Vaginal Health During Menopause and Beyond

About 50% of women will experience changes to their vaginal health during and after menopause.¹ Although common, these changes — which can include vaginal atrophy, dryness, tightness, infection, vaginal pH imbalance, odor and thinning tissues — can be physically and emotionally challenging. Yet as many as 90% of women who experience these symptoms don’t seek treatment for them.²

For some women, menopause may be the first time they’ve experienced issues related to their vaginal health. They may not understand why these changes are happening, or what they can do to support better vaginal health through menopause and beyond.

Understanding what’s happening to your vagina during the menopausal transition might help you make sense of any new vaginal symptoms you’re experiencing, prepare you for what you can expect, and help you better manage your vaginal health as a part of the menopausal hormonal evolution.  

Let’s explore some educational information and vaginal health tips that are designed to help you navigate the changes happening in your body during menopause.

Why Does Vaginal Health Change During Menopause?

As with so many things that happen to a woman’s body during menopause, changes in vaginal health can be attributed to dropping estrogen levels. When your body has less estrogen, the tissues of the vaginal walls can become thinner, drier and less elastic; this is known as vaginal atrophy.³

Because vaginal atrophy is often accompanied by a multitude of genital symptoms including urinary complaints like frequency, doctors use the umbrella term "genitourinary syndrome of menopause (GSM)” to describe both vaginal atrophy and urinary symptoms related to menopause.⁴

“Estrogen stimulation is responsible for maintaining vaginal tissue thickness, elasticity and normal secretions that create moisture,” says Dr. Suzanne Hall, an OBGYN and women’s health advocate. “Declining estrogen levels during our transition to menopause may lead to changes in the overall vaginal health as well as vaginal tissues, that can include thinning, loss of elasticity, narrowing of the vaginal opening and decreased secretions.”

What Common Symptoms Are Associated with Vaginal Changes During Menopause?

Since some women may not have given much thought to what’s happening to their vaginal health before menopause, it can be helpful to know what symptoms are typically associated with the changes in vaginal health that happen around this time.

According to Dr. Hall, the most common genital symptoms are:

• Vaginal dryness
• Burning
• Irritation
• Lack of lubrication
• Discomfort or pain with intercourse
• A shift in vaginal pH levels

One study of over 3,500 postmenopausal women found that nearly half of them reported “vaginal discomfort” related to menopause: 85% of these women experienced vaginal dryness, and 82% said they’d been dealing with vaginal symptoms for one year or more.⁵

Dr. Hall goes on to explain that the most common urinary symptoms experienced by women during and after menopause are:

• Urinary urgency/frequency (feeling a strong need to urinate, or needing to urinate often)
• Painful urination
• Recurrent bladder infections
• Urinary incontinence

Urinary symptoms of GSM may happen because lack of estrogen weakens the bladder and urethra, affecting their ability to function properly.⁶ These symptoms can also be linked to a weakening of the pelvic floor that may occur during menopause.

The pelvic floor is the group of muscles and ligaments found in the base of your pelvis that support the bladder, rectum, uterus, and intestines. Lowered estrogen levels during menopause — along with aging, childbirth, and other factors — can weaken these muscles, which may lead to urinary symptoms.⁷

Supporting Good Vaginal Health During Menopause and Beyond

There are steps women can take to support their vaginal health during menopause, potentially relieving the more common symptoms of GSM. For those seeking options other than prescription medications like hormone replacement therapy (HRT), these suggestions may provide a natural, easy-to-implement alternative to supporting your vaginal health during menopause.

1. Find Ways to Be Intimate

Dr. Hall says regular sex is a great way to support vaginal health during menopause. “Genital stimulation increases blood flow to the area, providing oxygen and nutrients that help to maintain healthy tissue,” she explains. Regular sexual activity during menopause may also help to keep vaginal muscles toned while maintaining the vagina’s length and elasticity.⁸

For women who struggle with discomfort during sexual activity, Dr. Hall says the use of vaginal lubricants and moisturizers may be helpful. Products like Revaree®, which features an easy-to-use vaginal insert, can provide hormone-free relief from vaginal dryness, and make intimacy more comfortable.

