Menopause happens. It is inevitable.
At some point in your 40s or 50s, your period will stop, and your reproductive hormone levels will drop. This drop in hormone levels causes changes in your body. Some of these changes are silent, like bone loss. Othermenopause symptomsare more obvious, like hot flashes. Lying somewhere between these two extremes are the changes that happen below your belt.
Although menopause causes changes to your vulva, vagina, urethra, and bladder, potentially causing discomfort and distress, you may not feel comfortable talking about it. And worse, your healthcare provider may not ask you.
The symptoms associated with the changes of menopause in these parts of your body are collectively called thegenitourinary syndrome of menopause (GSM). The evidence suggests that up to 50% of menopausal women experience GSM,although this percentage is likely higher due to underreporting.
GSM may affect your sex life, hindering your natural ability to self-lubricate, which can lead tovaginal drynessand painful intercourse. But don’t worry; there are things that you can do to ease such symptoms. This article discusses how menopause affects your body and what you can do to alleviate symptoms of GSM.
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Menopausal Changes
Your vulva, vagina, urethra, and bladder (your lower genitourinary tract) are very sensitive to the drop in your hormone levels that come with menopause. Specifically, the drop in your estrogen, also known as the hypoestrogenic state of menopause or hypoestrogenism, causes changes in how your lower genital tract looks, feels, and functions.
The Early Signs of Menopause
Your Vulva
Interestingly enough, it is thought that the origin of the wordvulvais from Latin, meaning “wrapper” or “a covering.” The vulva is often referred to as your vagina, but it is actually its own separate anatomy. It is made up of several distinct structures including your labia, your clitoris, the opening of your urethra, and the opening of your vagina.
You have two separate labia or skin folds that function to protect the more delicate structures of your vulva. The outer labia majora is larger and contains fat cells or adipose tissue as well as hair follicles. It acts as a protective cushion for the more delicate structures of your vulva.
The labia minora lies just inside the labia majora. It contains multiple glands that produce secretions that provide lubrication to protect the area from dryness and irritation.
Now let’s look at your menopausal vulva.
The drop in estrogen levels causes changes to your vulva. First, you lose the fat pad in your labia majora, causing a decrease in the volume or size of your labia.
Without adequate estrogen, there is also a thinning and shrinkage of the labia minora. Rarely, it may fuse to your labia majora.As the labia minora thins out, it also produces less protective secretions.In some women, the clitoral hood can also thin out, shrink, or even fuse together.
This loss of padding and lubrication exposes the more sensitive underlying structures like your clitoris and the opening of your vagina to chaffing, irritation, and trauma.
These changes often causesex to be painfuland can lead to a decreased interest in sex. Sometimes, changes can be so significant that it causes increased sensitivity and chronic clitoral pain not associated with sex.
Your Vagina
Like your vulva, menopause brings unpleasant changes to your vagina as well.
For starters, yourvaginais lined with a special type of skin tissue that is composed of three layers. The topmost or superficial layer is very sensitive to estrogen. During your reproductive years, normal estrogen levels keep your vaginal lining thick and well lubricated.
This allows the vagina to resist trauma and promotes elasticity (i.e., the ability of the vagina to stretch and recover), which can be helpful in childbirth and sex.
The drop in estrogen can cause the walls of the vagina to become thin and dry (referred to asvaginal atrophy), losing their elasticity and lubrication, which may make sex painful.Vaginal atrophy can also lead to a narrowing of the vaginal opening.These changes may cause the vagina to tear easily from normal minor trauma like sex or a pelvic exam.
Your Bladder
There is some debate over whether the menopausal changes to yourlower urinary tract(bladder and urethra) are hormone or age-related. But there is evidence to support that low estrogen levels do contribute to the urinary tract problems of menopause.
Your bladder andurethra(the tube that carries urine out of your bladder) are rich in estrogen receptors. Like your vulva and vagina, these tissues lose their volume and elasticity when your estrogen levels drop in menopause.
Your bladder may not expand like it used to, and you may find yourself needing to go to the bathroom more frequently. You also may notice that you dribble or drip urine occasionally just when you finish urinating.
Urinary tract infections (UTIs)can also be more common in menopause.The low estrogen levels create changes in the vagina that increase the concentration of UTI-causing bacteria. Also, the thinned-out lining of your urethra makes it easier for the bacteria to get into your bladder.
