Menopause is natural, but if dryness, pain, infections, or urine leaks are getting in the way of feeling confident, know that you’re not alone!

Dryness, Pain, Infection and Urine Loss: What, Why and How to Fix It!

Menopause is natural, but the vaginal changes that come with it aren’t always easy to talk about. If dryness, pain, infections, or urine leaks are getting in the way of feeling confident, know that you’re not alone — and you don’t have to put up with these symptoms. Here’s how estrogen loss drives these issues, and what everyday solutions can help you feel better, inside and out. Let’s unpack why this happens and how you can take back control of your vaginal and urinary health.

Why Do These Symptoms Happen?

During menopause, the ovaries make less estrogen. That’s the key hormone that keeps your vagina and bladder tissues healthy. When estrogen dips, the skin and lining of these areas become thinner, dry, and less elastic. The healthy bacteria that normally protect against infection may also decrease, making things even more uncomfortable.

Why Estrogen Matters

Estrogen is more than a reproductive hormone. In the vagina and lower urinary tract, it:

• Keeps the vaginal lining thick, elastic, and well-lubricated.
• Maintains blood flow to the tissues, supporting sensation and healthy function.
• Promotes the growth of protective lactobacilli, the “good bacteria” that guard against infections.
• Supports the urethra and bladder lining, helping maintain continence.

When estrogen levels fall during and after menopause, all of these protective effects diminish, setting the stage for multiple problems.

Four Common Vaginal & Bladder Changes

• Dryness and Pain: Less moisture means the vagina feels dry, itchy, irritated, or even sore—especially during intimacy. Burning sensations, pain with sex and microtears after intercourse are common symptoms.
• Recurring Infections: Estrogen deficiency shifts the vaginal microbiome. Instead of healthy lactobacilli that keep the vagina slightly acidic, bacteria like E. coli and yeast are more likely to colonize. Yeast infections or urinary tract infections (UTIs) can strike more often, as can bacterial vaginosis episodes.
• Urine Leaks: Estrogen also maintains tone and elasticity in the urethra and pelvic tissues. When estrogen drops, sneezing, laughing, or working out suddenly leads to unexpected leaks. In addition, urgency incontinence (having a sudden, strong urge to urinate) may occur. For many women, these bladder symptoms appear hand-in-hand with vaginal dryness—a signal that estrogen loss is the unifying cause.
• Soreness, Burning or Itching: Thin tissue is easy to irritate, and you might notice discomfort day to day, not just with sex.

What You Can Do?

The good news? These problems are not inevitable. Many strategies can restore comfort and protect long-term health.

Pelvic Floor Exercises:

Kegel exercises can help strengthen muscles that control urine flow and support your bladder. Home-based Kegel programs (without supervision) have been shown to be effective at reducing stress urinary incontinence and mixed incontinence symptoms, with noticeable benefits in both symptom reduction and muscle strength compared to control groups who did not perform the exercises.

✓ PROS: can be done on your own time. Can be effective if performed consistently.

✖ CONS: oftentimes women are not clear that they are doing these exercises correctly. Can be very time-consuming and requires high levels of motivation and consistency. Does not address vaginal dryness or painful intercourse due to tissue thinning and atrophy. May not be adequate for moderate to severe incontinence issues.

Prescription and professional grade options:

vFit Plus by Joylux:This home-use vaginal wellness device designed to support vaginal health and address symptoms of urinary incontinence combines red light therapy (photobiomodulation), gentle heat, and sonic vibration to address incontinence, vaginal dryness, painful intercourse, arousal and sensation. The combination of red light therapy to promote natural tissue rejuvenation, hydration, and enhanced blood flow with gentle heat therapy further improves blood circulation and natural lubrication. At 12 minutes a day, 3 days a week, benefits are noticeable within 3 weeks.

✓ PROS: very effective, easy to do in the privacy of your own home, relatively inexpensive for a treatment device.

✖ CONS: requires ongoing treatments, 1-2x/week to maintain the benefit.

Local vaginal estrogen (in tablet, ring, or cream form) is effective for dryness, pain, and infections, restoring tissue elasticity and microbiome balance with minimal systemic absorption. It does require the use of hormones locally and ongoing therapy 2 days/week.

✓ PROS: Usually cost is covered by insurance, and is effective for all estrogen-deficiency symptoms.

✖ CONS: requires ongoing maintenance 2 days/week and some women are not comfortable using hormone therapy.

Systemic hormone therapy may be considered if you also struggle with hot flashes, night sweats, or bone loss. However 25% of women on systemic HRT, still require local vaginal treatment to address these symptoms.

DHEA suppositories or oral SERMs may also provide relief when estrogen is not an option.

✓ PROS: Usually covered by insurance. Requires daily medication. DHEA is a hormone that may convert to estrogen intracellularly.

Vaginal laser, microneedling or radiofrequency treatments: Femilift (CO2 laser), Morpheus 8V (microneedling) or Votiva Forma V (radiofrequency energy treatment) all work to improve collagen and elastin formation to restore vaginal tissue and bladder supports.

✓ PROS: The overwhelming benefit of these treatments is that they require an initial three session treatment package spaced one month apart – then one treatment a year to maintain vaginal health benefits. Definite upside is the effectiveness and the lack of effort involved or continuous maintenance. It is very effective for incontinence issues as well as painful intercourse, dryness, infections and sensation.

✖ CONS: These treatments are not covered by insurance and are more costly up front compared to other prescription interventions.

Lifestyle support:

Stay sexually active – regular stimulation improves blood flow and tissue health.

Maintain hydration and a Mediterranean-style diet for vascular and microbiome balance.

Strengthen your core and pelvic floor muscles with yoga, Pilates, or physical therapy.

Takeaway

Vaginal dryness, painful sex, recurrent infections, and urine leakage are not just “part of getting older.” They are direct consequences of estrogen loss during menopause. Once you understand the root cause, you can choose targeted therapies that reverse these changes, restore comfort, and boost quality of life.

A healthy vagina and bladder are essential to well-being at every age. Don’t suffer in silence — these issues are common, treatable, and most importantly, fixable.

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For more information about my wellness programs and my practice, check out my website drsadaty.com. Hey Look!  You are already here…

Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!

Mental Health Hormones Doctor Anita Sadaty Share The Health board certified gynecologist New York Functional Medicine NY Women’s Wellness