What vaginal atrophy means
Vaginal atrophy means thinning of the vaginal lining. Lubrication can fall at the same time. Women may notice irritation, itching, dryness and discomfort during sex. Research papers also use the terms vulvovaginal atrophy and genitourinary syndrome of menopause.
The lining is one issue. Muscle weakness, stretched tissue and prolapse are others, and each needs a different answer. A treatment for the lining will not fix a problem elsewhere. That is why an examination matters before you choose. It also means that a woman can have more than one cause, and that one option alone may not cover them. Results vary.
Vaginal atrophy treatment options at a glance
| Option | What it does | What it cannot do |
|---|---|---|
| Moisturisers and lubricants | Improve surface comfort and reduce friction | Change lining thickness or laxity |
| Prescribed vaginal oestrogen | Supports the lining where low oestrogen drives thinning | Treat looseness from stretched tissue |
| Pelvic floor exercises | Strengthen muscles that support the bladder, vagina and bowel | Change the quality of the lining |
| Fractional CO2 laser (G Lift) | Delivers heat to the lining to stimulate collagen | Strengthen the pelvic floor or correct prolapse |
| Surgical repair | Tightens the canal or repairs support tissues, by referral | Serve as a non-surgical option |
Start without a device
Moisturisers, lubricants and prescribed vaginal oestrogen remain standard options for dryness. Moisturisers and lubricants act on surface comfort, so they suit mild dryness and discomfort during sex. Prescribed oestrogen acts on the lining where low oestrogen is the driver. It needs a doctor's assessment and a prescription. If you have had cancer treatment, discuss it with your oncologist where relevant. For more on the first steps, read our guide to vaginal dryness after menopause.
What regulators and societies have said
The US Food and Drug Administration warned about energy-based devices marketed for vaginal rejuvenation. It said it had not evaluated these devices for those uses. It reported vaginal burns, scarring, painful intercourse and chronic pain, and sent notices to seven manufacturers.
The International Society for the Study of Vulvovaginal Disease and the International Continence Society recommended against using laser and radiofrequency for vulvovaginal atrophy. They said the devices should not be used for lichen sclerosus, vulvodynia, urinary incontinence or rejuvenation outside properly designed clinical trials.
The American College of Obstetricians and Gynecologists stated that laser is neither FDA-approved nor FDA-cleared for symptoms related to menopause. It called the evidence mostly small observational studies and said more research is needed before recommending it.
What the trials show
Two papers help frame the question. In a JAMA trial of 85 women, fractional CO2 laser did not significantly improve vaginal symptoms after 12 months compared with sham. A 2022 review of six randomised trials with 270 women found that CO2 laser was associated with similar improvement in genitourinary symptoms as vaginal oestrogen, with no significant differences on the main measures. So the picture is not simple. Most published studies are small, and sham-controlled trials have given mixed results. Neither paper tells you how you will respond. Our evidence library lists published sources.
How laser is used, if it is used
If you and your doctor decide to discuss a device, our G Lift is the relevant option for the lining. It is a fractional CO2 laser at 10,600 nm, the MonaLisa Touch, used through a vaginal probe. Treatment takes minutes, as an outpatient, without anaesthesia. It is usually felt as a light vibration. Some women may use it alongside or instead of vaginal oestrogen, which is a choice to make with a doctor. The course and any maintenance are planned individually, so no standard number of sessions is quoted.
Who should wait, avoid it or be referred
Pregnancy, breastfeeding until suitability is discussed, active infection including a herpes outbreak, undiagnosed bleeding, or an unresolved abnormal cervical screen.
Pelvic mesh or implants, and recent pelvic surgery or radiotherapy.
Prolapse or structural problems go to a gynaecologist or urogynaecologist. Leaking of unclear cause goes for urinary or pelvic floor assessment.
Risks and warning signs
Mild discharge, spotting, irritation or tenderness can follow laser. Infection, burn, scarring and discomfort during intercourse are uncommon. Your symptoms may not change at all. Aftercare covers tampons, vaginal products, douching, swimming, hot baths, saunas and strenuous exercise. Intercourse waits until you are advised at review. Contact the clinic the same day for heavy bleeding, bleeding that does not settle, fever, foul discharge, increasing pelvic pain, worsening burning on passing urine, severe pain, new leaking, or a feeling of bulging.