How Menopause Affects a Woman’s Urinary Tract
Vaginal Dryness Treatments
If you have mild symptoms of GSM or if you want to avoid usinghormone therapy, you could consider using a vaginal lubricant or moisturizer. These products are available over the counter at your pharmacy, online, or in specialty stores.
Vaginal lubricantsare the best choice if you are having pain with sex. Since your vagina does not self-lubricate as well as it did before menopause, using avaginal lubricantwill help decrease the friction, pain, and trauma that can be associated with sexual activity.
They work immediately. Their effect is short-acting and they may need to be reapplied as necessary. There are three types of vaginal lubricants:
Menopausal Hormone Therapy
Although lubricants and moisturizers soothe the symptoms of GSM, hormone-containing products can improve vaginal blood flow and estrogen production, returning thickness and elasticity to your vagina. In other words, they correct the problem rather than just treat the symptoms of GSM.
Although taking systemic hormones in the form of the pill or the patch can reduce vaginal atrophy, most products with the best results are applied in the vagina.
Estrogen-containing products:Applying estrogen directly to the vaginal tissues is an effective treatment for GSM. Usually, you will see significant improvement in your symptoms within a few weeks. There are a few different formulations of topical estrogen for vaginal use, which include:
Estrogen and CancerResearch suggests that taking oral estrogen alone increases the risk ofendometrial cancer(cancer of the uterus) for women who have a uterus, in addition toovarian cancer. There is also an increased risk of breast cancer if estrogen is taken in combination with progestin.But research shows that forms of hormonal therapy inserted in or applied to the vagina can decrease such risks as estrogen is not absorbed into the bloodstream.More research in this area is needed, but this is an important point for women for whom estrogen pills may not be safe to use, such as those with a prior history of breast cancer.
Estrogen and Cancer
Research suggests that taking oral estrogen alone increases the risk ofendometrial cancer(cancer of the uterus) for women who have a uterus, in addition toovarian cancer. There is also an increased risk of breast cancer if estrogen is taken in combination with progestin.But research shows that forms of hormonal therapy inserted in or applied to the vagina can decrease such risks as estrogen is not absorbed into the bloodstream.More research in this area is needed, but this is an important point for women for whom estrogen pills may not be safe to use, such as those with a prior history of breast cancer.
Research suggests that taking oral estrogen alone increases the risk ofendometrial cancer(cancer of the uterus) for women who have a uterus, in addition toovarian cancer. There is also an increased risk of breast cancer if estrogen is taken in combination with progestin.
But research shows that forms of hormonal therapy inserted in or applied to the vagina can decrease such risks as estrogen is not absorbed into the bloodstream.
More research in this area is needed, but this is an important point for women for whom estrogen pills may not be safe to use, such as those with a prior history of breast cancer.
Selective estrogen receptor modulators (SERMs):SERMs are a class of synthetic hormones that both act like estrogen and block estrogen activity in different parts of your body. These hormones are emerging as an alternative to estrogen. An example of a SERM istamoxifen, which is a powerful anti-estrogen used to treat breast cancer but that also causes hot flashes andvaginal dryness.
Specifically, a newer SERM known as ospemifene is an effective treatment for GSM and is FDA-approved to treat the symptom of painful sex associated with GSM.
However, although early studies suggest an anti-estrogen effect in breast tissue similar to tamoxifen, there is not enough data to recommend its use in women with a history of breast cancer.
Using Your Vagina Helps
Believe it or not, staying sexually active in menopause helps maintain a healthy vagina.
Regular sexual activity increases blood flow to your vaginal tissues and can maintain some of the elasticity of the vagina.And, you shouldn’t be afraid to take things into your own hands, literally.
Direct clitoral stimulation through masturbation or the use of a vibrator is an excellent way to encourage blood flow.Kegel exercisescan strengthen your pelvic floor muscles and encourage vaginal blood flow as well. Even if you are taking a break from having sex, there are ways to maintain your vaginal health.
Summary
Many women experience menopausal symptoms like vaginal dryness, itchiness, and irritation that can make sex painful. Vaginal lubricants are common products used to reduce dryness and friction and ease such symptoms.
Hormonal-based pills, creams, and inserts like topical estrogen and vaginal DHEA can be a more effective measure of treatment to improves vaginal blood flow and estrogen production.
