Vaginal Changes After Menopause and How to Manage the Changes

What is menopause?

Every menstruator goes through three main phases in their cycle - menarche, perimenopause and menopause. After your first period, you experience menstruation almost every month for a period of 2-7 days. As you begin to age and reach your late thirties or early forties, you start experiencing certain symptoms as your body prepares itself for menopause.

During this time, you may experience irregular periods, spotting, hot flashes, vaginal dryness, etc. Once your perimenopausal stage is over and you have not had a period in 12 months and is no longer capable of becoming pregnant, you are said to have reached menopause. This marks the end of ovulation and your menstrual cycle.

What changes does your body go through during menopause?

When your body experiences menopause, your natural reproductive hormones are on a decline. The most important factor responsible for your bodily changes is the decline in estrogen levels, when you may experience the following symptoms:

• Vaginal changes - Your vulvovaginal region undergoes changes after menopause in various ways. You may experience vaginal atrophy, increased chances of infection and a shift in odour and aesthetics among other changes.

• Weight gain - As your estrogen level declines, you may experience some weight gain which can vary up to 2 kgs.

• Changes in your bone mass - Your bones may start to become less dense, putting you at risk for osteoporosis, fractures, etc.

• Lowered libido - You may also experience a low sex drive due to declining estrogen levels.

• Hot flashes - Sudden sensation of heat coupled with blushing or sweating is known as hot flashes, which is a common menopausal symptom.

• Sleep pattern changes - Hormonal fluctuations can lead to insomnia and other changes in your sleep pattern.

• Memory issues - Menopause can also affect your memory and put you at a higher risk of Alzheimer’s disease.
  
  

The role of estrogen for your vaginal health

Estrogen is an important hormone where vaginal health is concerned. The hormone maintains tissue integrity by interacting with the estrogen receptors inside the vaginal epithelium. The walls remain thick and elastic in the presence of adequate estrogen and so, when the hormone level decreases, the vagina and the vulva start to become dry.

A drop in estrogen levels also makes your vaginal pH change from acidic to more alkaline, which can make you experience a number of symptoms.

What are the common vaginal changes after menopause?

After menopause, your vagina undergoes some changes and these can appear in various forms:

• It can become dry and itchy - Estrogen helps in maintaining vaginal lubrication and so, when the hormone decreases after menopause, your vagina starts to feel drier. This condition is known as vaginal atrophy and due to the thinning and drying of the vaginal walls, you may also experience a burning sensation and itching.

• Your vulva aesthetics may change - As you reach menopause, you may notice your labia minora becoming thinner and flatter. Over time, you may even lose it completely.

• You may become more prone to UTIs - With lowered levels of estrogen, your urinary tract may start to lose volume, contributing to more frequent UTIs. Another reason for this is that your vaginal pH changes after menopause. A vagina usually has an acidic pH, but after menopause, it becomes more alkaline, making it more prone to UTIs.

• You may experience urinary incontinence - Your pelvic floor muscles start to weaken post-menopause, making it difficult to hold urine inside. Urinary incontinence can result from this, making you experience leaks while coughing, sneezing or laughing.

• The vaginal odour could change - The pH change results in a watery discharge which can often be smelly at times and is a result of the declining estrogen levels.

• It can shrink in size - When you stop having sex for a long time, the vaginal muscles remain unused. This can result in it shrinking and losing its tone. Sex or even masturbation with vaginal penetration can help against this.

• You may tear or bleed during sex - As the skin starts to become thinner down there, sex may result in tearing and bleeding. Also, with lesser lubrication, you are more prone to chafing.

• The vagina can stretch into other organs - Known as vaginal prolapse, weaker pelvic muscles can result in your vagina stretching into other organs. Usually, there are no symptoms when it happens, but some women may experience a pull, accompanied by lower back pain. You may also experience urinary incontinence as a result of this.

• The vaginal lining may thin down - The vagina has a protective lining of epithelial cells, which start to degrade as your estrogen levels lower. The vagina starts to become thin, saggy and wrinkly as a result of a decline in elastin and collagen production.

• You may experience vaginal infections - The acidic environment of the vagina protects it from frequent infections and when the pH becomes more alkaline, you start to experience vaginitis. Vaginitis refers to vaginal infections like vaginal thrush, yeast infections, etc. 

• Vaginismus is a possibility - The involuntary muscles contractions of a vagina during sex is known as vaginismus. It can make sex extremely painful or impossible and is a result of estrogen levels dropping. With vaginal atrophy comes dryness and painful sex, which can lead to vaginismus.
  
  

How do you manage the vaginal changes?

Sex after menopause may be difficult, but not impossible. With a little maintenance of intimate hygiene and taking other steps, you can help feel better. Even though you can’t get rid of your symptoms completely, you can take steps to ease your discomfort:

• Make underwear changes - Try wearing loose, cotton underwear, going commando where possible. This will ensure you don’t trap unwanted sweat and moisture, thus increasing your risk of infections and chafing.

• Avoid using soap on your vulva - Your pH already gets disrupted after menopause. Using soap will only make matters worse by further interfering with the ecosystem further. Try washing your vagina with plain water and an intimate wash like the Carmesi Intimate Cleanser which helps maintain your vaginal pH.

• Use a lubricant during sex - Vaginal dryness can hamper your sex life, which is why it is advisable to use a lubricant during sex. This will make intercourse easier and also prevent pain and bleeding.

• Practice pelvic floor exercises - Pelvic floor exercises, like Kegels, can help strengthen your pelvic floor muscles. Doing this can help you with urinary incontinence, vaginal prolapse and even sex.

• Use topical emollients - Emollients are soothing and softening agents which can help vaginal dryness and itching. You can try using jojoba oil, Vitamin E, aloe vera and jojoba oil to help with your symptoms.

• Try a topical estrogen therapy - There are topical estrogen therapies available in the market which can reduce vaginal atrophy symptoms. You should consult a doctor and explore options like vaginal rings, creams, moisturizers or tablets.