01

How treatments differ

Treatments for vaginal dryness fall into three categories that work differently:

• Symptom relief (lubricants): used at the moment of sex, wear off within hours. Make sex more comfortable but don't change the underlying tissue.
• Tissue support (moisturisers): applied every few days, hold moisture in the vaginal walls between uses. Improve daily comfort but don't restore the tissue itself.
• Tissue restoration (vaginal oestrogen, DHEA, ospemifene, MHT): treat the underlying cause by restoring the hormonal environment. The vaginal tissue rebuilds thickness, lubrication, and elasticity.

Most women benefit from a combination: a moisturiser for daily comfort, a lubricant for sex, and a prescription option if dryness is persistent or causing pain.

02

Lubricants

Used at the moment of intercourse, lubricants are the first line for women whose only symptom is discomfort during sex. They don't treat the underlying dryness, but they make intercourse comfortable while other treatments work.

Water-based lubricants

• Examples: YES WB, Sliquid H2O, Astroglide Natural
• Pros: safe with condoms, easy to wash off, widely available
• Cons: can dry out mid-use, may need reapplication
• Best for: general daily use, sensitive skin, couples using latex condoms

Silicone-based lubricants

• Examples: Pjur Original, YES Silicone, Überlube
• Pros: longer-lasting, doesn't dry out, ideal for water-based settings
• Cons: harder to wash off, can stain bedding, not compatible with silicone toys
• Best for: longer intercourse, swimming or bath use, when frequent reapplication is impractical

Oil-based lubricants

• Examples: YES OB, organic coconut oil
• Pros: very long-lasting, moisturising, can double as a daily moisturiser
• Cons: not compatible with latex condoms (breaks them down), can stain
• Best for: women in monogamous relationships not relying on barrier contraception

What to avoid

• Glycerin or sugar-based lubricants in women prone to yeast infections
• Heavily fragranced or warming lubricants which can irritate sensitive tissue
• Petroleum-based products (Vaseline) which trap bacteria and don't wash out cleanly

03

Vaginal moisturisers

Different from lubricants: moisturisers are applied every 2–3 days regardless of sex, and they hydrate the vaginal walls. They improve baseline comfort, reduce irritation, and complement lubricants and prescription treatments rather than replacing them.

Hyaluronic acid moisturisers

The most evidence-supported non-hormonal moisturiser. Hyaluronic acid binds water in vaginal tissue and has been shown in randomised trials to be roughly comparable to low-dose vaginal oestrogen for daily symptom relief.² For the full evidence picture, read Does Hyaluronic Acid for Vaginal Dryness Really Work?.

Polycarbophil-based moisturisers (Replens)

A bioadhesive gel that bonds to the vaginal wall and slowly releases water. Used 2–3 times per week. Well-studied, available without prescription.

Coconut oil

Anecdotally effective and widely used as a daily moisturiser. No randomised trial evidence for vaginal dryness specifically, but the safety profile is good and many women find it useful.

Vitamin E suppositories

Useful for some women, though the evidence base is weaker than for hyaluronic acid or polycarbophil.

04

Vaginal oestrogen (prescription)

The single most effective treatment for moderate to severe vaginal dryness, vaginal atrophy, and GSM. Restores the tissue itself rather than masking the dryness.

How it works

A small amount of oestrogen applied directly to the vaginal tissue rebuilds the thickness, lubrication, and elasticity that fell with menopause. Local oestrogen acts on local tissue without raising systemic oestrogen levels meaningfully³, which means it can be used safely by most women, including many who cannot use systemic MHT.

Forms available in Australia

• Vagifem (vaginal tablets): inserted into the vagina, twice a week after the loading phase
• Ovestin (vaginal cream): applied with a small applicator
• Premarin (vaginal cream): alternative cream formulation

What to expect

• First 2 weeks: some improvement in comfort and lubrication
• 6–12 weeks: full effect, with vaginal tissue substantially restored
• Ongoing: continued maintenance use needed to sustain the effect

Side effects

Generally well tolerated. Some women have light spotting or mild irritation in the first few weeks. Systemic side effects are rare at standard doses.