A Word From Verywell
Don’t be ashamed to discuss symptoms of GSM with your healthcare provider. These symptoms are common and easily treated with a variety of options available. Together, you and your healthcare provider can make a treatment plan to help you live well during your menopausal years.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wSantoro N, Lin I.Genitourinary syndrome of menopause: underdiagnosed and undertreated.Contemporary OB/GYN Journal. 2018;64(7):10-13.Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S.The genitourinary syndrome of menopause: an overview of the recent data.Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586Boston University School of Medicine.Sexual medicine.Abduljabbar HS.Reproductive and sexual anatomy.Anat Physiol. 2015;s5. doi:10.4172/2161-0940.S5-002Nair PA.Dermatosis associated with menopause.J Midlife Health. 2014;5(4):168-175. doi:10.4103/0976-7800.145152Singh P, Han HC.Labial adhesions in postmenopausal women: presentation and management.Int Urogynecol J. 2019;30(9):1429-1432. doi:10.1007/s00192-018-3821-1Jones RE, Lopez KH.The female reproductive system. In:Human Reproductive Biology. Elsevier; 2014:23-50. doi:10.1016/B978-0-12-382184-3.00002-7MedlinePlus.Aging changes in the female reproductive system.Khanjani S, Khanjani S.Effect of conjugated estrogen in stress urinary incontinence in women with menopause.IJCM. 2017;08(06):375-385. doi:10.4236/ijcm.2017.86035Caretto M, Giannini A, Russo E, Simoncini T.Preventing urinary tract infections after menopause without antibiotics.Maturitas. 2017;99:43-46. doi:10.1016/j.maturitas.2017.02.004Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wBrusselaers N, Tamimi RM, Konings P, Rosner B, Adami HO, Lagergren J.Different menopausal hormone regimens and risk of breast cancer.Ann Oncol. 2018;29(8):1771-1776. doi:10.1093/annonc/mdy212Moon Z, Hunter MS, Moss-Morris R, Hughes LD.Factors related to the experience of menopausal symptoms in women prescribed tamoxifen.J Psychosom Obstet Gynaecol. 2017;38(3):226-235. doi:10.1080/0167482X.2016.1216963National Library of Medicine. MedlinePlus.Prasterone vaginal.UptoDate.Patient education: vaginal dryness (beyond the basics).
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wSantoro N, Lin I.Genitourinary syndrome of menopause: underdiagnosed and undertreated.Contemporary OB/GYN Journal. 2018;64(7):10-13.Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S.The genitourinary syndrome of menopause: an overview of the recent data.Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586Boston University School of Medicine.Sexual medicine.Abduljabbar HS.Reproductive and sexual anatomy.Anat Physiol. 2015;s5. doi:10.4172/2161-0940.S5-002Nair PA.Dermatosis associated with menopause.J Midlife Health. 2014;5(4):168-175. doi:10.4103/0976-7800.145152Singh P, Han HC.Labial adhesions in postmenopausal women: presentation and management.Int Urogynecol J. 2019;30(9):1429-1432. doi:10.1007/s00192-018-3821-1Jones RE, Lopez KH.The female reproductive system. In:Human Reproductive Biology. Elsevier; 2014:23-50. doi:10.1016/B978-0-12-382184-3.00002-7MedlinePlus.Aging changes in the female reproductive system.Khanjani S, Khanjani S.Effect of conjugated estrogen in stress urinary incontinence in women with menopause.IJCM. 2017;08(06):375-385. doi:10.4236/ijcm.2017.86035Caretto M, Giannini A, Russo E, Simoncini T.Preventing urinary tract infections after menopause without antibiotics.Maturitas. 2017;99:43-46. doi:10.1016/j.maturitas.2017.02.004Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wBrusselaers N, Tamimi RM, Konings P, Rosner B, Adami HO, Lagergren J.Different menopausal hormone regimens and risk of breast cancer.Ann Oncol. 2018;29(8):1771-1776. doi:10.1093/annonc/mdy212Moon Z, Hunter MS, Moss-Morris R, Hughes LD.Factors related to the experience of menopausal symptoms in women prescribed tamoxifen.J Psychosom Obstet Gynaecol. 2017;38(3):226-235. doi:10.1080/0167482X.2016.1216963National Library of Medicine. MedlinePlus.Prasterone vaginal.UptoDate.Patient education: vaginal dryness (beyond the basics).