7 Changes that Happen to your Vagina During Menopause

Vaginal Changes During Menopause - Vaginal changes may occur throughout all stages of menopause: perimenopause, menopause, and postmenopause. From dryness to changes in the size and shape of your vagina, these changes can be significant but are considered normal.

Vaginal Changes During Menopause

In this article, you will learn seven vaginal changes during menopause, rather say; 7 changes that happen to your vagina during menopause. There’s a lot going on as we age, and not all of it is welcome. A lot of women are blindsided by the changes that occur from menopause.

During menopause, women experience a drop in estrogen levels and physical changes to the vagina, vulva, and vaginal opening, which can cause symptoms like dryness and urinary tract infections. Vaginal changes may occur throughout all stages of menopause: perimenopause, menopause, and postmenopause.

These changes, which used to be called vaginal atrophy, are now known as genitourinary syndrome of menopause (GSM), a condition that affects more than half of postmenopausal women, according to a research review.

The good news is that these changes can be treated — and reversed, says Dr. Mclee Tembo. Keep reading to learn exactly how your vagina transforms throughout menopause.

1. Painful sex

Sex can be uncomfortable or even painful: Premenopause, the vagina has a thick wall that’s comprised of rugal folds, which are accordion-like wrinkles that allow the vagina to expand to accommodate a baby or penis. During menopause, many women experience a thinning-out of that layer; what’s more, those rugal folds flatten, preventing the vagina from expanding. The result of these changes: Penetration may be painful, even if you are aroused.

If intercourse is particularly painful — think “stabbing” or “fiery” pain — there may be a problem near the opening of your vagina. For example, doctors will sometimes see inflamed red patches in this area, says Dr. Mclee Tembo. “If a doctor touches a [cotton swab] here, people will say it’s painful,” he says. Aside from intercourse, you may feel irritation or vaginal burning in general.

Over-the-counter vaginal lubricants or moisturizers can help improve comfort during intercourse or alleviate dryness. If you’re feeling dry, there’s no reason not to try one and see what it can do for you. If those options don’t work, you may want to talk to your doctor about whether you should take vaginal estrogen.

You may also find sex less pleasurable. This happens because blood flow to the area is reduced and because the nerves supplying the genital area also work more effectively in the presence of oestrogen (which is now in decline).

2. Itching, pain and burning

It can also burn when you pee: Feeling the burn? You aren’t the only one. The tissues that line the vagina and urethra are similar, in that they both have estrogen receptors, says Dr. Mclee Tembo. When estrogen levels decrease, these tissues begin to dry up, which gives “bad” bacteria a chance to populate.

“You have this perfect storm for infection in the bladder and urethra,” he says. You may experience burning, itching and pain either internally or externally. This can be extremely uncomfortable and disruptive, and is one of the most common symptoms of GSM. In some cases it can even be severe enough to disrupt normal activities, including cycling and sitting down.

This happens when typical menopausal changes to the genitals are accompanied by inflammation. The same process can also cause bleeding and changes to the appearance.

Drinking a lot of fluids and urinating regularly are both good habits to practice. Cranberry supplements can also help prevent bacteria from sticking to the wall of the bladder, says Dr. Mclee Tembo.

3. It may become more prone to UTIs

Lower estrogen levels don’t just cause your vaginal lining to become thinner and drier—they can also cause the lining of your urinary tract to lose volume, according to the American College of Obstetricians and Gynecologists (ACOG). This can result in vaginal and urinary tract infections and more frequent urination.

The good news is there are a number of treatments for these, issues including vaginal moisturizers and lubricants; local estrogen therapy (think vaginal creams and tablets); systemic estrogen therapy (like pills and patches); and selective estrogen receptor modulators (SERMs), which stimulate estrogen-responsive tissues.

4. Vulva changes in menopause

You may also notice that you look different down there after going through menopause. This is normal and just like the other symptoms of GSM is due to reduced oestrogen levels – blood flow to the area decreases, collagen and elastin levels drop.  Menopause triggers changes to more than just the vagina; it can also alter the look of the vulva. “We see an actual thinning and flattening out of the labia minora. Over time, some women completely lose their labia minora.

