Vaginal atrophy can happen naturally to any woman as she ages. It's also a known side effect of Femara although like most things, the degree may vary widely. For older women like me, there is the murky uncertainty of whether it's "normal" or completely a side effect or, more likely, an uncertain element of both! What you choose or can do about it (the Mona Lisa treatment may not be as effective if you are having hormonal treatment) is also variable. Many find a lubricant sufficient. I don't have some of the side effects @positive3negative describes in her blog so am less urgently seeking a correction. More details are available through the private group, but like so much else this is horses for courses territory and what suits one may not suit another.