What Causes Vaginal Dryness in Menopause?

by Deborah Maragopoulos FNP | Oct 6, 2021 | Menopause, Women's Health | 1 comment

Vaginal dryness is probably one of the most annoying symptoms you can experience during menopause. It can also be very subtle. It starts with the usage of artificial lubricants in perimenopause. To impossibly painful sex in postmenopause. Over half of women over the age of 50 suffer from vaginal dryness. This increases up to 80% of postmenopausal women.

Why do you get vaginal dryness in menopause? 

Vaginal dryness is caused by atrophy (or shrinking) of the vaginal epithelial cells. Under the microscope, you can see that the healthy, plump squamous cells become shriveled like raisins. The medical term is atrophic vaginitis and it’s caused by the declining estrogen levels in menopause. Estrogen helps to keep all your tissues lush and juicy, especially vaginal tissues. With less intracellular fluid, there’s a lot less moisture. Your vagina becomes very dry and cannot lubricate itself enough. 

Lack of enough lubrication during sexual arousal can lead to very painful intercourse. Lack of enough estrogen can also lead to urinary tract infections. This is because your urethra, the tube from which urine exits from your body. It is very estrogen-dependent. During menopause, your urethra can also become atrophic. Which renders it unable to keep normal vaginal bacteria from entering the bladder. Especially during intercourse or even after bathing. Which leads to bladder infections. The treatment is not chronic use of antibiotics, but to prevent the infections in the first place. 

Can HRT help?

The very best way to treat vaginal dryness is to use hormones. Not systemic, but topical vaginal estrogen is the best treatment. Systemic hormone replacement therapy would have to be quite excessive in order to heal the vagina. You can maintain vaginal health with systemic hormone replacement therapy. But you can't rescue an incredibly dry, atrophic vagina without using topical estrogen therapy. 

The two types of estrogens that seem to work the best are estriol and estradiol. Estradiol can be used as a pharmaceutical preparation, or it can be compounded. Estriol must be compounded.

I find estriol works the best to get the vagina back to its healthy juiciness. Just a couple of milligrams nightly for at least six to eight weeks can rejuvenate atrophic vaginitis. Then, you can lower the dose to whatever is needed for maintenance. Which may just be once a week or so. Then, systemic bioidentical hormone replacement therapy can help maintain vaginal health. 

What alternative therapies help menopausal vaginal dryness?

The best way to keep your vagina healthy is to support your hypothalamus. My patients who take Genesis Gold® find that they need much less HRT and their vagina stays properly lubricated longer through the change. That’s because the herbal blend in Genesis Gold® helps maintain healthy hormone receptors. 

The best natural lubricant is coconut oil. It helps maintain proper vaginal PH to prevent bacterial or fungal overgrowth. While coconut oil will help protect thin atrophic vaginal tissues, it will not restore them.

Even if you have estrogen-related cancers, using topical estriol vaginally can be a safe alternative to systemic estrogens. It can also help get your vagina and urethra back in shape. 

If you have any questions regarding vaginal dryness, please join us in our Hormone Support Group. You can access it when you sign up for my free Hormone Reboot Training below. I hope to see you there!

Frequently Asked Questions:

Can your hypothalamus cause weight gain?

Yes. The hypothalamus is the master regulator of metabolism, controlling how your body stores and burns energy through its signaling to the thyroid, adrenals, and pancreas. When the hypothalamus becomes dysregulated by chronic stress, poor sleep, inflammation, or blood sugar instability, it defends a higher weight "set point" — causing the body to hold onto fat regardless of diet or exercise. This makes hypothalamic dysfunction an upstream root cause of stubborn weight gain.


What is a weight set point and why won't mine move?

A weight set point is the body weight your hypothalamus works to defend, calibrated over time by stress, sleep, hormones, and inflammation. When you diet, the hypothalamus perceives scarcity and responds by slowing metabolism, increasing hunger hormones, and suppressing satiety signals to return you to that set point. This is why most people regain lost weight within two to five years of conventional dieting — the set point itself was never recalibrated, only temporarily overridden.


Why do I gain weight under stress even when I'm not eating more?

Chronic stress raises cortisol, which disrupts blood sugar regulation, promotes abdominal fat storage, and signals the hypothalamus that the body is under threat. In survival mode, the hypothalamus defends fat stores and slows metabolism — so weight can increase even without any change in calorie intake. The stress chemistry, not the food, is driving the weight gain, which is why stress reduction is essential to any lasting metabolic reset.


Why do I regain weight after stopping GLP-1 medications?

GLP-1 medications work peripherally on appetite and gastric signaling, but they do not address the underlying hypothalamic dysregulation that sets your defended weight. Because the hypothalamic set point is never recalibrated, the body resumes defending its original weight once the medication stops — leading to significant regain. Long-term success requires restoring hypothalamic regulation so the set point itself lowers, rather than relying on appetite suppression alone.


How long does it take to reset your metabolism?

Genuine metabolic recalibration takes a minimum of 90 days, because the hypothalamus needs consistent signals of safety and sufficiency before it will lower its defended set point. This differs from a diet, which produces temporary suppression the body quickly corrects. A 90-day reset typically moves through three phases: stabilizing stress chemistry (days 1–30), rebuilding metabolic efficiency (days 31–60), and lowering the weight set point (days 61–90).


Why does my thyroid feel slow even though my labs are "normal"?

Under chronic stress, the body converts thyroid hormone into reverse T3, which blocks active thyroid receptors and slows metabolism at the cellular level — even when standard lab values appear normal. This means you can experience genuine symptoms of slow metabolism, such as fatigue, cold intolerance, and brain fog, while your thyroid panel looks unremarkable. Addressing the upstream hypothalamic and stress signaling often improves thyroid conversion and symptoms.


Is stubborn weight gain a willpower problem?

No. Stubborn weight gain is a signaling problem, not a willpower problem. The hypothalamus governs weight through survival mechanisms that operate below conscious control — defending its set point by slowing metabolism and increasing hunger when it perceives threat. No amount of discipline can override this system; lasting change comes from restoring hypothalamic regulation through reduced stress, balanced blood sugar, restorative sleep, and targeted nutritional support.

About the Author - Deborah Maragopoulos FNP

Known as the Hormone Queen®️, I’ve made it my mission to help everyone - no matter their age - balance their hormones, and live the energy and joy their DNA and true destiny desires. See more about me my story here...

     

Last Updated: January 12, 2023

1 Comment

  1. Linda MiramontesGray

    Dr Deborah has saved me!

    Reply

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