The vaginal dryness, irritation, and burning part of what’s called genitourinary syndrome of menopause, or GSM respond well to treatment, often remarkably well. There’s a whole ladder of options, from simple over-the-counter products to targeted prescription therapies, and most women find real relief. Here’s the landscape for the vaginal symptoms specifically; companion guides cover the sexual and urinary sides.

Start with moisturizers

Vaginal moisturizers are the first-line non-hormonal option for ongoing vaginal comfort. Used regularly two or three times a week, not just when symptoms flare they help restore comfort and improve natural moisture. Examples available without a prescription include products containing polycarbophil (such as Replens) or hyaluronic acid (Gynatrof, Repagyn). (Lubricants, applied during sex to reduce friction, are a separate tool covered in the guide to sexual symptoms; many women use both.)

A little self-care goes with it

Alongside products, a couple of everyday habits support the tissues: staying sexually active with a partner or through self-stimulation helps maintain blood flow and elasticity, and avoiding irritants such as perfumed soaps, douching, and tight clothing helps prevent symptoms from worsening. (There’s more on daily care in the companion guide.)

Local vaginal estrogen: often the most effective

When moisturizers and non-hormonal products aren’t enough, local vaginal estrogen therapy is often the most effective treatment. Available as creams, tablets, inserts, or vaginal rings, it delivers a low dose of estrogen directly to the tissues where it’s needed restoring thickness, elasticity, and moisture, and easing dryness and irritation. An important reassurance: it can be used on its own, without progesterone for uterine protection.

Local vaginal estrogen goes right where it’s needed and needs no progesterone for uterine protection.

Intravaginal DHEA (prasterone)

Intravaginal DHEA (prasterone) is another local, hormone-based option a prescription vaginal ovule (suppository) inserted once daily at bedtime. It contains DHEA, a hormone the body naturally produces but that declines with age; inside the vaginal cells it’s converted into small amounts of estrogen and androgens (like testosterone) that act locally to restore the thickness, elasticity, and moisture of the lining. Because it works primarily in the vaginal tissues, hormone levels in the rest of the body stay very low. Women often notice improvements in vaginal dryness, burning, and irritation.

Ospemifene: a pill option

Ospemifene is a prescription pill in a group of medicines called selective estrogen receptor modulators (SERMs). Although it isn’t estrogen, it acts on estrogen receptors especially in the vaginal lining to restore thickness, elasticity, and moisture. Taken by mouth once a day, it can suit women who prefer not to use vaginal products, or who find them inconvenient. Because it’s a systemic medication (it works throughout the body), it may not be suitable for everyone.

If you have other menopause symptoms too

For women who also have symptoms such as hot flashes, systemic menopausal hormone therapy may be recommended, benefiting both the vaginal symptoms and whole-body symptoms. Systemic and local hormone therapies can safely be used together if needed for optimal relief. (Our hormone-therapy guides go deeper on MHT.)

A note on laser treatments

Vaginal laser treatments (sometimes called “fractional CO₂ laser”) and other energy-based devices have been promoted for GSM. Some small studies suggest benefits, but larger, high-quality studies are limited and professional organizations, including the SOGC and the U.S. FDA, caution that more research is needed before these can be recommended as standard treatment. At present, laser therapy isn’t widely covered by insurance, can be expensive, and may carry some risks; anyone considering it should have a careful discussion with a knowledgeable provider.

When to seek help

Talk to your provider if vaginal symptoms are interfering with daily life, or if persistent burning or itching isn’t settling. If self-care, moisturizers, and lubricants aren’t enough, local therapies such as vaginal estrogen or intravaginal DHEA and options like ospemifene are highly effective when symptoms are bothersome.

Any unexplained vaginal spotting or bleeding, or a new lesion or lump in or around the vagina, should always be examined by a healthcare provider.

This article is general information, not medical advice. Any decision about managing menopause symptoms should be made with your own healthcare provider.