Menopause does not only bring symptoms such as hot flashes and mood swings but also causes changes in the vaginal area. As estrogen levels decline during perimenopause and menopause, these changes can affect the vulva and vagina, leading to thinning, dryness, and discomfort. Estrogen is essential for the health of the vaginal tissue, and a decrease in its levels can cause a variety of unpleasant side effects. The labia minora can become thin or even seem to disappear, and there may be less natural lubrication, leading to pain and irritation during sexual activity. The physical appearance of the vulva can also change, with the labia minora becoming thinner and fat distribution shifting, creating the appearance of sagging.
In addition to physical changes, menopause can also disrupt the vaginal microbiome. As estrogen levels decrease, the amount of protective bacteria in the vagina diminishes, leading to a change in vaginal pH. This can make the vaginal environment more inviting to harmful pathogens, increasing the risk of infections such as yeast and bacterial infections. Menopause can also weaken the pelvic floor muscles, leading to issues such as urinary incontinence, bladder dysfunction, and pelvic organ prolapses. Studies show that between 25% and 50% of postmenopausal women experience some form of urinary incontinence, which can be managed with protective pads but may also lead to vulvar dryness and irritation.
While the physical changes to the vulva during menopause cannot be fully avoided, there are ways to minimize their impact. Practicing healthy feminine hygiene care from an early age can protect the delicate skin of the vulva and vagina from dryness and other issues. For symptoms like thinning tissue and dryness, vaginal moisturizers and lubricants can provide relief. Prescription remedies such as Osphena and estrogen creams, tablets, and Estring may also be effective. Advanced options like radiofrequency therapy or fractional CO2 laser treatments can stimulate collagen production and rejuvenate tissue. Vaginal dilators can help with pain during penetration, and topical estrogen therapy can help balance vaginal pH.
If dealing with pelvic floor changes, physical therapy can help improve muscle coordination and strength. While Kegel exercises are commonly recommended, some women may require different therapeutic approaches depending on whether they have hypertonic or hypotonic pelvic floor dysfunction. Probiotic supplementation containing specific Lactobacillus strains may also help normalize the vaginal environment and support the regrowth of beneficial bacteria. Overall, addressing these issues during menopause with appropriate treatments and therapies can help women manage the physical changes that occur in the vulva and vagina, improve their comfort and quality of life during this stage of life.
