Menopause marks the end of a woman’s reproductive years and periods becoming a thing of the past. It is caused by a decline in oestrogen levels, as a result of the natural ageing process a woman’s body goes through. This drop in oestrogen is responsible for causing a number of menopausal symptoms, including changes to your vagina.

For some women, menopause can be a time of liberation - no more worrying about periods and getting pregnant! But although these are great advantages, it can be extremely difficult adjusting to the changes your body goes through. 

Intimate issues that arise during the menopause are sometimes associated with shame and embarrassment. After all, this isn’t a topic that is broadly spoken about, so women can feel alone. But what you are going through during this time is completely natural! Improving your understanding of how the menopause affects your vagina is key to empowering you on your journey through this phase of your life. Let us explain what is going on downstairs during the menopause and how you can maintain your vaginal health.

Menopause and Your Vagina

The vagina normally keeps a delicate pH balance. Oestrogen causes the cervix to produce a slightly acidic mucus that helps keep the vagina moist and fight off invading bacteria and fungi that may cause infections. As oestrogen levels start to decline around the menopause, mucus production can be affected and the vagina can lose its acidity. This can have an impact on your vaginal health and cause some of the following problems.

Vaginal atrophy

A reduction in oestrogen and vaginal fluids can cause the vaginal walls to become drier, thinner and more easily irritated. This can lead to a common condition known as vaginal atrophy, or genitourinary syndrome of menopause (GSM). According to research, vaginal atrophy affects up to 84% of postmenopausal women, however its thought symptoms are often underreported and the condition sometimes misdiagnosed. 

Symptoms of vaginal atrophy can include:

• Vaginal dryness
• Redness and itching
• A burning sensation
• Changes in discharge
• Pain during sex
• Burning or pain during urination
• More frequent urinary tract infections (UTI)
• Urinary incontinence
• Bleeding after sex
• Tightening and shortening of the vaginal canal

Vaginal atrophy symptoms can vary from mild to severe. According to one study, 75% of women with vaginal atrophy claim it impacts their quality of life, sexual intimacy, body image and mental wellbeing. The good news is there are a number of treatment options available that can help alleviate discomfort. More on this later.

Infections

A reduction in mucus and acidity in the vagina means bacteria and fungi may be more likely to colonise the vagina. Vaginal atrophy also creates a perfect environment for these nasties to thrive. This can increase the risk of a fungal infection (thrush) or a bacterial imbalance such as bacterial vaginosis. These conditions can be uncomfortable and lead to significant anxiety. Thankfully, vaginal infections are usually easily treated, so see your healthcare provider if you think you have something!

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Discharge

During menopause, some women experience increased levels of discharge which may also smell stronger and seem more unpleasant. This happens when vagina alkalinity increases, enabling more bacteria to grow. According to research, a change in vaginal discharge is the second most common symptom of menopause after vaginal dryness. While discharge is normal, certain characteristics are important to look out for as they may indicate an infection. 

Check out this guide to help you recognise unhealthy vaginal discharge.

Dryness

Vaginal dryness is one of the most common symptoms of menopause. A decline in oestrogen causes a reduction in vaginal secretions and lubrication. Drier vaginal tissue is more fragile and prone to injury and tearing, meaning penetration can become painful for many women. 

Menopause vs STIs

You may no longer need to worry about pregnancy and periods once you have officially reached menopause, but you do still need to worry about STIs! Contrary to popular belief, sex doesn’t necessarily stop after the menopause. According to one UK study, more than 80% of 50-90 year olds are sexually active. However, despite this pleasing finding, there is also a concerning rise of STIs emerging in older adults. Practising safe sex is important, regardless of age.

The difficulty sexually active menopausal women face, is that many of the symptoms of STIs and menopause cross over. For example, vaginal discharge, itching, redness, painful urination, and painful sex can apply to both. As such, STIs may be misinterpreted as menopause symptoms, meaning you may be suffering unnecessarily. And vice versa. Many menopausal women also wrongly self diagnose themselves with an STI or vaginal infection, as they may not be aware of the changes that happen to their vagina during this time.

If you are concerned about whether you have an STI, it's important to get tested. Yoxly’s home STI testing kits can help make sure you aren't wrongly diagnosing yourself, so you can seek the appropriate treatment.

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Keep Your Vagina Healthy During Menopause 

According to research, only 25% of women with vaginal atrophy seek medical help, perhaps due to a lack of education or difficulty discussing intimate complaints. But there’s no need to suffer in silence. There are a number of things you can try to help optimise your vaginal health during and after the menopause. Some examples of treatments include:

• Vaginal moisturisers: can help prevent dryness and keep vaginal tissues moist and supple.
• Vaginal lubricants: can help make sexual intercourse less painful. Natural lubricants like coconut oil contain less irritating chemicals so can be a better choice for some.
• Systemic hormone replacement therapy (HRT): can help treat menopause symptoms including vaginal dryness by delivering synthetic oestrogen to the body. HRT comes in many forms, and is not suitable for everyone, so discuss your needs with your healthcare provider. 
• Vaginal oestrogen creams and pessaries: can help reduce dryness and improve symptoms of vaginal atrophy. These deliver localised oestrogen directly to the vagina. A recent development in the self-treatment of vaginal atrophy is a proposal to make vaginal oestrogen tablets readily available from pharmacies. 
• Ospemifene (Osphena): a non-oestrogen pill taken by mouth can exert the same effects as oestrogen, and is used to treat painful intercourse associated with vaginal atrophy. This is only available via prescription, so talk to your healthcare provider. 
• Avoid using personal care products that are heavily scented and contain lots of chemicals, as this can disrupt your pH balance further.
• Taking a probiotic can help maintain the balance of your body’s bacterial ecosystem and can help minimise vaginal imbalances.

Conclusion

The menopause is a natural part of the ageing process for all women, triggered by a drop in oestrogen levels. This decline in oestrogen brings about a number of changes to the vagina that can be uncomfortable and impact your quality of life. These changes can also easily be confused with STIs, so it's important to get checked if you are unsure. 

There are also a number of different treatment options to explore that can help support optimum vaginal health during the menopause and alleviate any symptoms. Your general practitioner or menopause specialist can help you to decide which regime is right for you.