Hormonal Changes

If hormones were people, oestrogen would be the social one who remembers everyone's birthday and always brings the good wine. She keeps things lively: supple skin, sharp mind, happy joints, and well-lubricated everything. So when she steps out for a few days, a few months, or forever, tissues that once hummed with life start feeling a little creaky. 

Hormonal shifts are the number-one cause of vaginal and vulval dryness. They happen at different life stages, from periods to menopause, and the fix depends on what's causing the dip. 

After giving birth, oestrogen and progesterone levels drop sharply, while prolactin (the milk-making hormone) stays high. This combination keeps oestrogen low for as long as breastfeeding continues, so vulval and vaginal tissues can feel dry, tight, or sore. Scar tissue from tears or an episiotomy adds to the discomfort because it has fewer lubricating glands. 

A small pilot study of 59 women tested a very low dose of estradiol cream applied twice weekly to support healing after birth-related tears and cuts. The group using the cream showed improved comfort and tissue recovery, and the treatment was safe and well tolerated. 

Because low oestrogen after birth and during breastfeeding is temporary, many women choose a non-hormonal approach with their doctor's advice: hyaluronic acid pessaries or creams, or plant-based balms to maintain moisture and support healing until hormone levels naturally recover. 

For most women, the hormone rollercoaster of perimenopause starts somewhere in the mid to late forties, with menopause (the final period) arriving in the early fifties. Perimenopause is the zigzag part, when oestrogen levels rise and fall unpredictably. Once menopause is complete, oestrogen settles at a much lower baseline. 

After menopause, hormone levels stabilise but not all at the same place. Some women's oestrogen levels remain high enough to avoid significant long-term symptoms, while others settle much lower, leading to ongoing dryness, irritation, or changes in sexual comfort. There's no "average" menopause. It's a shared biological transition that varies widely in how it feels and how long symptoms last. 

When oestrogen drops, blood flow slows, collagen and elasticity decline, and the moisture-producing glands in the vagina and vulva start to quieten down. These changes can lead to Genitourinary Syndrome of Menopause (GSM), the modern term for what used to be called "vaginal atrophy." According to the British Menopause Society, more than half of postmenopausal women experience some degree of GSM, though many never mention it to their doctor. The good news is that these tissues respond well once the right signals are restored. 

About 3% of women and girls experience Premature Ovarian Insufficiency (POI), a menopause that happens early, anywhere from adolescence up to age 40. Sometimes it's linked to genetics, autoimmune conditions, or medical treatments like surgery, chemotherapy, or radiotherapy. In many cases, there's no clear reason. Another 5% or so go through an early menopause between 40 and 45. 

As the Daisy Network and European Society of Human Reproduction and Embryology (ESHRE) both point out, POI and early menopause can bring extra challenges: fertility loss, delayed diagnosis, and the emotional impact of hormonal change at a younger age. 

HRT restores circulating hormones throughout the body, supporting bone, brain, and heart while easing hot flushes, mood changes, and vaginal dryness from the inside out. Most HRT prescribed in the UK now uses body-identical hormones, meaning they're molecularly identical to those your body once made. This contrasts with the synthetic hormones used in most contraceptives, which differ in molecular structure from natural hormones. A previous bad reaction to hormonal contraception doesn't necessarily mean you'll react badly to HRT. 

Women with Premature Ovarian Insufficiency (POI) or an early menopause usually need much higher doses of oestrogen, often two to three times the standard HRT levels, to get their hormones back into a healthy, premenopausal range. If that's you, ask for a referral to a specialist menopause or POI clinic, or take the British Menopause Society's clinicians' notes to your GP. Most GPs haven't had detailed menopause or POI training, not because they don't care, but because it isn't part of standard GP education in England, Scotland, or Wales. A good information sheet helps you work effectively together.