Understanding Vaginal Changes

During the menopausal transition, the state of the vagina often changes. The tissues in the vagina weaken, get thinner, dryer, and may get inflamed, causing pain, burning, or discharge. Vaginal dryness and pain are symptoms of vaginal atrophy (atrophic vaginitis) that occur as a result of lowered estrogen levels. [1] 

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Normal vaginal function includes all of the following:

Discharge:

• All females will experience vaginal discharge, which is the name for any substance that exits the body through the vagina. The cells in the muscular tissue lining the vagina secrete mucus, which makes the walls slippery. This mucus also protects against bacteria and yeast overgrowth.

  Normal daily vaginal discharge includes a small amount of vaginal lubricants, cervical mucus, and sexual arousal fluid. If you are experiencing excessive amounts of discharge, or discharge with a strong odour or a different colour than normal, see your healthcare provider as these can be signs of other issues, including infections, that need to be immediately treated. [2]

Odor:

• Normal vaginal odor is mild and may occasionally be so mild that there is no apparent smell at all. While this does vary from individual to individual, strong odors from the vagina are not typical. If you do notice a change in the odor ‘down there’, especially if you have other vaginal symptoms such as itching, burning or changes to your normal discharge, talk to your healthcare provider, as you may have an infection or other condition that needs treatment.
• Vaginal odors are known to vary throughout the menstrual cycle, meaning there is a hormonal component to them. If you notice a change in your vaginal odor, it could be caused by a number of other factors including your changing hormones or even your diet. [3]

Dryness:

• Estrogen ensures that the cells in the vagina are elastic and that the walls of the vagina are thick and healthy. When estrogen levels drop, the walls of your vagina can become dryer than your normal amount of lubrication. This is one of the signs of a common female aging symptom called vaginal atrophy, where the lowered estrogen also causes the walls of the vagina to become thin and inflamed.
• Perimenopause, another name for the menopausal transition, is not the only possible cause for lowered estrogen levels. If you have recently experienced childbirth, are breastfeeding, undergoing cancer treatment, or experiencing any condition that requires estrogen-blocking drugs, you may also experience vaginal dryness. In these cases, when estrogen levels return to normal, the vaginal atrophy will correct itself. In the case of perimenopause, estrogen levels will continue to drop until they stabilize at a lower level permanently in menopause, meaning that most women will experience vaginal atrophy as they age.
• Non-hormonal factors can also cause vaginal dryness. The most common causes are some cold and allergy medications, some antidepressants, or a condition called Sjögren syndrome. This is an autoimmune condition resulting in a dry mouth and eyes, and on some occasions, vaginal dryness. [1] [4] [5] [6] [7]

Pain:

• Changes in the vagina during perimenopause can also result in pain, including pain during sex, after orgasm, and/or during urination, as well as other uncomfortable sensations such as burning and itching. Refer to Sexual Changes for more detailed information on pain during sex, and Urinary System Changes for more detailed information on pain during urination. [8] [9]

Women may be very reluctant to speak up and act on vaginal issues due to embarrassment and negative feelings about aging. However, these are conditions that can often be treated easily at home and with the help of a medical practitioner.