Vaginal Dryness in Perimenopause and Menopause: Why It Happens and What Actually Helps
If sex has started to hurt, if you feel dry or raw or irritated more days than not, or if you've noticed friction and discomfort that wasn't there a few years ago — you're not imagining it, and you're not alone. This is one of the most common, and most under-treated, symptoms of the perimenopause and menopause transition. It has a clinical name — genitourinary syndrome of menopause (GSM) — but you don't need to know that term to know something's changed. As a naturopathic doctor in Leslieville, Toronto who focuses on hormones and the perimenopause transition, this is a symptom I hear about constantly, almost always after someone has quietly managed around it for months or years, not because good treatments don't exist, but because no one told them what was actually happening or what was safe to use.
Here's why vaginal dryness happens during this transition, what can quietly make it worse, and the treatment options — from over-the-counter to prescription — that are actually backed by evidence.
Why vaginal dryness happens in perimenopause and menopause
Estrogen keeps the tissue of the vulva and vagina thick, elastic, and well-lubricated, and it helps maintain healthy blood flow and the vaginal microbiome. As estrogen drops during perimenopause and menopause, that tissue thins, loses elasticity, and produces less natural lubrication — which is what creates the dryness, friction, and fragility so many women notice. The same drop in estrogen affects the tissue lining the urethra and bladder, which is why urinary symptoms (urgency, frequency, more frequent UTIs) often show up around the same time.
When these symptoms are grouped together clinically, they're called genitourinary syndrome of menopause, or GSM — a term that replaced the older, narrower label "vaginal atrophy" because the changes aren't limited to the vagina; they involve the vulva, the vagina, and the lower urinary tract together.
Symptoms can include:
Dryness, irritation, and a persistent feeling of friction in the vulvar and vaginal area
Itching, burning, or a change in tissue colour or texture
Pain during sex, and in some cases light bleeding or spotting afterward
Urinary symptoms — urgency, frequency, discomfort, or more frequent UTIs
This affects roughly 40–54% of postmenopausal women closely enough to be bothersome — and unlike hot flashes, which tend to ease with time, it's usually progressive, meaning it tends to get worse, not better, without treatment. Because it touches daily comfort, sexual function, and confidence all at once, it's worth treating early rather than working around.
What can make it worse
A few very common go-to remedies can backfire:
Coconut oil. It's a popular natural moisturizer, but there's no real research on its safety or effectiveness for regular vaginal use, and some clinical sources caution that oil-based products can disrupt vaginal pH and microbiome. If tissue is already thinned and more vulnerable from low estrogen, that's not the ingredient I'd want doing daily duty — it's fine occasionally, but I don't recommend it as a long-term maintenance moisturizer.
Vaginal cleansers and douches. Any product marketed to "cleanse" or "freshen" the vagina — including douches — flushes out the healthy bacteria that protect the tissue and temporarily disrupts vaginal pH. In tissue that's already thinner and drier from declining estrogen, that disruption tends to make irritation and dryness worse, not better. The vagina doesn't need cleansing products; water is enough for the external (vulvar) area.
What actually helps
Vulvar moisturizers and vaginal lubricants are the first-line, over-the-counter step — and they do two different jobs, so it's worth using both rather than picking one:
Vulvar/vaginal moisturizers are used regularly (typically every 2–3 days), regardless of sexual activity, to rehydrate tissue and maintain comfort day to day.
Lubricants are used at the time of intercourse specifically to reduce friction.
Look for products without glycerin, parabens, or added fragrance, since these can be irritating to already-sensitive tissue.
Pelvic floor physical therapy is worth knowing about too, especially if dryness has led to guarding, tightness, or pain that lingers even once lubrication is addressed — a pelvic floor physiotherapist can work directly with that tissue and muscle response. And staying sexually active, whether with a partner or on your own, along with using vaginal dilators, helps maintain tissue elasticity and blood flow to the area. It's one of the few places where "use it or lose it" has real physiological backing.
Low-dose vaginal estrogen is the most effective treatment when moisturizers and lubricants aren't enough, particularly for dryness and sexual sensation. In Canada, this is available as Vagifem (estradiol vaginal tablets) or Imvexxy (estradiol vaginal inserts). Because it's applied locally and at a low dose, absorption into the rest of the body is minimal, which is different from systemic hormone therapy.
Vaginal DHEA (Intrarosa) is another prescription option, using prasterone to support local estrogen and androgen levels in vaginal tissue directly.
In Ontario, naturopathic doctors who have completed the College of Naturopaths of Ontario's additional Therapeutic Prescribing certification are authorized to prescribe bioidentical estrogen in topical or suppository form — which includes vaginal estrogen for this. That means this doesn't have to be a treatment you can only access through a family doctor or gynecologist; it can be part of a naturopathic, whole-person perimenopause and menopause care plan.
The naturopathic, whole-person piece
GSM is driven by estrogen decline, so the most effective treatments target that directly — this isn't a symptom that lifestyle changes alone reliably fix. But as a gut and hormone-health-focused naturopathic doctor, I also look at the bigger picture: overall vaginal and gut microbiome health, pelvic floor function, and the other perimenopausal symptoms that often show up at the same time (sleep, mood, energy, cycle changes). GSM rarely travels alone, and treating it in the context of everything else that's shifting tends to get better results than treating it in isolation.
When to see someone about it
If dryness, irritation, or pain during sex has become a regular thing — not just an occasional bad week — it's worth a conversation rather than something to quietly manage around. This is exactly the kind of symptom that responds well to treatment once it's actually named and addressed. If this sounds like what you've been dealing with, you can book a 1:1 session through neginsayar.com.
FAQ
Is GSM the same thing as vaginal atrophy? They describe the same underlying changes. "Vaginal atrophy" was the older term; GSM replaced it in 2014 to better reflect that urinary symptoms and vulvar tissue are affected too, not just the vagina.
Is coconut oil safe to use for vaginal dryness? Occasionally, it's unlikely to cause harm, but it hasn't been studied for regular vaginal use and may affect vaginal pH and microbiome. For daily or long-term dryness, a purpose-made vulvar moisturizer is the better-supported choice.
Is vaginal estrogen safe? Low-dose vaginal estrogen is applied locally, and absorption into the bloodstream is minimal compared with systemic hormone therapy. It's still a prescription decision that should be individualized to your health history — book a consult to review whether it's a fit for you.
Can a naturopathic doctor prescribe vaginal estrogen in Ontario? Yes, if they've completed the College of Naturopaths of Ontario's Therapeutic Prescribing certification, which authorizes bioidentical estrogen in topical or suppository form — this includes vaginal estrogen for GSM.
How do I know if it's GSM or an infection? GSM symptoms (dryness, friction, thinning, gradual onset tied to the perimenopause/menopause transition) can overlap with infections like a yeast infection, bacterial vaginosis, or a UTI, which tend to come on more suddenly and may include discharge, odour, or fever. If you're not sure which you're dealing with, it's worth getting assessed rather than guessing.
This article is for educational purposes and isn't a substitute for individualized medical advice. Book a consultation to discuss what's right for your health history.
Dr. Negin Sayar, ND, is a naturopathic doctor in Leslieville, Toronto, and a former medical Doctor with a clinical focus on gut health, hormones, and metabolic health. She's regulated by the College of Naturopaths of Ontario and sees patients virtually across the province.