Menopause brings a variety of changes, and while we’re often prepared for the hot flashes and mood swings, the sexual and vaginal health challenges that come with it are less talked about. If you’ve found yourself wondering, “What’s going on down there?” you’re not alone. Many women are caught off guard by how menopause affects their vaginal health. 

The good news? While these changes can feel overwhelming, they’re completely natural—and, better yet, they’re manageable. This post dives into the most common vaginal health concerns during menopause, why they happen, and how you can take action to maintain comfort, confidence, and intimacy in this next chapter of your life. 

What Happened to My Vagina?!

During menopause, your body’s estrogen levels take a nosedive. This hormonal shift has a widespread impact on your body, but one area where it’s particularly noticeable is your vaginal area. A decrease in estrogen affects the tissues of the vagina, vulva, and even the urinary tract, leading to a collection of symptoms that fall under what’s now called Genitourinary Syndrome of Menopause (GSM). 

Once referred to as “vaginal atrophy,” GSM encompasses a range of changes, such as vaginal dryness, thinning tissues, irritation, and more. Over half of women post-menopause experience these symptoms, yet it remains a hush-hush topic. 

But here’s the thing—these changes are not just unspoken; they’re also reversible. 

Common Vaginal Health Concerns During Menopause 

1. Painful or Uncomfortable Sex 

One of the first changes many women notice is discomfort during intercourse. If sex has started to feel more painful than pleasurable, you’re not imagining things.  

Before menopause, your vaginal walls are thick and full of accordion-like folds called rugal folds. These folds allow the vagina to stretch and accommodate comfortably. As estrogen drops, these folds flatten, the tissue becomes thinner, and natural lubrication diminishes, making penetration more difficult and even painful. 

Over-the-counter vaginal lubricants and moisturizers can be your new best friends here. Look for fragrance-free, water-based options and steer clear of products with “tingling” or “tightening” effects—they’re more irritating than helpful. If OTC products don’t cut it, speak with your naturopathic doctor about vaginal estrogen treatments, which can restore the health of your tissues. 

2. The Burning Sensation When You Pee 

Have you felt like peeing burns, but it’s not exactly a urinary tract infection (UTI)? You’re not alone. The same estrogen receptors that affect vaginal tissue also influence the urethra. When estrogen levels dip, the tissues around the urethra thin, dry out, and become more prone to irritation. 

This creates the perfect storm for infections in the bladder and urethra. Drinking plenty of fluids and urinating regularly can help reduce risk, as can supplements like cranberry that may prevent bacteria from sticking to the bladder walls. Always consult your healthcare provider before starting any new supplement to ensure it’s a good fit for you. 

3. Changes in the Vulva 

It’s not just the internal areas that are affected by menopause—the way your vulva looks changes, too. The labia minora (the smaller, inner lips of the vulva) may thin out or even disappear entirely over time. It’s important to be aware of these changes, as external issues with the vulva can make penetration difficult or painful, even if the vagina itself seems fine. 

Make sure your doctor evaluates both your internal and external anatomy during check-ups if you’re experiencing discomfort. 

4. Shifts in Your Vaginal Microbiome 

The natural balance of bacteria in your vagina—often referred to as the microbiome—tends to shift as vaginal pH rises during menopause. A lower vaginal pH allows “good” bacteria like Lactobacillus to thrive, but as pH increases, the balance shifts and bad bacteria may take over, potentially leading to infections. 

Vaginal estrogen treatments not only help restore moisture but also support a more favorable pH and microbiome. Discuss this option with your doctor to see if it’s right for you. 

5. Leaking When You Laugh, Cough, or Sneeze 

If you’re finding yourself leaking a little urine when you cough or sneeze, you might have a weaker pelvic floor. This is another symptom often tied to menopause and dropping estrogen levels. While it can feel embarrassing, it’s incredibly common and very treatable. 

Consider working with a pelvic floor physical therapist. They’ll guide you through targeted exercises to strengthen the muscles that support your bladder and urethra, giving you better control. 

How to Take Control of Your Vaginal Health During Menopause 

The key to managing vaginal health during menopause is staying proactive. Here are some practical steps you can take to minimize symptoms and maintain vaginal comfort and sexual wellness: 

• Use Lubricants and Moisturizers: Regular application of moisturizers (there are creams specifically designed for vaginal use) can help with dryness, while lubricants can make sex more comfortable. 
• Stay Sexually Active: Whether solo or with a partner, sexual activity can help improve blood flow to the vaginal tissues and keep them more elastic. 
• Talk to Your Doctor About Hormone Therapy: Vaginal estrogen options—like creams, rings, or tablets—can help to restore tissue health. Hormone therapy is not for everyone, but it’s worth discussing with a healthcare provider. 
• Hydrate and Add Supplements: Keeping hydrated is key to urinary health. Additions like cranberry supplements, when approved by a doctor, can also protect against unwanted UTIs. 
• Strengthen Your Pelvic Floor: Incorporating pelvic floor exercises, such as Kegels, can help address incontinence and improve sexual satisfaction. 

You Don’t Have to Struggle Alone 

Navigating the changes of vaginal health during menopause can feel isolating, but it doesn’t have to be. Remember, these challenges are incredibly common, and there are effective solutions to help restore your comfort, confidence, and intimacy. 

At every stage of life, your health and happiness are worth prioritizing. If you’re ready to take action and feel empowered in this next chapter, schedule a free 15-minute discovery call with Dr. Melissa McCarty. Together, we’ll craft a personalized approach to your health and make this your most fulfilling chapter yet!