Tissues including the vulva, labia and clitoral hood can all be affected. You may notice that you have less pubic hair, that your labia seem to shrink or even disappear. Some women may find that the labia fuse together, and that the vaginal opening narrows. Internally, the vaginal walls often become paler, drier and smooth in texture. 

Less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier, and less elastic or flexible. Shifting levels of hormones—especially estrogen—during the menopause transition produce changes in a woman’s body.

Here’s why it is important to know: It’s not always enough to treat the inside of your vagina; outside problems can make penetration impossible. At your appointment, a doctor should evaluate both areas.

5. It could take on a new odor

“During menopause, many women notice a smelly, watery vaginal discharge, which is caused by a change of pH in the vagina,” says Dr. Mclee Tembo. The pH of the vagina becomes less acidic, which is a result of declining estrogen levels. This is a normal symptom of menopause, but if you’re concerned, talk to your gynecologist.

6. The vagina’s microbiome may shift

It’s not unusual for the vaginal pH to change with menopause. A normal, healthy vaginal pH is low, but as a woman develops GSM, that pH increases. A rise in pH alone won’t cause symptoms, but this change can alter the vaginal microbiome (a network of bacteria), leading to an increased risk of vaginal infections.

Treatment with vaginal estrogen to manage other menopause-related symptoms can help decrease your pH levels and improve “good” vaginal bacteria, although estrogen treatment is not typically used solely to address pH issues. Talk to your doctor about your options.

7. You may leak a bit when you cough

If that “gotta go” feeling hits so strong that you struggle to make it to the bathroom, your pelvic floor may be weak. “A lot of the urinary symptoms of incontinence [are] from the pelvic floor,” says Dr. Mclee Tembo. A physical therapist who specializes in pelvic floor exercises can be helpful, he says.

When to See your Doctor

If you have any symptoms that are bothering you, including any from the list above, book an appointment! While this is not an easy subject to talk about, your doctor will have dealt with this problem many times over and can offer effective treatments. 

It is important to note that some symptoms of GSM can be caused by other conditions, therefore it’s important to get them assessed properly by your doctor. Book in as soon as possible if you have any vaginal bleeding, blood in your pee, sores or ulcers on the genitals, severe pain or anything that is particularly worrying you. 

When do changes to your vagina happen?

It varies. Some women will begin to notice changes to their vagina and genitals happening alongside the first symptoms of menopause. Others may only begin to notice problems several years after their other menopause symptoms have disappeared.

What does vulvar inflammation look like?

With vulvitis or vulvovaginitis, your genitals may look red or swollen. Your skin may look scaly, white and patchy and you may have blisters. In more severe cases, your skin may be so irritated that it sticks together. Don’t postpone scheduling an appointment with your provider if your vulva looks or feels abnormal.

What does menopause discharge look like?

Women who are menopausal normally have minimal vaginal discharge as a result of lower levels of estrogen. In women who are premenopausal, it is normal to have approximately one-half to one teaspoon (2 to 5 mL) of white or clear, thick, mucus-like, and mostly odorless vaginal discharge every day.

Menopause vaginal pain

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms.

Perimenopause vulvar irritation

Vaginal itching is one of many symptoms women experience during perimenopause, which is the transition into menopause, as well as after menopause. This is due to a condition called atrophic vaginitis (vaginal atrophy), where the vagina’s lining becomes drier and thinner from decreased estrogen levels.

Menopause vaginal itching

The tissue that lines the wall of your vagina becomes thin, dry and inflamed when you have vaginal atrophy. Often, the first sign is less lubrication (dryness), which you may notice during sex. Other symptoms of genitourinary syndrome of menopause include: Burning and/or itching in your vagina

Vaginal burning menopause

During menopause, levels of estrogen, an important hormone in women, naturally go down. As a result, the walls of the vagina become thin, dry, and sometimes inflamed. In many women, this leads to symptoms of vaginal burning, irritation, pain (especially during sex), bleeding, or discharge.