What if hormone replacement therapy does not relieve vaginal dryness?

Systemic hormone treatment may not provide enough estrogen to vaginal tissues for every person, and it may take time to find a formulation or delivery method that suits you. Dryness can also be linked with irritation from scented products, some medicines, breastfeeding, infection, or skin conditions. Pain during sex can make the pelvic floor tighten, which may add to discomfort even when tissue changes are being treated.

Book a medication review rather than changing the dose yourself. A clinician may ask about symptoms, bleeding, discharge, itching, urinary discomfort, and the effect on sex or daily activities. Depending on your history, they may discuss a vaginal moisturizer used regularly, a lubricant for sexual activity, or a locally applied treatment. Avoid douching and fragranced washes, and choose gentle external cleansing. Keep a note of when symptoms occur and any products that make them worse.

Contact a clinician promptly for bleeding after sex, unexpected vaginal bleeding, new sores, marked swelling, fever, or unusual discharge with a strong smell. Seek urgent help for severe pelvic pain, heavy bleeding, faintness, or trouble passing urine. Persistent symptoms deserve assessment even without these warning signs, especially if they interfere with sleep, intimacy, or urination.

Could another condition or medicine be contributing to the dryness? Would a local treatment or a different HRT method be appropriate for me? How should I use a moisturizer or lubricant, and when should I return if symptoms continue?