What You Need To Know

Menopause is the point in time when your period has stopped for 12 months in a row. It’s characterized by decreased production of the hormone estrogen, which can cause hot flashes and night sweats, mood swings, or trouble sleeping.

Menopause also commonly leads to vaginal changes, including dryness, discomfort, or visible changes around your vulva (the outer area surrounding your vagina), labia minora, or inside your vaginal canal.

As your estrogen levels drop during menopause, the lining of your vagina becomes thinner and less stretchy. You lose collagen, elastin, and fat as you age, which can lead to visible and physical changes in your vulva. You might also notice that your pubic hair starts to thin.

More specifically, you may notice changes in these parts of your body:

• Vagina: Rugal folds (the natural ridges that help your vagina stretch) may smooth out and flatten, leaving the tissue more delicate.
• Urethra: The tissue of your urethra (the tube that carries urine out of your body) can become dry and irritated.
• Clitoris: This small, sensitive organ above your urethral opening may shrink. You may also experience clitoral phimosis or adhesion, when your clitoral hood tightens and doesn’t retract to expose the clitoris as easily. It can cause irritation and sexual problems.

Estrogen also helps maintain a healthy vaginal pH and vaginal flora (microbiome), the balance of bacteria in your vagina. When estrogen drops, the vagina becomes less acidic, making it easier for harmful bacteria to grow.

This pH change raises your risk of common infections, such as urinary tract infections (UTIs) and bacterial vaginosis (BV).

Lower estrogen levels during menopause can lead to visible changes in the labia minora, the inner lips (folds) of the vulva.

Your inner labia may become flatter or thinner, and the skin may appear pale, smooth, or fragile. In some cases, labial atrophy may occur, where the labia minora shrink so much that they seem to disappear.

In severe cases, the skin of the labia can become so thin that it sticks together, a condition called labial adhesion.

In some people, the labia minora may appear more prominent than before. This can happen when the labia majora (outer folds) lose volume and no longer cover the inner lips as they once did. 

These changes occur because estrogen helps keep your vulvar tissues thick, elastic, and well-hydrated. As estrogen declines, the tissue loses volume and becomes more fragile.

Menopause-related changes in your vagina and vulvar area can lead to symptoms that affect your comfort, confidence, and daily life. The effects are often known as genitourinary syndrome of menopause (GSM).

GSM is a common condition that affects 50–75% of people during menopause. It may cause vaginal discomfort, pain during sex, and urinary symptoms.

Vaginal Irritation and Dryness

You may notice vaginal irritation and itching or a dry, tight feeling. This sensation can become more noticeable when walking, sitting, wiping, or wearing tight-fitting clothing.

Painful Sex

As the vaginal walls become thinner, your body also decreases the production of vaginal fluids, reducing your natural lubrication. During sex, these changes can cause burning or stinging.

These painful symptoms may happen due to tiny tears that can occur in your vaginal tissue from increased friction, which is caused by the decreased lubrication and thinning vaginal tissue.

Odors 

You may also notice new vaginal odors, often due to shifting pH levels and the loss of some of the protective bacteria that normally live in your vagina. A different smell may not be anything to worry about, but contact a healthcare provider if you notice a fishy, foul odor. It could be a sign of bacterial vaginosis.

Flaky or Shedding Skin

You may notice that the skin around your vulva or labia minora flakes or peels, especially during wiping, washing, or sex. Vaginal atrophy usually causes this shedding because thin, dry tissue breaks down more easily. 

Urinary Symptoms

Urinary symptoms may involve:

• A strong, sudden urge to urinate, even if your bladder isn’t full
• Frequent urination, including waking up at night to pee
• Irritation or sensitivity around your urethral opening
• Stinging or burning while peeing

Continuous urinary symptoms, along with cloudy or foul-smelling urine or fever, may be signs of a urinary tract infection. If you think you have a UTI, it’s important to seek medical attention.

There are several ways you can help reduce your symptoms if they cause you discomfort:

Moisturizers and Lubricants

Vaginal moisturizers and personal lubricants are methods you can try at home without a prescription for temporary relief.

Moisturizers restore hydration and improve tissue quality. Lubricants reduce friction during sex to ease pain and discomfort. Many people benefit from using both.

Prescription Medications

A healthcare provider may recommend prescription treatments, such as:

• Intrarosa (prasterone): This prescription-strength vaginal insert contains dehydroepiandrosterone (DHEA), a steroid that your body converts into estrogen.
• Osphena (ospemifene): This nonestrogen oral medication helps improve vaginal tissue.
• Systemic hormones: Oral medications, skin patches, and injections of estrogen or progesterone may help address broader menopause symptoms.
• Vaginal estrogen: Available as a cream, tablet, or flexible ring, this medication works locally in the vagina.
• Hyaluronic acid compounds: This nonhormonal substance may hydrate and improve tissue health.

Vaginal Dilators

Vaginal dilators, are soft silicone devices that gently stretch your vaginal tissues. They can help if you have tightness or narrowing of your vaginal canal, which can cause discomfort during penetrative sex or pelvic exams.

Vaginal dilators can be very helpful, especially when paired with moisturizers or estrogen therapy.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy is a supportive option for vaginal and urinary health. A trained physical therapist can help relax tight pelvic muscles through stretching, breathing exercises, and manual therapy. This may improve your physical comfort and help with urinary symptoms. 

Menopause can cause vaginal and vulvar changes due to lower estrogen levels. You may notice thinning of your vaginal walls, shrinking of your labia minora, and dryness, irritation, or pain during sex and urination.

Moisturizers, lubricants, and estrogen therapy may help. Talk to your healthcare provider to find the best treatment for your needs, comfort, and well-being.