What Is the Best Treatment for Vaginal Dryness?

No single treatment for vaginal dryness has been proven best. Vaginal moisturizers, vaginal estrogen, vaginal DHEA inserts and the ospemifene pill may all ease dryness in trials that mostly lasted about 12 weeks. If dryness is your only problem, a vaginal moisturizer is a reasonable place to start. If sex hurts or the dryness won't budge, ask your clinical team about a prescription such as vaginal estrogen.

What are the main treatments for vaginal dryness?

There are four main options. A 2024 review of randomized trials compared each one with placebo or no treatment. It rated all of the evidence as low certainty.

Most of these studies lasted 12 weeks or less, and few compared treatments head to head. No one can name a single winner. Choose by the symptom that bothers you most, your health history and how you want to take it.

Will a vaginal moisturizer be enough, or do I need a prescription?

A moisturizer can be enough if dryness is your main problem. The review found moisturizers may improve dryness. It did not find that they help pain with sex, which estrogen, DHEA and ospemifene may help.

One trial changes how to think about your first step. In a 12-week trial of 302 women with an average age of 61, all three groups improved by about the same amount. One group used a low-dose 10 μg estradiol tablet (daily for two weeks, then twice a week). Another group used a vaginal moisturizer, and the third used a placebo tablet and placebo gel. On a 0 to 3 scale, each woman's most bothersome symptom dropped 1.4 points with estradiol, 1.2 with the moisturizer and 1.3 with placebo. Neither treatment did significantly better than placebo.

That trial does not show that estrogen fails. The larger review still found it may help. The trial does show that many women improve over 12 weeks of regular use. So an over-the-counter moisturizer for a few months is a fair first step if dryness is what bothers you.

Pain with penetration was the most common main complaint in that trial, for 182 women (60%). Dryness came next, at 21%. If pain is your main problem, talk to your clinical team about a prescription rather than waiting it out on a moisturizer.

Is vaginal estrogen safe, and what about the cancer warning?

The frightening boxed warning on estrogen labels covers uterine cancer, heart and blood vessel problems, breast cancer and probable dementia. Those risks come from the Women's Health Initiative trials, which used full-body hormone doses. Researchers writing on the Nurses' Health Study say those risks should not be carried over to the much lower doses in vaginal estrogen.

There is a gap in the evidence. No randomized trial has followed low-dose vaginal estrogen long enough to settle cancer and heart risk. Large studies of women in everyday life are mostly reassuring, but not uniform. One found no link to breast or uterine cancer, and another found a higher risk of uterine cancer. The Nurses' Health Study researchers concluded that their findings reassure women who use low-dose vaginal estrogen for more than six months.

The Menopause Society's 2020 position statement says a progestogen (a progesterone-type hormone that protects the uterine lining) is not needed with low-dose vaginal estrogen. It also notes that uterine safety data beyond one year are limited. Ask your clinical team what strength you are getting and how often to use it.

Our clinical team can prescribe bioidentical estrogen if it fits your goal.

Which vaginal dryness treatment fits me?

• Dryness is the main issue and sex doesn't hurt: Start with a vaginal moisturizer. Use it regularly for a few months before you judge it.
• Sex hurts, or the dryness hasn't eased: Ask about vaginal estrogen first. Of the options in the review, it covered the widest set of symptoms: dryness, pain with sex and your most bothersome symptom.
• You're past menopause and pain with sex is the big problem: A nightly DHEA insert is another option. In a 12-week trial, pain severity dropped 1.27 points on a 0 to 3 scale with the insert and 0.87 points with placebo, according to the Intrarosa label. Your body turns DHEA into estrogen. The insert has not been studied in women who have had breast cancer.
• You'd rather take a pill than put anything in: Ospemifene is a daily tablet for moderate to severe dryness or pain with sex after menopause. Its label has a boxed warning for uterine cancer, stroke and blood clots. It is not for women who have had blood clots, a stroke, a heart attack or breast cancer. It can also bring on hot flashes or make them worse.
• You've had breast cancer: Few studies of these treatments included women with a cancer history. Discuss any hormonal option directly with your oncologist and your clinical team.
• You've had bleeding after menopause that no one has checked: Get it checked before you start a prescription.

How much does vaginal dryness affect sex and desire?

For some women, the changes around menopause go past discomfort. One woman in r/Perimenopause described how her desire faded during perimenopause: "That part of me feels like it just… disappeared."

Wanting sex to feel good again is reason enough to treat this. On a r/TwoXChromosomes post about a doctor who brushed off a woman's concern about her libido, the top comment put it this way: "if you were a man, this would be a crisis."

Most treatment studies ran 12 weeks or less. Give a treatment about that long before you decide it isn't working, and tell your clinical team if sex still hurts. If dryness is making sex hurt or putting you off it altogether, take the quiz so your clinical team can see whether bioidentical estrogen fits your plan.