Perimenopause, the beginning stage of the menopause transition, typically starts when you’re in your early or mid-40s. Some women, however, enter perimenopause as early as their mid-30s, or as late as their early 50s.1 This wide age range at onset may make it hard to identify perimenopausal symptoms, and more specifically, when they start to occur.
While irregular periods and mood changes are some of the more typical perimenopause symptoms, you may also notice some subtle changes to your vaginal health, due to the volatility in your hormones. During perimenopause, vaginal changes may confuse you, or even catch you off guard. In this article, we’ll identify some of the more common vaginal symptoms that can occur during perimenopause. We’ll also provide guidance about how you can best manage them.
Check out a brief video from Chief Medical Officer, Dr. Alyssa Dweck, discussing some of these perimenopause vaginal changes, below:
Vaginal Changes During Perimenopause
Perimenopause is earmarked by variable, erratic and eventually declining levels of estrogen production. There are estrogen receptors throughout your body, but many of them are located in the reproductive organs.2 For that reason, irregular periods may be one of the first perimenopausal symptoms you start to notice.3 You may also experience changes to your vagina and vulva.
In addition to regulating ovulation, estrogen helps keep the vagina naturally moisturized and supple. When estrogen levels decline, the walls of the vagina tend to lose their thickness and elasticity, becoming dryer, thinner, and less flexible.4 This can cause sensations like itching and burning and may even lead to pain with sex. Your vulva, the external genital area, may also become dry, irritated and uncomfortable.5
Estrogen also supports vaginal readiness during sexual arousal, by increasing lubrication and blood flow to the vagina, labia, and clitoris. This helps the vagina to lengthen and become slick, making penetrative vaginal sex more comfortable.6
Changes to the Vaginal Microbiome
Before perimenopause, the vaginal microbiome, or the uniquely balanced ecosystem of microorganisms in the vagina, is naturally acidic, with a pH level of around 3.8 to 4.5. During perimenopause and menopause, the pH level of the vagina becomes slightly more alkaline, with a pH level of over 4.5.7
This increase in alkalinity can make you more susceptible to bacterial and yeast overgrowth – which can subsequently lead to infection.8 During perimenopause, it’s possible that you may notice you’re having more vaginal infections than you did in the past due to these pH changes. You may also notice changes to the amount of vaginal lubrication and discharge you produce, as well as its smell.9
It’s important to note, however, that changes in vaginal smell during perimenopause do not necessarily mean you have an infection. A natural shift in your vagina’s scent is common and may not always be cause for alarm If you’re noticing a strong scent, or one that is accompanied by symptoms such as itching, burning or a lot of discharge, it’s important to reach out to your healthcare provider just to rule out infection.
Urinary Tract Changes During Perimenopause
Declining estrogen levels also cause the linings of the bladder and urethra to become thinner than they were before. This can lend itself to urinary leakage, as well as an increased need to urinate often – this is commonly referred to as urinary incontinence or overactive bladder.10
Other Potential Vulvar or Vaginal Changes in Perimenopause and Beyond
Vulvovaginal wear and tear from childbirth, along with associated vulvar or vaginal skin pigment changes, less plump or flatter labia, possible skin tags and even changes in pubic hair (grayer as well as sparser), are all possible during perimenopause and beyond.11 If any of these changes are concerning or you have questions, be sure to check in with your healthcare provider.
How to Manage Perimenopause and Vaginal Changes
In many instances, the vaginal changes that occur during perimenopause may be subtle enough to cause little or no symptoms. But in some instances, they may make you feel less like yourself and interrupt your daily quality of life. Luckily, there are things you can do to make your vagina, and yourself, feel more comfortable during perimenopause and beyond.
Addressing Vaginal Dryness and Associated Symptoms
Chief among them is vaginal dryness relief. Hormone-free lubricants and vaginal moisturizers are available over-the-counter and are designed to restore vaginal moisture, keeping your vagina and vulva more comfortable, and less itchy or irritated.
There are also some dietary supplements on the market that you can take orally that support sexual arousal and vaginal health. It’s important to check in with your healthcare provider before starting anything new, as they know your medical history best, and can best advise on ways to effectively manage your symptoms.
Consider Evolving Your Lifestyle to Support Your Vaginal Health in Perimenopause
Taking care of yourself wholistically is also very important. Adopting healthy habits like exercising, meditating, or doing yoga can help support your ability to feel more mentally and physically balanced. Eating healthy foods, such as whole grains, a variety of fruits and vegetables and protein rich foods, can also help you take charge of your body and health from the inside.
You can help support your vaginal microbiome by investing in a quality probiotic (with “good” bacteria).12 Probiotics geared toward vaginal health typically work to improve the vaginal flora, by increasing beneficial bacteria, reducing the number of harmful bacteria, and helping to maintain the stability of vaginal flora environment.13 Probiotics are available as non-prescription, over-the-counter supplements you take orally. They can also be found in certain fermented foods, like yogurt, miso, and sauerkraut.14
Increasing your intake of prebiotics may also help to support your vaginal health in perimenopause.15 Prebiotics are a type of “food” for probiotics and help in promoting the growth of beneficial microorganisms. When probiotics break down these prebiotic substances, they derive energy from them, which enables them to flourish.16 Prebiotics are found in foods like almonds, bananas, flaxseed, and soy.17
And, of course, try to get enough sleep. Hormonal changes can affect your ability to fall asleep and stay asleep during perimenopause, by causing symptoms like restless leg syndrome, insomnia and night sweats.18 Poor sleep quality may not directly cause vaginal symptoms, but it can make you irritable and less able to cope with any other symptoms you may be experiencing.
Poor sleep quality and quantity may also decrease your sexual drive. This could affect vaginal health as sexual activity can actually help to support your vagina in experiencing the physical manifestations of arousal (i.e. lubrication). It can also help you maintain pelvic floor strength, and bladder control.19 All the more reason to focus on improving your sleep quality during perimenopause.
When To Talk with Your Healthcare Provider
A healthcare provider, such as a gynecologist, can talk you through the natural changes that are occurring in your body throughout this transitional period. They can also recommend management options for symptoms that are severe, or that don’t respond to at-home solutions.
Talk to your healthcare provider if you’re having ongoing issues with UTIs or vaginal infections. In these instances, you may benefit from treatment options like antibiotics or vaginal estrogen therapy.20 Also let them know if penetrative, vaginal sex is too painful to enjoy as they can help to provide some recommendations to ease your symptoms.
Bleeding or spotting during or after sex, as well as bleeding that is not associated with menstruation, should always be brought to your healthcare provider’s attention.
Perimenopause may be a natural part of life, but if its symptoms are causing you distress, especially any vaginal symptoms, don’t hesitate to seek help. There are effective management options out there, so there’s no need to just “tough it out.”