Who can't use it

• Active or recent breast cancer (some exceptions with specialist input)
• Active endometrial cancer
• Undiagnosed postmenopausal bleeding

If you have a history of breast cancer, a conversation with your oncologist about local oestrogen is worth having; many women are eligible.⁴

05

Other prescription options

DHEA (prasterone) vaginal pessaries

A non-oestrogen prescription option. The pessary delivers DHEA locally, which is converted to oestrogen and testosterone in the vaginal tissue. Useful for women who can't or prefer not to use vaginal oestrogen. Marketed as Intrarosa in some countries.⁵

Ospemifene

An oral SERM (selective oestrogen receptor modulator) that acts as oestrogen on vaginal tissue without acting on the breast or uterus. Available in some markets; not currently widely available in Australia.

Systemic menopausal hormone therapy (MHT)

For women with multiple menopausal symptoms (hot flushes, sleep, mood) alongside vaginal dryness, systemic MHT may resolve both. However, systemic MHT alone often doesn't fully resolve vaginal dryness, and many women need local vaginal oestrogen alongside their systemic MHT for full effect.⁶

Laser and radiofrequency treatments

Marketed for vaginal rejuvenation. Evidence is mixed, and Australian regulators have warned against marketing them as treatments for GSM without proper trial data.⁷ Cost is substantial and outcomes are unpredictable. Not a first-line option.

06

Lifestyle and habits that help

Alongside any treatment, a few practical changes reduce day-to-day irritation:

• Avoid douches, scented washes, and "feminine hygiene" sprays. They disrupt the vaginal microbiome and worsen dryness.
• Use unfragranced soap or just water to wash the vulva.
• Switch to cotton underwear and breathable fabrics.
• Reduce alcohol and caffeine, which can worsen tissue dryness.
• Maintain regular sexual activity if comfortable. Sexual activity (with a partner or solo) helps maintain blood flow to vaginal tissue, which supports lubrication and elasticity.
• Pelvic floor physiotherapy for women whose dryness is accompanied by pelvic floor tension or pain. A women's-health physiotherapist can substantially change the picture.

07

How to choose your starting point

Match the treatment to the dominant problem:

Discomfort only during sex

Start with a water-based or silicone-based lubricant. Add a hyaluronic acid moisturiser if discomfort persists between sexual encounters.

Daily dryness, irritation, itching

Start with a hyaluronic acid or polycarbophil moisturiser, 2–3 times a week. Add a lubricant for sex.

Pain during sex (dyspareunia) or burning urination

This usually indicates more substantial tissue thinning. See your GP for a discussion of vaginal oestrogen. Use lubricants and moisturisers in the meantime.

Multiple menopausal symptoms (hot flushes, sleep, mood) plus dryness

Discuss MHT with your GP. Most women will also benefit from local vaginal oestrogen for the dryness specifically.

History of breast cancer

Speak to your oncologist or a women's-health GP. Many treatments are still available, including hyaluronic acid, polycarbophil moisturisers, and (with specialist input) low-dose vaginal oestrogen or DHEA.

Own Your Menopause Appointment: 5 Tips from a GP walks through how to raise vaginal symptoms in a way that gets a productive response.

08

Why treatment matters

Untreated vaginal dryness rarely resolves on its own and often worsens slowly over years. The downstream effects extend well beyond physical discomfort: avoidance of sex, relationship strain, reduced quality of life, recurrent UTIs, and a gradual loss of confidence about the body.

The flip side is that women who treat vaginal dryness actively, particularly with a moisturiser plus low-dose vaginal oestrogen, almost always describe the result the same way: substantial improvement within 6–12 weeks, with most of the comfort, lubrication, and confidence restored. The treatments are effective, the side effect profile is reassuring, and the threshold to start is low.

If vaginal dryness is affecting your daily life, your sex life, or your sense of yourself, it's worth raising with a GP. The conversations are short. The relief is real.