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YOUR CYCLE MENOPAUSE CHANGES

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Vaginal Changes and Problems

During Menopause
What your body goes through Premenopause vaginal changes
Changes during menopause Changes after menopause
Common vaginal problems Vulvar and vaginal comfort

Changes in the vagina pre- and postmenopause are quite

significant. Maximum vaginal and vulvar comfort becomes
crucial at this time of women's lives, and there are several
ways to prevent vulvovaginal atrophy/genitourinary syndrome
of menopause.

What your body goes through during

menopause
Menopause happens when the ovaries no longer release an egg on a monthly basis and the
menstrual cycle totally stops. Some of the physiological changes during menopause include:

An average woman gains from 2 to 5 pounds during the transition from perimenopause to
menopause. This happens due to the decline in estrogen levels during menopause. 
Most women during menopause experience hot flashes, often with blushing and some sweating.
Some other changes that take place at the time of menopause include irregular or skipped
periods, fatigue, depression, irritation, joint and muscle aches, headaches, racing heart, vaginal
dryness, itching and burning, weakening in vision, increased skin wrinkling, poor muscle power,
and bladder control problems.
Hormonal fluctuations during menopause also make it difficult to fall asleep at night resulting in
insomnia.  
Different moods that fluctuate between cheerfulness, sadness, and depression. 
Bones start becoming brittle increasing the risk of osteoporosis. Bone density decreases with
menopause increasing the risk of bone fractures
A drop in estrogen during menopause lowers the sex drive or libido.
Menopause is also said to affect memory increasing risk of Alzheimer’s disease. 

Premenopause vaginal changes

Before attaining menopause, the vagina is well supplied with the hormone called estrogen which
keeps it lubricated and maintains its elasticity. There is no change in the vaginal walls and lining. The
lining is thicker and has more folds that allow it to stretch with sexual intercourse and childbirth. 

At age 50, I find Flo to be a very useful tool during

my final year(s) of the female cycle activity and peri-
menopause. Great insights and it’s wonderful to
track your periods!

Vaginal changes during menopause

vaginal lining becomes thin, dry, less elastic and less flexible
declined vaginal lubrication
vaginal atrophy – avoiding sexual intercourse because of pain and discomfort
vaginal lining has fewer folds due to the decline in estrogen levels
dry, fragile vulvovaginal tissues are susceptible to bleeding, injury and tearing during intercourse
sparse pubic hair
smooth, thin external genitalia
pelvic organ prolapses (bulges in the walls of the vagina)

Vaginal changes after menopause

Menopause is the time in a woman’s life (aged 45 and 55) when there is a natural decline in
reproductive hormones and her ovaries no longer release eggs.

Some other changes during menopause include permanent termination of monthly periods. A
woman is postmenopausal when she has not had a period for nearly twelve months or longer.

Menopause occurs in the following ways:

As natural aging in women in the age group of 45-55 years

As a result of hysterectomy (removal of the uterus)
Chemotherapy and radiation therapy
Primary ovarian insufficiency

One of the biggest changes that accompany menopause is the decline in estrogen levels. With the
significant drop in estrogen levels after menopause, the vaginal tissues become thin, dry and less
elastic. This condition is medically termed as atrophic vaginitis or vaginal atrophy. 

Some of the changes that happen due to this condition include vaginal soreness, itching in and
around the vagina, vaginal dryness and irritation, tightening or shortening of the vagina, distressing
urinary symptoms, vaginal discharge, chafing and burning, inflammation of the walls of the vagina,
decreased vaginal lubrication during sexual activity, and/or more frequent infections in the area,
such as yeast infections and UTI. All these symptoms also cause pain and bleeding during sexual
intercourse or vaginal penetration (a medical condition technically known as dyspareunia). 

A normal vagina before menopause is naturally acidic, but after menopause it becomes more
alkaline, increasing vulnerability to UTI. Low estrogen levels result in more UTIs and vaginitis in
postmenopausal women.

After menopause, the urge for sexual intercourse declines due to the expectation of pain. Much
more complex change is a decline or significant lowering of the libido or the sex drive. Vaginal
symptoms are a contributing factor to decreased sex drive and other associated life stresses
including changes in your relationship with your spouse or partner. 

Some other vaginal changes after menopause include:

Vaginitis — this is also termed as inflammation of the vagina caused by a yeast or bacterial
infection or by irritability from soaps or hygiene items. Symptoms include itching, vaginal
discharge, burning, and inflammation of the vulva and vagina.
Vaginismus — involuntary spasms or contractions of the tissues at the vaginal opening
Vaginismus is painful causing stinging sensations. It is a result of painful intercourse caused by
estrogen deficiency and vaginal atrophy. 

