Vaginal Burning During Menopause: Causes & Treatments

Vaginal burning is a common symptom of vaginal atrophy, which can occur during or after menopause. However, it can also be an indication of another condition unrelated to menopause. Vaginal burning can be incredibly uncomfortable, impacting your physical and emotional well-being.

In this guide, we explain what can cause vaginal burning, the symptoms you might experience and how it can be treated.

What causes vaginal burning?

If you experience a burning sensation in or around your vagina during menopause, it is likely due to vaginal atrophy. This is a condition where the lining of the vagina becomes drier and thinner, resulting in a variety of undesirable symptoms. As the condition can also cause urinary tract problems, it is often referred to as genitourinary syndrome of menopause (GSM) to encompass both its vaginal and urinary symptoms1. It is a common condition which affects approximately 70% of women2.

Women are most likely to experience vaginal atrophy due to the natural decrease of oestrogen. However, other factors can contribute to GSM including:

Surgical menopause due removal of the ovaries
Cancer treatments such as radiotherapy, chemotherapy or hormonal treatment
Certain medications such as tamoxifen, letrozole, nafarelin and medroxyprogesterone.
Some contraceptive pills
Smoking cigarettes
No vaginal births
Breastfeeding
Immune disorders
Reduced or no sexual activity1,4

Learn more about other vaginal changes during menopause.

Although vaginal atrophy is often the cause, other conditions can coincidentally occur during menopause that produce some of the same symptoms. Vaginal burning can also be caused by:

Bacterial vaginosis
Yeast infections
Sexually transmitted infections
Irritants such as soaps, detergents, menstrual pads and tight underwear
Urinary tract infection
Allergic reaction
Skin conditions such as Eczema, Lichen Simplex or Lichen Sclerosis5

During menopause, you may also experience some of the below symptoms as well as vaginal burning. These are all symptoms of vaginal atrophy.

Vaginal pain including dryness, soreness, itching, pressure, splits, tears and micro-cuts in the vaginal tissue, and abnormal vaginal bleeding
Unusual vaginal discharge
Thinning or greying pubic hair
Shrinkage or change in labial shape or the clitoris
Urinary symptoms including painful urination (dysuria), recurrent urinary tract infections (UTIs), urgency, stress incontinence and needing to urinate at night (nocturia)
Sexual symptoms during or after intercourse such as pain, decreased lubrication, spotting or bleeding
Lower arousal or loss of libido, or the inability to orgasm
Other symptoms such as pelvic organ prolapse, painful smear tests or painful episiotomy scars, even years after the procedure occurred1,2,4,6

There are also other symptoms of menopause that can occur at the same time as vaginal atrophy. Take a look at our menopause checker to determine whether changes you’ve noticed may be a symptom.

Vaginal health and mental health

Vaginal burning and other vaginal atrophy symptoms can increase the risk of vaginal and urinary tract infections. However, the physical symptoms can also have a profound impact on your emotional and mental well-being. They can:

Affect your quality of life
Cause relationship strain
Lead to a loss of interest in sex and/or intimacy
Limit spontaneity
Damage self-esteem
Create a sense of embarrassment
Decrease how feminine you feel1,4,7

If you are experiencing a decline in your mental health due to vaginal burning or other genitourinary symptoms in menopause, reach out for support. You can:

Contact your GP
Call the Samaritans on 116 123
Find an NHS talking therapies service
Join the Menopause Matters forum
Book a free discovery call with our CBT specialist

How is vaginal atrophy (GSM) diagnosed?

Vaginal atrophy can often be diagnosed through a review of your symptoms and a physical examination of your vagina and cervix. Indications of vaginal atrophy during physical examination include:

Dryness
Redness
Swelling
A shortened or narrowed vaginal canal
Loss of elasticity
Labial shrinkage
Small cuts or tears near the vaginal opening
White discolouration of the genitals
Vulval skin conditions1

While a pelvic examination alone is normally sufficient to diagnose vaginal atrophy, further testing may be carried out for confirmation or to rule out other causes. These tests include:

Urine test
Vaginal infection testing (urine or swab testing)
Ultrasound
Cervical smear test1,8

Can vaginal atrophy (GSM) be prevented?

