Vaginal Changes During Menopause

When your estrogen levels drop after menopause — whether menopause happens naturally or as a result of breast cancer treatment — the tissues of the vagina and the vulva often become thinner, drier, and less elastic. When this happens, you may experience vaginal dryness, burning, or other issues. These vaginal changes, along with urinary problems such as incontinence, urinary tract infections (UTIs), and bladder infections, are called genitourinary syndrome of menopause (GSM). You may also see this called vaginal atrophy.

Your vaginal lining is lubricated with fluid that helps keep it moist, thick, and elastic. As you go through menopause and hormone levels drop, the vaginal lining gets thinner and dryer, which is vaginal dryness. This can lead to discomfort, especially during sex.

Lower levels of estrogen make it harder for the vagina to keep bacteria under control because sex hormones like estrogen feed good bacteria that live in the vagina. This means that the risk of infection increases after menopause.

Vaginal discharge is fluid that comes out of your vagina. It can look different depending on your hormone levels and vaginal microbiome. Discharge that is white or clear is usually normal, but changes in the amount, color, or smell may mean you have a problem. Talk to your healthcare provider if you notice these changes, as they could be the sign of an infection or even growths in the reproductive tract.

Vaginal infections can cause itching, burning, and discomfort. Two of the most common infections after menopause are yeast infections and bacterial vaginosis. 

Lower estrogen levels during menopause can also weaken your pelvic muscles (also called the pelvic floor) — which help you control when you go to the bathroom and affect how you might experience pleasure from sex. If these muscles weaken, they may have a hard time working together to relax, which can lead to pain during sex. Pelvic floor weakness can also lead to unwanted urine leakage

Loss of libido means your sex drive is low or non-existent. This can happen for many reasons. Stress, anxiety, and depression about a breast cancer diagnosis can cause changes in libido. This is very common. Sex may now be painful if treatments have caused early menopause. Your interest in having sex also can fluctuate depending on what stage of treatment you’re in, as side effects like fatigue, nausea, and hair loss can make having sex the last thing you feel like doing.