6 Ways Your Vagina Changes During Menopause

Menopause likely conjures images of hot flashes and mood swings. But have you ever thought about how the change impacts your vagina? Turns out, the decrease in estrogen that happens during menopause affects more than your mood and your cycle—it can also cause physical changes to your nether regions.

“Vaginal changes may occur throughout all stages of menopause: perimenopause, menopause, and postmenopause,” says Anna Klepchukova, MD, Chief Science Officer at Flo Health. From dryness to changes in the size and shape of your vagina, these changes can be significant but are considered normal, she notes.

Keep reading to learn exactly how your vagina transforms throughout menopause.

1. It becomes dry and potentially itchy.

Estrogen helps keep your vaginal walls lubricated. With less of it, you’ll notice your vagina feels much drier. Known as vaginal atrophy, this thinning and drying of the vaginal walls may lead to other symptoms, including vaginal itching and burning, according to the Mayo Clinic. Talk to your doctor about possible treatments, which may include vaginal moisturizers and lubricants.

2. It may be more likely to tear or bleed during sex.

Because the skin in the vaginal area becomes thinner and more fragile during menopause, tearing and bleeding during sex can occur, says Monique May, MD, a family and emergency room doctor based in Charlotte, North Carolina. Ironically, more frequent intercourse and masturbation (with vaginal penetration) can make the vagina less prone to tearing since it increases blood flow and moisture to the area (all the more reason to keep up your sex life if you can!).

3. It may shrink in size.

Speaking of sex, a lack of it can change the shape of your vagina. “The vagina is comprised of muscle tissue, and like any other muscle, if it’s not used frequently it can shrink and lose tone,” says Dr. May. The best way to keep this from happening is to continue having sex or masturbating (with vaginal penetration) during menopause. If it’s painful, try using a vaginal moisturizer or water-based lubricant, and if that doesn’t help, talk to your doctor.

4. 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.

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. Klepchukova. The pH of the vagina becomes less acidic, which is a result of declining estrogen levels.

Dr. Klepchukova notes that this is a normal symptom of menopause, but if you’re concerned, talk to your gynecologist.

6. It could stretch or expand into other organs.

Vaginal prolapse happens when the vagina stretches or expands into other organs. It occurs during menopause because of decreased muscle tone in the pelvic regions, according to the Cleveland Clinic.

Though many women don’t experience symptoms, those that do may feel fullness in the vagina, a pulling or heavy feeling, low back pain that feels better when you lay down, or incontinence. If you experience any of these issues, talk to your doctor, who may recommend pelvic exercises that can help or surgery (in extreme cases).