Vaginal atrophy, now often included under the broader term genitourinary syndrome of menopause (GSM), can cause dryness, irritation, painful sex, urinary urgency, and recurrent UTIs. Treatment can improve symptoms and tissue health, but the right approach depends on whether the problem is primarily vaginal, urinary, pelvic floor-related, or a combination.
Updated: August 15, 2026
Author: Elidah Medical Staff
Vaginal atrophy describes thinning, drying, and inflammation of vaginal tissues that can occur when estrogen levels decline. Today, healthcare providers often use the broader term genitourinary syndrome of menopause (GSM) because the changes can affect not only the vagina, but also the vulva, urethra, and bladder.
GSM is especially common after menopause, but it can also occur during perimenopause or after treatments that reduce estrogen, including certain cancer therapies.
Unlike hot flashes, which may improve over time, vaginal and urinary symptoms associated with low estrogen often persist unless they are treated.
The main cause is a decline in estrogen. Estrogen helps maintain vaginal tissue thickness, elasticity, blood flow, lubrication, and an acidic vaginal environment.
When estrogen decreases, vaginal tissues may become thinner and less elastic, natural lubrication may decrease, and vaginal pH may rise. These changes can also alter the vaginal microbiome and contribute to urinary symptoms or recurrent urinary tract infections.
Lower estrogen may occur with:
Symptoms can vary from mild dryness to significant vaginal and urinary discomfort. Common symptoms include:
Some women also notice bladder leakage during the same stage of life, but vaginal atrophy and urinary incontinence are not the same condition. Stress incontinence, overactive bladder, and GSM can occur together and may require different treatments.
Vaginal atrophy can often be significantly improved and managed, but “reversed” can be misleading because symptoms may return if treatment is stopped and estrogen remains low.
Treatment can improve moisture, comfort, tissue quality, and some urinary symptoms. The most appropriate option depends on symptom severity, medical history, whether hormone therapy is appropriate, and whether pelvic floor weakness or another bladder condition is also present.
Treatment for vaginal atrophy depends on which symptoms are most bothersome. Some women need only nonhormonal moisturizers or lubricants, while others benefit from local vaginal hormone therapy or additional treatment for bladder or pelvic floor symptoms.
The goal is not just to reduce dryness. Effective treatment may also improve comfort, sexual function, urinary symptoms, and tissue health.
Low-dose vaginal estrogen is one of the best-established treatments for GSM. It is applied directly to vaginal tissues as a cream, tablet or insert, or ring and can improve dryness, irritation, painful sex, and some urinary symptoms.
Because vaginal estrogen is used locally, systemic estrogen exposure is generally much lower than with full-body hormone replacement therapy. Other prescription options may also be available depending on symptoms and medical history.
Women with a history of hormone-sensitive cancer should discuss vaginal hormone therapy with their oncology and gynecology teams before starting treatment.
Women who prefer to avoid hormones or who have milder symptoms may benefit from nonhormonal options.
If pain during sex is associated with pelvic floor tightness rather than weakness, strengthening exercises may make symptoms worse. See What Is Hypertonicity? for more on an overly tight pelvic floor.
GSM can affect the urinary tract as well as the vagina. Lower estrogen can contribute to urinary urgency, frequency, burning, and recurrent urinary tract infections.
Urinary incontinence may occur at the same time, but it should be evaluated separately. Leakage with coughing, sneezing, laughing, exercise, or lifting usually points toward stress urinary incontinence, while sudden urgency and leaking before reaching the bathroom are more typical of overactive bladder or urge incontinence.
If bladder changes began around perimenopause or menopause, see Perimenopause Symptoms and Bladder Problems for a broader explanation of how hormones, pelvic floor function, and bladder control can overlap.
Pelvic floor treatment does not reverse vaginal atrophy itself, but it can be useful when pelvic floor weakness or urinary incontinence occurs alongside GSM.
Kegel exercises and pelvic floor muscle training can help strengthen the muscles that support the bladder and urethra. For women who also experience stress or mixed urinary incontinence, Elitone is an FDA-cleared, external treatment that stimulates the pelvic floor muscles through the skin and produces 100 contraction and rest cycles during each 20-minute treatment.
If the main problem is sudden urgency, frequent urination, or leaking before reaching the bathroom, pelvic floor strengthening alone may not address the underlying bladder-control problem. Elitone Urge is designed for urinary urgency and overactive bladder by stimulating nerves involved in bladder control.
The key is matching treatment to the symptom. Vaginal atrophy, stress incontinence, overactive bladder, and pelvic floor tightness can overlap, but they are not interchangeable conditions.
Talk with a healthcare provider if vaginal dryness, burning, painful sex, urinary symptoms, or recurrent UTIs are persistent or affecting quality of life.
Seek medical evaluation for unexplained vaginal bleeding, blood in the urine, significant pelvic pain, fever, recurrent infections, or symptoms that do not improve with basic treatment.
For many women, the most effective approach is to treat each part of the problem separately: vaginal tissue changes, pelvic floor weakness or tightness, and bladder symptoms may each require a different strategy.
Can lifestyle changes alone reverse vaginal atrophy?
Lifestyle changes may help reduce irritation and support overall vaginal health, but they usually do not address the underlying low-estrogen changes by themselves. Vaginal moisturizers, lubricants, and prescription treatments may be needed depending on symptom severity.
Are laser treatments for vaginal atrophy safe?
Energy-based vaginal laser and radiofrequency treatments are still being studied. They are not FDA-cleared specifically to treat vaginal atrophy or genitourinary syndrome of menopause, and major medical organizations generally recommend caution because long-term safety and effectiveness data are limited.
How long does it take to see results from estrogen therapy?
Some women notice improvement within several weeks of starting local vaginal estrogen, although full benefit may take longer. Response varies depending on symptom severity, treatment type, and consistency of use.
Can I use the Elitone device at home?
Yes. Elitone is an FDA-cleared, external at-home treatment for stress and mixed urinary incontinence. It stimulates the pelvic floor muscles through the skin and may be useful when bladder leakage or pelvic floor weakness occurs alongside vaginal atrophy. Elitone does not directly treat the vaginal tissue changes of atrophy itself.
Are natural remedies effective for severe vaginal atrophy?
Natural or nonhormonal approaches such as vaginal moisturizers and lubricants can help relieve dryness and discomfort, especially when symptoms are mild. More persistent or severe symptoms may require prescription treatment, including local vaginal estrogen or other therapies when appropriate.
Can Elitone be used during pregnancy and after childbirth?
You should not use the device during pregnancy.
After childbirth, Elitone is perfect to help you “get your normal back” quickly. We recommend waiting 6 weeks after you deliver but consult your doctor about using Elitone earlier.
For those planning on getting pregnant and wondering if they should wait until after childbirth, we encourage you to have a strong pelvic floor BEFORE you deliver so that you can recover quickly. Elitone trains you about which muscles to contract during Kegels, so you can keep your pelvic floor fit on your own during pregnancy.
Will Elitone help with prolapse?
The pelvic floor muscles do a lot to support everything above it, including the uterus and bladder. As the muscles get weak, often the organs above it start to drop (prolapse).
If the condition is mild, doctors often recommend Kegel exercises to help support the organs. If this is the case, Elitone may help because that’s the purpose of the device. However, if the prolapse condition is severe, Elitone is less likely to help. Please consult your doctor.
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