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2. Stick to Fragrance-Free Soap and Water, or Just Water

When it comes to cleaning and caring for your vagina during menopause, Dr. Hall recommends cleaning the vulva (outer genital area) with fragrance-free soap and water. “There is no recommendation for cleaning the vagina internally,” she says.

In fact, Dr. Hall says women who want to support their vaginal health should avoid douching or utilizing soaps or fragrances in the vagina. “Douching can change the natural vaginal flora, and increase the risk for vaginal infections,” she says.⁹ Additionally, when the vagina’s natural flora, or microbiome, is disrupted, a vaginal pH imbalance can occur, leading to additional symptoms and discomfort.  Dr. Hall advises women with concerns about vaginal odor, discharge, or abnormal bleeding to talk with their healthcare provider.

3. Consider Eating Probiotic-Rich Foods

Probiotics are beneficial organisms that occur naturally in your body, helping to maintain a healthy balance between “good” and “bad” bacteria. This balanced state may help to prevent vaginal infections and promote wellbeing.¹⁰

The gut is home to many of your body’s probiotics, as is the vagina. ¹¹ Research suggests additional probiotics from food or supplements can support the composition of microorganisms in the vagina, helping to prevent vaginal infections in postmenopausal women.¹²

To support vaginal health during menopause, consider adding some of these probiotic-rich foods to your diet to stave off infection or a vaginal pH imbalance:¹³

• Yogurt
• Kombucha
• Kimchi
• Sourdough bread
• Fermented pickles
• Sauerkraut
• Miso

If you’re not sure your diet can accommodate the above foods, you may want to add a high-quality supplement designed to promote vaginal health into your routine, along with balanced digestion and strong immunity.

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4. Try Some Pelvic Floor Exercises

If you’re unfamiliar with Kegels, these exercises are designed to strengthen the muscles of your pelvic floor.¹⁴ According to Dr. Hall, improving pelvic muscle strength with Kegels may help to reduce some of the GSM symptoms associated with menopause.¹⁵

Kegels involve relaxing and tightening the muscles that control urine flow; some experts liken the exercise to pretending you need to urinate and then holding it. Just like any other muscle-building exercise, Kegels are most effective when they’re done consistently. You should aim to perform three sets of 10-15 Kegels every day.¹⁶

5. Talk to Your Healthcare Provider

Vaginal health isn’t always easy to talk about, but your healthcare provider can be a valuable resource when it comes to addressing the changes happening in your vagina during menopause.

Whether you are entering menopause and are starting to notice GSM symptoms or need advice on navigating vaginal changes as a postmenopausal woman, having an honest conversation with your provider is a great way to get the information and support you need.

Resources

1. https://www.health.harvard.edu/womens-health/dont-ignore-vaginal-dryness-and-pain
2. https://www.health.harvard.edu/womens-health/dont-ignore-vaginal-dryness-and-pain
3. https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288#:~:text=A%20dry%20vaginal%20lining%20becomes,less%20elastic%20and%20more%20fragile.
4. https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288#:~:text=A%20dry%20vaginal%20lining%20becomes,less%20elastic%20and%20more%20fragile.
5. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause. 2013;20(10):1043-1048. doi:10.1097/GME.0b013e318287342d
6. https://urogyn.coloradowomenshealth.com/conditions/bladder/menopause-urinary-symptoms.html
7. https://urogyn.coloradowomenshealth.com/conditions/bladder/menopause-urinary-symptoms.html
8. https://www.menopause.org/for-women/sexual-health-menopause-online/frequently-asked-questions
9. https://www.womenshealth.gov/a-z-topics/douching#:~:text=Douching%20can%20cause%20an%20overgrowth,%2C%20fallopian%20tubes%2C%20and%20ovaries.
10. https://my.clevelandclinic.org/health/articles/14598-probiotics
11. https://my.clevelandclinic.org/health/articles/14598-probiotics
12. Kim JM, Park YJ. Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article. J Menopausal Med. 2017;23(3):139-145. doi:10.6118/jmm.2017.23.3.139
13. https://my.clevelandclinic.org/health/articles/14598-probiotics
14. https://www.health.harvard.edu/bladder-and-bowel/step-by-step-guide-to-performing-kegel-exercises
15. https://www.health.harvard.edu/bladder-and-bowel/step-by-step-guide-to-performing-kegel-exercises
16. https://medlineplus.gov/ency/patientinstructions/000141.htm