Menopause marks the end of a woman’s reproductive years, usually occurring between the ages of 45 and 55. During this natural transition, the ovaries gradually produce less oestrogen, the hormone that plays a vital role in maintaining the health and function of the vaginal environment. This significant hormonal shift can lead to a range of physical changes that affect the vagina and vulva, impacting comfort, sexual health, and overall well-being.
Understanding these changes is crucial. Many women experience symptoms but feel uncertain about what is normal or are hesitant to seek help. The good news is that vaginal changes during menopause are both common and treatable.
This article explores the types of changes you may experience, what causes them, and the effective treatment options available to help you maintain comfort and quality of life during and after menopause.
Many women notice physical and sensory changes in their vaginal and vulval area after menopause. These may include dryness, tightness, discomfort, and changes in discharge or tissue texture. The extent and severity vary, but most stem from the same underlying cause: reduced oestrogen levels.
One of the earliest and most common symptoms of menopause is vaginal dryness. The drop in oestrogen reduces the amount of natural lubrication produced by the vaginal tissues, leading to a persistent feeling of dryness. This can be accompanied by itching and a burning sensation that causes discomfort during daily activities, exercise, or intimate moments. Over time, reduced moisture may also alter the pH balance of the vagina, increasing susceptibility to infection and inflammation.
Many women notice these symptoms affecting their quality of life well before other menopausal changes become apparent.
The vaginal walls rely on oestrogen to maintain their thickness, elasticity, and resilience. Without adequate oestrogen, these tissues become thinner, less elastic, and more fragile, a condition medically known as vaginal atrophy.
This thinning may create a sensation of tightness or narrowing within the vagina. The broader term “Genitourinary Syndrome of Menopause” (GSM) encompasses not only vaginal atrophy but also urinary and sexual symptoms related to oestrogen loss.
Fortunately, these changes are reversible with appropriate care. You can learn more about professional vaginal atrophy treatment options available at the London Women’s Centre.
A healthy vaginal environment is naturally acidic, with a pH between 3.8 and 4.5, and is maintained by Lactobacillus, a beneficial bacterium that helps keep the vagina’s pH balanced. These bacteria thrive on glycogen stored in vaginal cells, a process stimulated by oestrogen.
When oestrogen declines during menopause, glycogen levels drop, leading to fewer Lactobacilli and a subsequent rise in vaginal pH. This less acidic environment disrupts the natural protective barrier, making the vagina more vulnerable to infections and irritation.
The thinning of vaginal and urethral tissues, combined with changes in pH and flora, increases susceptibility to infections. Many menopausal women experience recurrent urinary tract infections (UTIs), alongside symptoms such as burning during urination, urgency, frequency, and even stress incontinence.
These issues stem from the same oestrogen deficiency affecting vaginal health and can significantly impact daily life.
Vaginal dryness and reduced elasticity often result in painful intercourse, medically termed dyspareunia. The lack of natural lubrication creates friction, whilst thinned tissues are more prone to micro-tears and discomfort. For many women, this leads to anxiety around intimacy, avoidance of sexual activity, and emotional distress that can strain relationships. Addressing these physical symptoms is essential for restoring both comfort and confidence.
During the reproductive years, vaginal discharge helps keep tissues moist and clean. After menopause, this discharge typically becomes less abundant and may change in texture or colour. Whilst reduced discharge is a normal consequence of lower oestrogen, it is important to distinguish between typical menopausal changes and signs of infection, such as unusual odour, discolouration, or accompanying irritation.
The primary driver of vaginal and vulval changes during menopause is declining oestrogen levels. Oestrogen is essential for maintaining healthy vaginal tissue, it promotes blood flow, supports collagen production, encourages cell turnover, and helps tissues retain moisture. Without sufficient oestrogen, the vaginal walls thin, lose elasticity, and produce less lubrication.
Reduced collagen and moisture retention further compound these effects. Collagen provides structural support and elasticity to the vaginal tissues, and its decline contributes to the fragility and tightness associated with vaginal atrophy. The altered vaginal microbiome, characterised by fewer beneficial bacteria and higher pH, creates an environment more prone to infection.
Lifestyle factors can also worsen symptoms. Smoking reduces blood flow to tissues and accelerates collagen breakdown. A lack of regular sexual activity can lead to decreased blood flow and further narrowing of the vaginal canal. Certain cancer treatments, particularly those affecting hormone levels, may intensify menopausal symptoms and vaginal changes.
Fortunately, numerous effective treatments and strategies can alleviate discomfort and support vaginal health during and after menopause.
Over-the-counter vaginal moisturisers and lubricants provide immediate relief from dryness and friction. Moisturisers are used regularly (typically several times a week) to maintain tissue hydration, whilst lubricants are applied before sexual activity. Choose fragrance-free, pH-balanced products specifically designed for intimate use to avoid irritation.
Topical oestrogen therapy is highly effective for treating vaginal atrophy and dryness. Available as creams, tablets, or vaginal rings, these treatments deliver oestrogen directly to the vaginal tissues, restoring moisture, thickness, and elasticity with minimal absorption into the bloodstream. Most women tolerate local oestrogen well, though it is important to discuss this option with your doctor, particularly if you have a history of breast cancer or other contraindications.
For women who cannot or prefer not to use oestrogen, several non-hormonal options exist. Vaginal moisturisers containing hyaluronic acid or vitamin E can improve hydration. Newer treatments include DHEA pessaries, which the body converts locally into oestrogen and testosterone, and selective oestrogen receptor modulators (SERMs) such as ospemifene, which act on vaginal tissues without affecting breast or uterine tissue.
Regular sexual activity – whether partnered or solo – improves blood flow to the vaginal tissues and helps maintain elasticity. Pelvic floor exercises, such as Kegels, strengthen the muscles supporting the vagina, bladder, and uterus, improving vaginal tone and urinary control whilst reducing the risk of prolapse.
Simple lifestyle changes can make a meaningful difference. Avoid harsh soaps, douches, and perfumed products that disrupt vaginal pH and irritate sensitive tissues. Stay well-hydrated, as adequate fluid intake supports overall tissue health. Stopping smoking improves blood flow and collagen production. Maintaining a balanced diet rich in nutrients and engaging in regular exercise also supports hormonal balance and tissue resilience.
Emerging therapies, such as vaginal laser treatments and radiofrequency devices, aim to stimulate collagen production and increase tissue thickness. Whilst promising, these treatments are still being studied for long-term efficacy and safety. If you are considering these options, ensure they are performed under proper medical supervision by qualified practitioners.
It is important to seek medical advice if you experience persistent discomfort, pain during intercourse, unusual vaginal discharge, or bleeding after sex. Recurrent infections or troublesome urinary symptoms also warrant professional evaluation. Remember, these symptoms are not something you “just have to live with”, they are treatable conditions!
A menopause or gynaecology specialist can assess your individual situation and tailor treatment to your needs, ensuring you receive the most appropriate and effective care.
At London Women’s Centre, we specialise in women’s health with a particular focus on menopause and gynaecological care. Our compassionate team understands the physical and emotional challenges that vaginal changes during menopause can bring, and we are dedicated to providing personalised, evidence-based treatment in a confidential, professional, and supportive environment.
Whether you are experiencing vaginal dryness, changes in the vulva after menopause, or any other menopausal symptoms, we are here to help you regain comfort and confidence.