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wSantoro N, Lin I.Genitourinary syndrome of menopause: underdiagnosed and undertreated.Contemporary OB/GYN Journal. 2018;64(7):10-13.Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S.The genitourinary syndrome of menopause: an overview of the recent data.Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586Boston University School of Medicine.Sexual medicine.Abduljabbar HS.Reproductive and sexual anatomy.Anat Physiol. 2015;s5. doi:10.4172/2161-0940.S5-002Nair PA.Dermatosis associated with menopause.J Midlife Health. 2014;5(4):168-175. doi:10.4103/0976-7800.145152Singh P, Han HC.Labial adhesions in postmenopausal women: presentation and management.Int Urogynecol J. 2019;30(9):1429-1432. doi:10.1007/s00192-018-3821-1Jones RE, Lopez KH.The female reproductive system. In:Human Reproductive Biology. Elsevier; 2014:23-50. doi:10.1016/B978-0-12-382184-3.00002-7MedlinePlus.Aging changes in the female reproductive system.Khanjani S, Khanjani S.Effect of conjugated estrogen in stress urinary incontinence in women with menopause.IJCM. 2017;08(06):375-385. doi:10.4236/ijcm.2017.86035Caretto M, Giannini A, Russo E, Simoncini T.Preventing urinary tract infections after menopause without antibiotics.Maturitas. 2017;99:43-46. doi:10.1016/j.maturitas.2017.02.004Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-wBrusselaers N, Tamimi RM, Konings P, Rosner B, Adami HO, Lagergren J.Different menopausal hormone regimens and risk of breast cancer.Ann Oncol. 2018;29(8):1771-1776. doi:10.1093/annonc/mdy212Moon Z, Hunter MS, Moss-Morris R, Hughes LD.Factors related to the experience of menopausal symptoms in women prescribed tamoxifen.J Psychosom Obstet Gynaecol. 2017;38(3):226-235. doi:10.1080/0167482X.2016.1216963National Library of Medicine. MedlinePlus.Prasterone vaginal.UptoDate.Patient education: vaginal dryness (beyond the basics).
Kagan R, Kellogg-Spadt S, Parish SJ.Practical treatment considerations in the management of genitourinary syndrome of menopause.Drugs Aging. 2019;36(10):897-908. doi:10.1007/s40266-019-00700-w
Santoro N, Lin I.Genitourinary syndrome of menopause: underdiagnosed and undertreated.Contemporary OB/GYN Journal. 2018;64(7):10-13.
Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S.The genitourinary syndrome of menopause: an overview of the recent data.Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586
Boston University School of Medicine.Sexual medicine.
Abduljabbar HS.Reproductive and sexual anatomy.Anat Physiol. 2015;s5. doi:10.4172/2161-0940.S5-002
Nair PA.Dermatosis associated with menopause.J Midlife Health. 2014;5(4):168-175. doi:10.4103/0976-7800.145152
Singh P, Han HC.Labial adhesions in postmenopausal women: presentation and management.Int Urogynecol J. 2019;30(9):1429-1432. doi:10.1007/s00192-018-3821-1
Jones RE, Lopez KH.The female reproductive system. In:Human Reproductive Biology. Elsevier; 2014:23-50. doi:10.1016/B978-0-12-382184-3.00002-7
MedlinePlus.Aging changes in the female reproductive system.
Khanjani S, Khanjani S.Effect of conjugated estrogen in stress urinary incontinence in women with menopause.IJCM. 2017;08(06):375-385. doi:10.4236/ijcm.2017.86035
Caretto M, Giannini A, Russo E, Simoncini T.Preventing urinary tract infections after menopause without antibiotics.Maturitas. 2017;99:43-46. doi:10.1016/j.maturitas.2017.02.004
Brusselaers N, Tamimi RM, Konings P, Rosner B, Adami HO, Lagergren J.Different menopausal hormone regimens and risk of breast cancer.Ann Oncol. 2018;29(8):1771-1776. doi:10.1093/annonc/mdy212
Moon Z, Hunter MS, Moss-Morris R, Hughes LD.Factors related to the experience of menopausal symptoms in women prescribed tamoxifen.J Psychosom Obstet Gynaecol. 2017;38(3):226-235. doi:10.1080/0167482X.2016.1216963
National Library of Medicine. MedlinePlus.Prasterone vaginal.
UptoDate.Patient education: vaginal dryness (beyond the basics).
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