If you’re currently going through perimenopause, a natural process in which the ovaries gradually stop producing the reproductive hormones estrogen and progesterone, you may be noticing several symptoms related to these turbulent hormonal fluctuations, which are likely signaling that menopause, i.e. the end of menstruation, is near. For reference, the duration of the perimenopause stage could last approximately 4-8, or even 10 years.1
“Perimenopause can cause several physical changes in the body due to the fluctuation and eventual drop of hormones, such as estrogen,” says Meggie Smith, MD, a Nashville, Tennessee -based OB-GYN who specializes in reproductive endocrinology and infertility.
Several of these changes, which are not uncommon, are specifically related to the vagina and vaginal health and can include symptoms such as vaginal dryness, painful sex, changes in discharge, and irritation. Another shift that many women may find uncomfortable to talk about, even though it is actually quite common, is a difference in how the vagina smells.
While having a vaginal scent is completely normal and nothing to be embarrassed about, symptoms of discomfort that can accompany a change in smell are not. Here, experts break down what’s normal and what’s not, as well as when to seek medical care for perimenopause vaginal odor.
What Causes Vaginal Odor During Perimenopause?
As with virtually everything related to menopause, changes in vaginal smell are typically due to hormonal fluctuations and a disruption in your vaginal pH, which maintains the delicate acidic pH of your vagina. According to Cleveland Clinic, if you experience an imbalance in the levels of bacteria in the vagina, or have a shift in your vaginal flora, you may experience symptoms.2 Our vaginal flora, also known as the vaginal microbiome, includes good bacteria, along with others. If you experience an overgrowth of bad bacteria, you may start to experience an unpleasant odor, along with symptoms such as vaginal itching or burning, which can be signs of an infection.
“When our estrogen levels are low, as in menopause, this affects the vaginal walls and they become thinner and drier,” Dr. Smith explains. “From there, the pH of the vagina [also] changes, and ultimately, what happens is that you’re more susceptible to getting vaginal infections or urinary tract infections, and infections are often the culprit in terms of a change in [vaginal] odor.”
“Vaginal dryness and changes in the pH of your vagina can also affect moisture, lubrication and elasticity, making you more susceptible to infections,” adds Stephanie Buck-Haskin, MD, an OB-GYN in Long Island and Queens, New York.
It’s important to note that it’s also possible to experience changes in vaginal smell that aren’t necessarily associated with infection. This can be tied to things like fluctuations in vaginal pH, which, as mentioned, can be impacted by the hormonal fluctuations commonly experienced during perimenopause and menopause. When in doubt, it’s always best to check in with your healthcare provider if you’ve noticed a new vaginal odor, or are experiencing any of the abovementioned symptoms.
Can You Treat Vaginal Odor During Perimenopause at Home?
While a shift in vaginal smell can be frustrating, there’s some good news. There are solutions available to address bothersome vaginal symptoms and get to the root cause of vaginal odor, versus just masking the symptoms. According to Dr. Buck-Haskin, taking an over-the-counter probiotic can help to regulate vaginal pH and clear up perimenopause vaginal odors that are caused by changes in hormone levels along with dryness.
In fact, one study showed that women who took Bonafide’s vaginal probiotic Clairvee® for bothersome vaginal odor, saw an improvement not only in smell, but also in symptoms such as itching, discharge, burning, dryness, irritation or painful urination — within two weeks, with additional improvements noted at four weeks.3
“If probiotics don't work, you should see your gynecologist,” Dr. Buck-Haskin advises.
Other Symptoms to Watch For
Perimenopause vaginal odor typically doesn’t pop up on its own with no other changes, and if you’re experiencing other less-than-pleasant vaginal symptoms, you’re definitely not alone. “Vaginal dryness can cause other uncomfortable symptoms on top of odor, which are not normal,” Dr. Smith says. These include severe irritation, as well as pain with intercourse, which she emphasizes are quality of life issues that shouldn’t be ignored.
Research has also shown that you may be able to find relief from perimenopause symptoms like vaginal dryness and irritation, with lubricants or vaginal moisturizers.4 One potential solution is Revaree®, a clinically studied, hormone-free vaginal insert, whose key ingredient is hyaluronic acid - a naturally occurring molecule in the body that can retain up to 1000 times its weight in moisture. When in doubt you should also speak with your provider to determine what treatment option is best for you based on your symptoms.
When Should You See a Healthcare Provider About Perimenopause Vaginal Odor?
Drs. Buck-Haskin and Smith both recommend seeing your healthcare provider not only if you’re experiencing a new and unusual vaginal odor, but also if you’re experiencing any persistent vaginal discomfort along with vaginal changes during menopause, such as irritation, painful intercourse, or general dryness, that could be due to a change in vaginal pH.
“[It’s important to] check in with your doctor to confirm [that there’s] no infection that requires treatment and to address any quality-of-life symptoms, too,” Dr. Smith says.
According to Dr. Buck-Haskin, you should seek out medical assistance if you’re experiencing extreme vaginal dryness, urinary changes, frequent pain during intercourse, and dryness that is not responding to over-the-counter lubricants. Your provider can also help you determine if you may be a good candidate for hormone replacement therapy to better manage severe and disruptive vaginal symptoms experienced during perimenopause or menopause.
“[Additionally,] if there is a vaginal odor post-intercourse, especially a fishy odor, you should visit your gynecologist to see if bacterial vaginosis should be ruled out and for additional treatment options,” she adds.
While rare, vaginal odor may be a sign of vaginal or cervical cancer, especially if accompanied by heavy discharge with a strong or foul-smelling odor5, so don’t hesitate to speak with your healthcare provider if you’re experiencing such symptoms, as well.
The Bottom Line
While vaginal odor during perimenopause is certainly not uncommon and nothing to be embarrassed or ashamed about, you don’t have to simply live with it if it causes any physical or emotional discomfort. Don’t hesitate to talk to your healthcare provider if you’re experiencing anything out of the ordinary for you, as there are management options available.
- Data from an open label study: https://www.healio.com/news/womens-health-ob-gyn/20221014/probiotic-supplement-improves-bothersome-vaginal-odor-symptoms-at-warp-speed#:~:text=Women%20who%20took%20a%20probiotic,at%20the%20NAMS%20Annual%20Meeting.