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What Is Vaginal Atrophy? Symptoms, Causes, and Treatment

Clara Siegmund
Clara Siegmund

Here’s everything you need to know about vaginal atrophy, including what it is, why it happens, and how you can find relief.

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May 9, 2024
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Sep 27, 2025
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Here’s everything you need to know about vaginal atrophy, including what it is, why it happens, and how you can find relief.

Perimenopause
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Here’s everything you need to know about vaginal atrophy, including what it is, why it happens, and how you can find relief.

If you’ve ever experienced persistent vaginal dryness, irritation, itching, or pain, it could be related to vaginal atrophy.

Vaginal atrophy frequently occurs during perimenopause and menopause, but it can also happen at other stages of your life. The condition can cause discomfort, frustration, and pain in anything from your day-to-day life to intimate moments.

Vaginal atrophy is quite common, but it often goes undiagnosed and untreated. The condition is very treatable, though—there are tons of different options that can help you address symptoms and find relief.

Here’s everything you need to know about vaginal atrophy, including what causes vaginal atrophy, symptoms of vaginal atrophy, and how to treat vaginal atrophy.

What is vaginal atrophy?

Vaginal atrophy is a condition that causes vaginal walls to become thinner and cervical mucus secretions to decrease. Thin vaginal walls and loss of vaginal lubrication can have lots of painful and distressing effects on health and wellbeing. 

Doctors now also refer to vaginal atrophy as “genitourinary syndrome of menopause,” or GSM. This expanded term provides a more complete picture of the symptoms associated with vaginal atrophy, including vaginal, sexual, and urinary symptoms.  

How many people experience vaginal atrophy?

Postmenopausal women make up the bulk of vaginal atrophy diagnoses, with 40% to 57% of the postmenopausal population experiencing symptoms.

Still, postmenopause isn’t the only time you may feel signs of vaginal atrophy. Although the term GSM includes the word “menopause,” you can also experience vaginal atrophy and related GSM symptoms before perimenopause and menopause. In fact, some reports suggest that 15% of women experience symptoms of vaginal atrophy premenopause.

However, total numbers may well be higher. Vaginal atrophy symptoms often go unreported for any number of reasons, including due to embarrassment and shame surrounding sexual health, or the misconception that these symptoms are an expected—and therefore unavoidable—part of getting older.

That means that the number of people who experience vaginal atrophy symptoms is likely higher. Some research indicates that around 70% of women with signs of vaginal atrophy don’t discuss their symptoms with their healthcare providers.

What are symptoms of vaginal atrophy?

Vaginal atrophy and genitourinary syndrome of menopause (GSM) can cause troubling, uncomfortable, and often painful symptoms ranging from vaginal and sexual to urinary.

Signs and symptoms of vaginal atrophy and GSM include:

  • Vaginal dryness
  • Vaginal irritation
  • Vaginal burning
  • Vaginal itching 
  • Vaginal or pelvic pain or pressure
  • Decreased lubrication
  • Discomfort during sex
  • Pain during sex (dyspareunia)
  • Bleeding during or after sex
  • Painful orgasms (dysorgasmia)
  • Loss of libido
  • Discomfort or pain while peeing (dysuria)
  • Overactive bladder
  • Urinary incontinence (sudden urge to pee, accompanied by a decrease in bladder control)
  • Recurrent urinary tract infections (UTIs)

While you may experience any and all of these vaginal atrophy symptoms, some are more common than others. Vaginal dryness, irritation, burning, and itching, as well as decreased lubrication and painful sex are the most frequently reported symptoms of vaginal atrophy.

What causes vaginal atrophy?

Vaginal atrophy and GSM are caused by significant drops in estrogen.

Estrogen is an essential part of vaginal health. It helps:

  • Keep vaginal lining thick
  • Maintain normal blood flow
  • Keep the vagina moist
  • Keep vaginal tissue flexible and elastic

When estrogen levels are low, the hormone can’t properly regulate vaginal health. Over time, persistently low estrogen can alter the anatomy and function of the vagina, and impact overall vaginal health. 

This link with low estrogen is why people often experience vaginal atrophy in perimenopause and menopause. 

During these stages of your life, your body’s production of estrogen (and other reproductive hormones, like progesterone) decreases significantly. These falling hormone levels can lead to a number of physical and emotional perimenopause and menopause symptoms, including vaginal atrophy and more.

>>MORE: Perimenopause vs. Menopause: What's the Difference?

