Vaginal dryness and POI (premature ovarian insufficiency): what helps

Premature ovarian insufficiency (POI) is when the ovaries stop working normally before the age of 40. It used to be called premature ovarian failure. You may also see it called primary ovarian insufficiency. It affects about 4 in 100 women. That's far more than the 1 in 100 once thought. Low oestrogen is part of POI, so vaginal and vulval dryness is common.

POI isn't simply an early menopause. The ovaries can sometimes start working again for a while. And having low oestrogen at a younger age brings its own health needs. That's why POI has its own international guideline, written by ESHRE, the European Society of Human Reproduction and Embryology. This post is based on that guideline and on the British Menopause Society's POI advice.

What helps with vaginal dryness in POI?

ESHRE says vaginal moisturisers and lubricants can help with vaginal discomfort and painful sex in POI. You can use them alongside other treatments. See How to relieve vaginal dryness: moisturisers, lubricants and what to avoid [add link when published]. ESHRE also says doctors should offer vaginal oestrogen for vaginal and sexual symptoms. It can be added if HRT alone doesn't help. See Vaginal oestrogen (estrogen): creams, pessaries, Gina and safety after breast cancer [add link when published].

HRT for POI: why your dose matters

Women with POI usually need a higher dose of HRT than women at the usual age of menopause. ESHRE's guideline says at least 2 mg of oral oestradiol a day, or a 100 microgram patch. That's around double the dose many women start on at menopause. Too low a dose can leave you short of oestrogen, and that includes your vulva and vagina. The combined pill is another option. ESHRE says to take it continuously, or with fewer breaks, so your oestrogen doesn't dip.

HRT also protects your bones and heart. ESHRE and the British Menopause Society both recommend HRT until at least the usual age of menopause, around 51. That applies whether or not you have symptoms. After that, you and your doctor can decide together whether to carry on. ESHRE also says there's no evidence that HRT raises the risk of breast cancer in women with POI, compared with women the same age.

Getting the right care

Ask for a referral to a specialist menopause or POI clinic. Or take the ESHRE and British Menopause Society guidance to your GP. POI training varies a lot between GPs. A good information sheet helps you work through it together. The Daisy Network supports women with POI and has more information.

For more on how low oestrogen affects the vulva and vagina, see Low oestrogen symptoms: why your vulva and vagina get dry.

References

ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI, "Evidence-based guideline: premature ovarian insufficiency," Climacteric (December 2024) https://doi.org/10.1080/13697137.2024.2423213

ESHRE, "Premature ovarian insufficiency: guideline for patients," (December 2024) https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Premature-ovarian-insufficiency

British Menopause Society, "Premature ovarian insufficiency," Consensus Statement (reviewed March 2024) https://thebms.org.uk/wp-content/uploads/2024/04/05-BMS-ConsensusStatement-Premature-ovarian-insufficiency-POI-APRIL2024-C.pdf

Daisy Network, "Premature Ovarian Insufficiency," https://daisynetwork.org/