by Patricia Shelton, MD
Women may experience a variety of symptoms around the time of menopause. During the menopausal transition and afterwards, many women feel vaginal itching or other discomfort in the vagina. What causes this, and what can you do to get relief?
What causes vaginal itching in menopause?
Most commonly, vaginal itching during and after menopause is caused by vaginal atrophy. As levels of estrogen decline, the tissues of the vagina become thinner and drier. This puts the sensitive nerve endings closer to the surface, where they can easily become irritated, leading to itching or other discomfort.
Some women notice vaginal itching only during sexual activity, while others may be aware of it throughout the day. In addition to itching, vaginal atrophy can cause a variety of other symptoms, including:
- Pain (especially during sex)
- More frequent urinary tract infections (UTIs)
Vaginal atrophy occurs in every woman who goes through menopause, unless she’s taking hormone replacement therapy. However, the symptoms can vary between one woman and another, and can also change over time.
What else can cause vaginal itching?
Although vaginal itching during and after menopause is commonly caused by vaginal atrophy, there are also other conditions that can cause this symptom. Some of these include:
- Infections, such as a yeast infection or bacterial vaginosis. These infections will often cause vaginal discharge along with itching.
- Irritation. Chemicals such as fragrances are common causes of irritation. Your laundry detergent, soap or body wash, or even scented toilet paper can expose your tissues to these irritants, leading to itching.
- Cancer of the vagina or vulva. This is rare, but it’s important to consider the possibility.
There are also other potential causes of vaginal itching. If you’ve recently begun to notice this symptom, it’s best to get checked by your doctor to determine the cause.
How can you address vaginal itching during and after menopause?
If you’re experiencing itching due to vaginal atrophy, then there are a few options that may help you to feel more comfortable.
Because vaginal atrophy is caused by declining estrogen levels, women who are taking hormone replacement therapy (HRT) will generally have far fewer symptoms of this condition. Some women choose to take systemic HRT, which releases hormones to the whole body. There are some potential risks to using HRT, and the decision of whether or not to pursue this option is very personal. However, it’s considered to be relatively safe for many women, and can help to relieve not only vaginal atrophy, but also other symptoms associated with menopause.
If you’re bothered by symptoms of vaginal atrophy but don’t want to take systemic HRT, then you may want to consider using topical estradiol. This is a form of estrogen that’s applied inside the vagina, and helps to plump up the tissues and relieve your symptoms. It comes in the form of a cream, suppository, ring, or tablet. Although some of the hormone will be absorbed through the vaginal walls, the levels of estradiol in your bloodstream will be far lower with this method than if you used systemic HRT.
If you prefer to avoid using hormones altogether, or if you have a condition that makes them unsafe for you (such as a history of breast cancer), then lubricants may be helpful. Applying lubricant inside the vagina can help to relieve dryness and itching, although it won’t help to restore the thickness of the tissues. You may choose to apply lubricant just before having sex, or more frequently. It’s important to ensure that you choose a hypoallergenic product; otherwise, it may cause irritation and actually worsen your itching.
Although itching due to vaginal atrophy is very common in women during and after the transition to menopause, there are ways to address the problem and help you to feel more comfortable. Talk with a medical provider to get personalized advice on the best option for you.
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Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.
Benini V, Ruffolo AF, et al. New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review. Medicina (Kaunas). 2022 Jun 6;58(6):770. doi: 10.3390/medicina58060770.
Bleibel B, Nguyen H. Vaginal Atrophy. StatPearls (National Library of Medicine). https://www.ncbi.nlm.nih.gov/books/NBK559297/. Accessed 5 April 2023.
Donders GG, Ruban K, et al. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835. doi: 10.1080/14656566.2019.1574752.
Potter N, Panay N. Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. Climacteric. 2021 Feb;24(1):19-24. doi: 10.1080/13697137.2020.1820478.
Zhang GQ, Chen JL, et al. Menopausal hormone therapy and women’s health: An umbrella review. PLoS Med. 2021 Aug 2;18(8):e1003731. doi: 10.1371/journal.pmed.1003731.