But perimenopause and menopause aren’t the only causes of low estrogen. It’s entirely possible to experience decreased estrogen levels—and resulting vaginal atrophy—at other points in your life, premenopause.

For example, vaginal atrophy and GSM symptoms may occur due to low estrogen if:

  • You’re breastfeeding after giving birth
  • You have certain hypothalamic-pituitary disorders
  • You take certain anti-estrogen medications, like those used to treat endometriosis or uterine fibroids
  • You have primary ovarian insufficiency 
  • You had your ovaries removed (oophorectomy)
  • You’re undergoing or recently underwent cancer treatment, including chemotherapy or aromatase inhibitors

How to treat vaginal atrophy

Vaginal atrophy and GSM can lead to distressing, uncomfortable, and even painful symptoms. The good news is, though, the condition isn’t permanent and symptoms are treatable.

Vaginal atrophy treatment includes over-the-counter methods, prescription medications, and natural remedies. These treatments can help you manage symptoms, find relief, and make your day-to-day life and intimate moments much more comfortable.

If you’re experiencing vaginal atrophy symptoms, know that you’re not alone, and that there’s nothing embarrassing or shameful about your body. Above all, you don’t have to suffer in silence.

Over-the-counter treatment

Certain vaginal atrophy treatments are available without a prescription. 

For some people, these over-the-counter treatment methods may help restore moisture, which may reduce dryness, itching, and discomfort, and make sex more comfortable. 

Non-prescription options include:

  • Vaginal moisturizers
  • Vaginal lubricants

Prescription medication

Prescription-strength versions of vaginal moisturizers and lubricants are also available, and may offer relief.

In other cases, stronger medication may be necessary.

If over-the-counter and prescription moisturizers or lubricants don’t help and vaginal atrophy symptoms continue to impact your quality of life, hormone replacement therapy (HRT) may be right for you. 

HRT administers hormones to supplement and stabilize your body’s hormone levels. There are two main types: estrogen replacement therapy (also called estrogen-only HRT) and combined HRT.

Vaginal estrogen replacement therapy is a form of localized estrogen-only HRT, meaning the estrogen stays in your vagina instead of entering your bloodstream. Side effects and risks are low. 

Vaginal estrogen therapy is the recommended treatment for moderate to severe vaginal atrophy symptoms. 

This form of HRT administers very low doses of estrogen directly into the vagina using a vaginal:

  • Tablet
  • Cream
  • Gel
  • Ring 

Vaginal estrogen therapy treats vaginal and sexual symptoms of vaginal atrophy by helping to increase vaginal lubrication, blood flow, and elasticity, thicken vaginal lining, and boost sensation in vaginal tissue. This treatment may also relieve urinary symptoms by preventing recurrent UTIs, overactive bladder, and urinary incontinence.

If you’re treating vaginal atrophy and GSM symptoms only, you’ll likely start with vaginal estrogen replacement therapy on its own. 

If you have other troubling perimenopause or menopause symptoms, like hot flashes, you may be prescribed higher doses of HRT, often in systemic forms that circulate throughout your body. (And if you have a uterus, you’ll take combined HRT to more safely supplement both estrogen and progesterone levels.)

Natural remedies

Certain lifestyle and diet changes may also be able to help you boost your estrogen levels to relieve vaginal atrophy symptoms.

Natural remedies include:

‍>>MORE: 7 High-Estrogen Foods to Balance Your Hormones Naturally

Vaginal atrophy: the bottom line

Vaginal atrophy, or genitourinary syndrome of menopause (GSM), is a condition caused by low estrogen levels in which the lining of the vaginal walls thins and vaginal lubrication decreases. 

While vaginal atrophy most commonly occurs during perimenopause and menopause, people can experience symptoms premenopause, as well. 

Vaginal atrophy can be distressing and painful, leading to symptoms like vaginal dryness, irritation, burning, and itching, and discomfort or pain during sex. 

Vaginal atrophy is treatable. Options include over-the-counter methods like vaginal moisturizers and lubricants, as well as prescription medications like vaginal estrogen replacement therapy.

If you’re experiencing vaginal atrophy, talk to you doctor about your symptoms. You don’t have to needlessly suffer—together, you and your doctor can work to find treatment options that are right for you.

About the author

Clara Siegmund
Clara Siegmund is a writer, editor, and translator (French to English) from Brooklyn, New York. She has a BA in English and French Studies from Wesleyan University and an MA in Translation from the Sorbonne. She is passionate about literature, reproductive justice, and using language to make information accessible.‍

Sources

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https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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