Best Vaginal Moisturisers for Perimenopause Dryness
A guide to the best vaginal moisturisers for perimenopause dryness, covering hyaluronic acid, Replens, pH-balanced options, and ingredients to avoid.
Vaginal Dryness in Perimenopause: What Is Happening
Vaginal dryness, itching, and discomfort affect around 50 percent of perimenopausal and postmenopausal women. Unlike hot flashes, which often ease after menopause, vaginal dryness tends to worsen over time without treatment. It happens because vaginal tissue is estrogen-dependent. As estrogen declines, the vaginal walls thin, become less elastic, and produce less natural lubrication. The condition is medically called genitourinary syndrome of menopause (GSM). It can cause discomfort during daily activities, burning when urinating, and pain during sex. The good news is that it responds well to treatment, and vaginal moisturisers are the first-line non-hormonal option.
Regular Moisturisers vs On-Demand Lubricants
It is important to understand the difference between vaginal moisturisers and lubricants. Vaginal moisturisers are used regularly, typically every 2 to 3 days, to maintain baseline hydration and improve the health of vaginal tissue over time. They are not specifically for sexual activity. Lubricants are used on-demand during sexual activity to reduce friction and discomfort in the moment. Both are useful but serve different purposes. For managing ongoing dryness and improving tissue health, a regular moisturiser is the more important choice. For women with GSM, using both consistently gives better results than either alone.
Hyaluronic Acid Moisturisers
Hyaluronic acid (HA) is a naturally occurring molecule that holds up to 1000 times its weight in water. In vaginal moisturisers, it works by drawing and retaining moisture in vaginal tissue. A 2021 study published in Menopause International found that a hyaluronic acid vaginal gel improved dryness, itching, and painful intercourse comparably to low-dose vaginal estrogen, making it a strong evidence-based option for women who cannot or prefer not to use hormones. Products such as Hyalofemme (available on prescription in the UK and also over the counter) contain 0.2 percent sodium hyaluronate and are applied internally 2 to 3 times per week. HA moisturisers are well tolerated and suitable for long-term use.
Replens and Polycarbophil-Based Options
Replens Long-Lasting Vaginal Moisturiser has been available for over 30 years and remains one of the most widely used options. It contains polycarbophil, a bioadhesive polymer that binds to vaginal cells and releases moisture gradually over several days. Studies show it reduces dryness, improves vaginal pH toward the normal acidic range, and reduces symptom scores. It is applied with an applicator every 2 to 3 days. Replens is available over the counter at UK pharmacies and is also available on NHS prescription in some areas. It is fragrance-free and generally well tolerated. Some women find the texture heavier than HA-based products.
pH-Balanced Options and Natural Alternatives
The vaginal environment is naturally acidic (pH 3.8 to 4.5), which protects against infection. Perimenopause causes vaginal pH to rise, increasing susceptibility to bacterial vaginosis and urinary tract infections. pH-balanced vaginal moisturisers help restore and maintain the correct acidity alongside hydrating tissue. Products in this category include Yes VM (certified organic, available in applicator format) and Sylk (plant-based, made from kiwifruit extract). Aloe vera gel designed for internal vaginal use is another natural option, though evidence is more limited. All of these are free from common irritants.
Ingredients to Avoid
Several ingredients commonly found in personal care products and general lubricants are problematic for vaginal tissue. Glycerin, a common lubricant base, is osmotically active and can draw moisture out of vaginal cells and disrupt the vaginal microbiome, increasing infection risk. Parabens are preservatives with potential endocrine-disrupting activity. Fragrance and flavouring are common irritants that can cause contact dermatitis in sensitive tissue. Petroleum-based products (including Vaseline) are not suitable for internal vaginal use. Chlorhexidine, found in some antiseptic gels, can disrupt the vaginal microbiome. Always check the ingredient list and choose products specifically formulated for internal vaginal use.
Local Estrogen: A Step Beyond Moisturisers
Vaginal moisturisers are effective for mild to moderate GSM, but for more significant dryness, thinning, or recurrent urinary infections, local vaginal estrogen is more effective. Local estrogen (available as creams, pessaries, or a vaginal ring) works directly on vaginal tissue without significant systemic absorption, making it appropriate even for many women who cannot use systemic HRT. NICE guidance and the British Menopause Society state that local vaginal estrogen can be used long-term and is not associated with the same risks as systemic therapy. If a moisturiser is not giving sufficient relief after 3 months of regular use, it is worth discussing local estrogen with your GP. Moisturisers and local estrogen can also be used together.
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