’t vanity. It isn’t an optional concern. It’s your health and quality of life.

If you have these symptoms, please talk to your provider. If your provider dismisses you, find another one. Effective treatments exist. You shouldn’t suffer in silence.