Health Library
Health Library

    Vaginal Changes After Menopause

    Updated 05 February 2021 |
    Published 09 November 2018
    Fact Checked
    Reviewed by Andrei Marhol, PhD, Flo lead medical advisor, Lithuania
    Flo Fact-Checking Standards

    Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles.

    At different stages of life, the vagina adapts. Especially right before and after menopause, you may notice some significant differences in your vagina. Let’s look at some ways to maximize vaginal and vulvar comfort at these times of life. 

    What your body goes through around menopause

    Menopause happens when the ovaries no longer release an egg each month and the menstrual cycle totally stops. 

    This event happens after a natural decline in reproductive hormones, usually around 45–55 years of age. The exact timing of menopause varies based on personal factors like genetics, previous pregnancies, physical activity, and body weight. 

    As you experience the changes of menopause, your monthly periods will eventually stop. According to the Stages of Reproductive Aging Workshop (STRAW +10), a few years before a person undergoes menopause, the length of the menstrual cycle becomes more irregular, leading to cycles that can be 60 days or longer. This time is known as the menopause transition or premenopause.

    Menopause is a one-time event that is marked by a person’s final menstrual period. It becomes clear that this menstrual period was the final one only after 12 months without periods. It also signals the end of “perimenopause,” a term that means the time around menopause. Perimenopause begins at the menopausal transition and ends 12 months after the final menstrual period. 

    The time after the final menstrual period is called postmenopause

    Menopause occurs in a few different ways. Here are some of the most common:

    • Naturally around the age 45–58 years (About 5% of people have early menopause at ages 40–45)
    • Because of surgery to remove the uterus (hysterectomy)
    • In response to chemotherapy or radiation therapy
    • Due to primary ovarian insufficiency

    One of the biggest changes of menopause is a decline in estrogen levels. This leads to certain symptoms, which people experience in a variety of ways. 

    Some of the physiological changes around menopause can involve the following:

    • Weight gain – It’s normal to gain two to five pounds during the transition from premenopause to menopause. This happens due to the decline in estrogen levels. 
    • Hot flashes – Most people experience hot flashes, often with blushing and some sweating. 
    • Trouble sleeping – Hormonal fluctuations also make falling asleep difficult, resulting in insomnia.  
    • Mood swings – Hormonal changes can prompt moods that fluctuate between cheerfulness, sadness, and depression. 
    • Bone changes – Bone density can drop, increasing the risk of bone fractures.
    • Sex drive changes – A drop in estrogen lowers the sex drive (libido).
    • Memory issues – Menopause may affect memory, which can increase the risk of Alzheimer’s disease. 

    Around the time of menopause, people also experience fatigue, depression, joint and muscle aches, headaches, a racing heart, vaginal dryness, vision changes, increased skin wrinkling, poor muscle strength, and bladder control issues.

    Vaginal Changes Around Menopause

    Before menopause, estrogen keeps the vagina lubricated and maintains its elasticity. The lining’s thickness folds allow it to stretch with sexual intercourse and childbirth. 

    With the significant drop in estrogen levels after menopause, the vagina often becomes thin, dry, and less elastic. This condition is medically known as atrophic vaginitis or vaginal atrophy. 

    People who develop this condition may experience vaginal soreness, itching in and around the vagina, vaginal dryness and irritation, tightening or shortening of the vagina, urinary symptoms, vaginal discharge, chafing and burning, inflammation of the walls of the vagina, decreased vaginal lubrication during sexual activity, and/or more frequent yeast infections and urinary tract infections (UTI). All these symptoms can also cause pain and bleeding during sexual intercourse or vaginal penetration (a medical condition technically known as dyspareunia). 

    Before menopause, the vagina is naturally acidic, but after menopause it becomes more alkaline, increasing the chance of UTIs. Low estrogen levels result in more UTIs and vaginitis in postmenopausal people.

    For some people who experience discomfort with menopause, the desire for sexual intercourse declines. Vaginal symptoms can also contribute to changes in sex drive. 

    In summary, vaginal changes around menopause vary from person to person. Often, they can include these signs:

    • Thinning, drying, and reduced elasticity of the vaginal lining
    • Decreased vaginal lubrication
    • Vaginal atrophy 
    • Discomfort during sexual intercourse 
    • Increased risk of  vulvovaginal tearing during intercourse
    • Smooth, thin external genitalia
    • Pelvic organ prolapses (bulges in the walls of the vagina)
    • Sparse pubic hair