Vaginal atrophy can’t be prevented as a decline in oestrogen is a natural part of ageing. However, there are ways to stop it from becoming worse or exasperating its symptoms.

Regular sexual activity: This increases blood flow to the vaginal tissue
Avoiding irritants: Perfumes, soaps, detergents and douching can affect the delicate vaginal skin1.
Stopping smoking: This is one of the risk factors for developing vaginal atrophy.
Pelvic floor exercises: These may improve vaginal tone and elasticity9.

Treatments for vaginal burning during menopause

Treatment of vaginal burning will depend on its cause, severity and accompanying symptoms, medical history and personal preferences.

Hormonal treatment

Prescription-only, hormone-based treatments are often considered the most effective, although they aren't for everyone. Your doctor should discuss all options with you.

Local oestrogen

Local oestrogen is used solely in the genital area. Its main advantage is that it is effective at providing direct relief for symptoms such as vaginal burning and itching at lower doses and limits your overall exposure to the hormone. As it is low dose and is not thought to be absorbed systemically, it is therefore not classed as an HRT (hormone replacement treatment) and does not need progesterone alongside it. Local oestrogen comes in several formats and Gina (a vaginal oestrogen tablet) is available over the counter, however it’s best to speak to a doctor first:

Vaginal oestrogen cream (Ovestin)
Vaginal oestrogen gel (Blissel)
Vaginal oestrogen pessaries (Imvaggis)
Vaginal oestrogen ring (Estring)
Vaginal oestrogen tablet (Gina, Vagifem, Vagirux)1,10

Hormone replacement therapy

There is also systemic oestrogen hormone replacement therapy (HRT). This treatment option may be particularly beneficial for women experiencing additional symptoms such as sweating.

As with local oestrogen, there are different types of HRT treatment:

Tablets
Spray
Gel
Patches

As with all medications, HRT does come with side effects. Bleeding while on HRT is common and although it is often temporary, it can be less than ideal if you are already experiencing spotting in conjunction with vaginal burning as symptoms of vaginal atrophy.

Read more on oestrogen therapy for menopause symptoms to help you understand whether it’s the right choice for you.

Dehydroepiandrosterone (DHEA)

DHEA is a hormone that is naturally produced by the adrenal glands, although its level declines with age. A synthetic version of DHEA is available as a tablet, capsule, powder, topical cream and gel.

Studies indicate vaginal DHEA is an effective and safe treatment in menopausal women to treat the symptoms of vaginal atrophy11, such as vaginal burning.

Non-hormonal treatment

If you can't take hormone-based treatments or would prefer not to, there are alternative ways to deal with vaginal burning during menopause and other symptoms of GSM. It is important to choose options that do not have irritants in, so as not to flare the symptoms further.

Lubricants

Water-based lubricants can be applied before sexual activity to reduce friction and discomfort during intercourse, which can give rise to a sensation of burning1,8.

The effects are short-lasting but lubricants can be bought over the counter and even in supermarkets, and are easy to apply.

Vaginal moisturisers

These help restore moisture to vaginal tissue, improve elasticity, relieve dryness and alleviate burning and itching. They are longer lasting so usually applied to the vagina every 1-3 days and can be purchased over the counter1,8.

Osphena

Osphena is a once-daily, non-hormonal prescription oral pill that helps with moderate to severe vaginal dryness, which can lead to burning and painful intercourse12.

Dilators

Vaginal dilators can be used on their own or in addition to oestrogen replacement therapy. They are tubelike devices made of plastic or medical-grade silicone which you gently insert into the vagina to stretch the vaginal tissue.This can help with vaginal burning, particularly if it is related to pain during intercourse and it can reduce friction and make sex more comfortable13.

In summary:

If you experience vaginal burning during menopause, it is most likely a symptom of vaginal atrophy, although there are other causes of vaginal burning such as infection, irritants and skin disorders.
This common condition is due to declining oestrogen and can lead to a range of genitourinary symptoms.
It can be diagnosed through a pelvic examination.
Symptoms can impact your quality of life and your emotional well-being.
There are hormone and non-hormone-based treatment options.

If you’re experiencing vaginal burning or other symptoms of vaginal atrophy, you should speak to a healthcare professional. If you’d like to be recommended to a Menopause Care specialist based on your personal symptoms and concerns, take our symptoms quiz.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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