Common vaginal problems during

menopause
Vaginal thrush
Vaginal thrush, also known as vulvovaginal candidiasis, is defined as an infection caused due to an
overgrowth of yeast named Candida albicans. The symptoms include soreness, itchiness and
discomfort. It is very unpleasant and uncomfortable and causes vaginal discharge, often white (like
cottage cheese) which is thick and usually odorless. An increased vulnerability to infection is
another possibility with dry vagina after menopause. As the acidity of the vagina declines, the vagina
loses its potential to fight vaginal infections like Candida Albicans (thrush) and other microbes.

Thin vaginal lining

While transitioning from pre-menopause to menopause, declining estrogen levels have a big impact
on the skin. Lower levels of estrogen make you prone to vaginal mucosa thinning, sagging, and
wrinkling. Reduced estrogen levels result in declined production and repair of elastin and collagen in
the dermis of the skin.

Vaginal dryness
Vaginal dryness can be a cause of discomfort for many postmenopausal women. It is an
uncomfortable and often painful condition that occurs naturally during perimenopause and
postmenopause. There is a sharp decline in estrogen during menopause which causes the dryness.
It is a hallmark sign of the GSM (genitourinary syndrome of menopause), also known as atrophic
vaginitis or vaginal atrophy. Problems associated with having a dry vagina include; narrowing and
shortening of the vagina, reduced libido or sex drive, pain during sex, vaginal itching, burning,
discomfort and irritation.

Change of smell
Many women during menopause notice a smelly, watery vaginal discharge that can cause you
distress. A change of pH in the vagina due to the decline in estrogen levels and fluctuating
hormones can result in vaginal odor.

I love that Flo allows me to keep track of my vaginal

health in relation to the health of the rest of my body
because your period is affected by how you live, so
I’m grateful Flo has this feature. I also love all the
questions they ask related to the type of birth
control you use (if any), sexual activity, mood,
exercise and sleep schedule. They really take YOUR
BODY & YOUR NEEDS into consideration!

Pelvic pain
During perimenopause and menopause, uterine fibroids commonly regress because of the decline in
levels of hormone-like estrogen.

Vulvar and vaginal comfort during

menopause
Several treatments and natural remedies are available for addressing vaginal dryness and atrophy.
Treatment options include:

Vaginal lubricants and creams

Products like Astroglide, K-Y jelly, Sliquid, jojoba, coconut oil, Vitamin E suppository, and Aloe Vera
can help moisten the vaginal area. 
Topical estrogen cream

Topical estrogen cream can reduce the symptoms of vaginal dryness. The cream is applied directly
to the vaginal area to get relief from the symptoms. This treatment involves much less absorption of
estrogen in comparison to estrogen taken as a pill. 

Examples of topical estrogen therapies include:

Vaginal ring. It's a flexible ring inserted into the vagina with an intention to release estrogen into
the tissues. The release of estrogen from the ring relieves vaginal discomfort after menopause.  
Vaginal creams. These can be applied to the interior of the vagina. Some of the estrogen in the
cream is absorbed into the blood which raises estrogen levels in the blood much the same as
estrogen pills. These creams are an effective and well-tolerated therapy for vaginal atrophy and
vaginal dryness in comparison to a placebo.
A vaginal tablet. In this treatment, a tablet is placed into the vagina. It helps replenish estrogen
lost due to menopause.
Vaginal moisturizers. These are used to keep vaginal tissues moist and healthy.
Ospemifene. This is a selective estrogen receptor modulator (SERM) medication consumed orally
and helps in the treatment of vaginal atrophy. Please note – this medication is not recommended
for women who have had breast cancer or those who are at a high risk of breast cancer.
Dehydroepiandrosterone (DHEA). It's a nightly vaginal suppository for the treatment of painful sex
in menopausal women.

Menopausal and postmenopausal women undergo tremendous changes in their bodies, especially
the vagina. A postmenopausal vagina can face a condition called vaginal atrophy. This condition
accompanies itching, burning, vaginal discharge, and pain. The thin vaginal lining caused during
menopause causes pain during intercourse, a condition called dyspareunia. As far as vulva is
concerned, some changes that occur during and post-menopause include loss of pubic hair and the
shrinking of the labia size.

This may all sound pretty awful, but the good news is that there's plenty of help available. Several
remedies and treatments like vaginal lubricants and creams and topical estrogen are available to
maximize vulvar and vaginal comfort during menopause.

Updated March 14, 2020

Anna Klepchukova, MD — Anesthesiology and Intensive Care Specialist, Chief Science Officer at Flo

References  

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