Why does menopause cause vaginal dryness?

Oestrogen helps maintain blood flow, natural lubrication and the flexible lining of the vagina. As levels fall during perimenopause and menopause, the lining can become thinner and produce less moisture. The tissues may feel dry, irritated or tender, and sex may cause friction or discomfort. Some people also notice burning, itching, urinary urgency or repeated urinary symptoms. Similar symptoms can result from scented products, infections, medicines or breastfeeding, so persistent discomfort deserves a proper assessment rather than self-diagnosis.

Use an unperfumed, gentle cleanser on the outside only and avoid douching or fragranced washes. A vaginal moisturiser used regularly may help ongoing dryness; a water-based lubricant can reduce friction during sex. Drink normally and give yourself time for arousal. If symptoms continue, a clinician can discuss local oestrogen or other treatments and check for infection or skin conditions. Tell them about breast or reproductive health history before choosing hormonal treatment.

Arrange an appointment for persistent pain, unusual discharge, sores, bleeding after sex, or urinary symptoms that keep returning. Seek prompt care for severe pelvic pain, fever, or heavy bleeding. A clinician can examine the tissues and test for infection when needed. Do not assume every new vaginal symptom is caused by menopause.

Could another condition be causing this irritation? Which moisturiser or lubricant is suitable? Would local treatment help, and what history should guide that choice? How should I respond if sex remains painful?