Vaginal moisturizers and lubricants for menopause dryness: what works
Vaginal moisturizers and lubricants are the usual first step for mild dryness and painful sex after menopause. They do not need a prescription and contain no hormones, but the research on them is limited.
See a doctor if dryness or pain does not improve, if you have bleeding after menopause, unusual discharge or odor, or burning when you urinate.
What they are
Lubricants are used during sex to reduce friction and pain. Moisturizers are used regularly, often a few times a week, to keep vaginal tissue more comfortable day to day.1
Lubricants are mainly water-based, silicone-based or oil-based.1 Some moisturizers contain hyaluronic acid, polycarbophil or polyacrylic acid. Vaginal suppositories with vitamin E or vitamin D are also used.3
They treat the symptoms of genitourinary syndrome of menopause, which affects an estimated 27% to 84% of women after menopause.2 They do not reverse the underlying thinning of the tissue the way estrogen can.
What the research shows
The Menopause Society calls these products first-line for milder symptoms.2 ACOG also lists them as first-line for women with a history of breast cancer.3
Good trials are scarce. No large placebo-controlled trials compare them directly with low-dose vaginal estrogen.1 In one trial of 302 women, every group improved, including a placebo gel. That gel probably acted as a lubricant itself.1
Four small trials compared hyaluronic acid with placebo or vaginal estrogen. Hyaluronic acid eased dryness and pain during sex about as well as estrogen. There is no evidence it beats other moisturizers.1
In a small trial in breast cancer survivors, silicone lubricants worked better than water-based ones.1 ACOG notes that no single non-hormonal product has been shown to be best, so trying more than one is reasonable.3
A meta-analysis found hormone treatments gave a small extra benefit for sexual function compared with lubricants.1
Safety and who should be careful
Many water-based products are very concentrated (hyperosmolar). In lab studies these damaged vaginal cells. The World Health Organization suggests keeping osmolality below 1,200 mOsm/kg.1 Silicone-based and near iso-osmolar products did not show this effect.1
Petroleum jelly was linked to a higher risk of bacterial vaginosis in one study. Oils were linked to more yeast.1 Oil-based lubricants can also damage latex condoms. Most water and silicone lubricants are condom-safe.1
There is little data on flavored, warming or preservative-containing products. If a product stings, you can test it on the skin first, or switch to a simpler silicone-based or propylene glycol-free product.1
Choosing a product
No published studies have measured how irritating most store-bought products are, so some trial and error is normal.1
- For sex: most silicone and water-based lubricants are condom-safe, while oil-based ones are not. One small trial favored silicone.1
- For daily comfort: a moisturizer used regularly, not just before sex.1
- If you are sensitive: look for products described as iso-osmolar, or free of propylene glycol, fragrance and warming agents.1
- Avoid petroleum jelly and household oils inside the vagina.1
A pharmacist can help you compare products. Ingredient lists and labeling rules differ between countries.
How they are available
Moisturizers and lubricants are sold over the counter in pharmacies and shops in most countries. They are a common choice for women who cannot or prefer not to use hormones.4
If symptoms are moderate to severe, or these products are not enough, prescription options include vaginal estrogen, vaginal DHEA (prasterone) and ospemifene.2 Some women use a moisturizer or lubricant alongside these.
Vaginal laser and other energy-based treatments are also marketed. The Menopause Society found too few placebo-controlled trials to recommend them.2
What it is used for: evidence rated
| Option | Evidence | What the research shows |
|---|---|---|
| Vaginal dryness (moisturizers) | Recommended as first-line by The Menopause Society and ACOG, though trial evidence is sparse.1,3 | |
| Pain during sex (lubricants) | Widely recommended for use with sex; few trials, and one small study favored silicone over water-based types.1 | |
| Dryness (hyaluronic acid moisturizers) | Four small trials found effects similar to vaginal estrogen; larger studies are needed.1 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society, Menopause (2020)
- NAMS publishes the 2020 Genitourinary Syndrome Of Menopause Position Statement, News-Medical (2020)
- Treatment of urogenital symptoms in individuals with a history of estrogen-dependent breast cancer, ACOG clinical consensus, via Guideline Central (2021, updated 2023)
- Hormone therapy: Is it right for you?, Mayo Clinic