Vaginal health during menopause

Menopause likely invokes the images of mood swings and hot flashes. But have you ever thought how menopause impacts your vagina?

As you age, your reproductive system will undergo a lot of changes. It begins to slow down and prepares to stop. As a precursor of menopause, the production of reproductive hormones by ovaries also decreases. During this time, you may notice that the vagina feels very different. At times it feels dry and smells different. This sudden drop in hormone levels causes significant changes in the vagina and affects its overall health.

Before discussing vaginal health, let us first understand about vagina to help you have a better idea of its changes during menopause and their management.

About vagina

Vagina is an elastic, muscular canal with a soft, flexible lining that extends from the vulva — the outside portion of the female genital area — to the neck of the uterus (cervix). It connects the uterus to the outside world. The walls of the vagina are covered by many folds and are highly elastic and robust.

How menopause affects vaginal health?

The drop in circulating hormone levels, especially estrogens, is the main trigger for vaginal health issues during menopause. Some of these changes may begin suddenly and are very noticeable, while others may be mild.

The hormone estrogen plays a vital role in vaginal health. Before menopause, the vaginal walls contain an abundance of estrogen receptors to which the estrogen hormone binds. The estrogen helps to keep the cells of the vaginal wall healthy and lubricated. As levels of estrogen tend to fall during menopause, the vaginal walls that were once elastic, expandable and sturdy will become tight, thin and fragile. The thin vulva and vaginal linings will be unable to withstand the sexual activity, and can even tear with intercourse.

Vaginal changes during menopause

Vaginal changes may occur throughout all stages of menopause: perimenopause (before), menopause during), and post menopause (after). From dryness to changes in the size and shape of your vagina, these changes can be significant in most women. These health concerns are grouped under the medical term ‘vaginal atrophy’.

Major changes that occur in vagina during menopause are:

vaginal lining becomes thin, dry, less elastic and less flexible
vaginal lubrication reduces
fewer folds in the vaginal lining
sparse pubic hair
smooth, thin external genitalia
pelvic organ prolapses

Common vaginal health issues during menopause

The physical changes to the vagina, vulva, and vaginal opening, during menopause can cause symptoms like dryness, thrust etc. In addition to the genital distress, these changes also cause distressing urinary symptoms. So, vaginal atrophy and its accompanying symptoms are together known as genitourinary syndrome of menopause (GSM).

The following are some vaginal health issues that occur during menopause:

Vaginal dryness

One of the major problems that most women experience during menopause is vaginal dryness. It is caused due to a drop in estrogen levels. Vaginal dryness can cause pain and discomfort during sex and increase the chance of vaginal infections. Some women may also notice bleeding after sex or vaginal burning and itching due to vaginal dryness.
Change of vaginal odor

Healthy vagina has a unique fragrance. However, this odor can change due to infections or other health concerns during menopause. Leakage of urine and during menopause can cause an unwanted vaginal odor. In addition, a change of pH in the vagina, caused from fluctuating hormones, can also contribute to a change in vaginal odor.
Pelvic cramps

Pelvic pain during menopause can be a sign of some underlying conditions, such as uterine fibroids, endometriosis, and uterine cancers. Typically, women who have pain in the lower abdomen may experience vaginal discharge and irregular vaginal bleeding.
Vaginal thrush

Vaginal thrush is a common infection caused by an overgrowth of the yeast Candida albicans. Though it is common, vaginal itch during menopause can cause itchiness and soreness of the labia and surrounding vaginal tissues, burning while urinating and pain during sexual intercourse. You may also notice a white, clumpy vaginal discharge.
Urinary tract infections (UTIs)

A normal pre-menopausal vagina is naturally acidic, but during menopause it may become more alkaline, increasing the susceptibility to urinary tract infections. The hormonal changes during menopause also affect vaginal microbiota. This also increases the susceptibility to UTIs.

Managing vaginal health during menopause

Keeping the vagina healthy is not a single step process. Following these simple and easy measures every day will keep vagina well protected and healthy:

Wear breathable cotton underwear and change underwear daily.
Avoid using feminine hygiene sprays and douching.
Use vaginal moisturizers and lubricants regularly.
Gently wash the skin of the genital area with plain water only.
Practice safe sex in order to reduce sexually transmitted infections.
Exercise regularly.
Follow healthy dietary habits.
Include more phytoestrogens (plant-based compounds that mimic estrogen in the body).
Local estrogen therapy in the form of:
- Vaginal tablets, gel or creams
- A vaginal silicone ring.

Vaginal health is an important part of a woman’s overall health. Estrogen plays a vital role in vaginal health. The declining estrogen levels during menopause causes vulvovaginal symptoms. Practicing good personal hygiene and some lifestyle changes will keep vagina healthy. If the symptoms persist, seek medical attention. Healthcare professionals can guide you with combination of medicines, nutrition, supplements that are right for you.