What happens to our vaginas as we hit menopause?

Most women are unprepared for changes in their vagina as they go through their perimenopause + menopause years, which are essentially the 40s and 50s. I know I was!

A healthy vagina has a pH of 3.6-4.5. This is an acidic environment where oestrogen creates glycogen and glycogen allows the predominance of lacotbacilli species to dominate.

This diverse gut microbiome is good in your tummy. But a diverse vaginal microbiome is not. A healthy vagina has LOW microbial diversity.

A healthy vagina also has a thick epithelium which provides protection from irritation, and chafing, whether that be from tight clothes or intercourse.

The menopausal vagina is very, very different than the pre menopausal vagina. Oestrogen drives the changes in the menopausal vagina.

When there is low/no oestrogen (as in menopause) + when there is waning oestrogen (as in perimenopause), vaginal health suffers.

I’m talking about this today because it needs to be brought out of the closet. Women suffer a lot from this and it is widely under reported due to embarrassment or thinking that it’s just ‘normal vaginal atrophy’.

Unlike hot flushes, which may settle with time, vaginal problems almost never do.

What can you do?

Smoking is an independent risk factor for contracting BV (bacterial vaginosis, common in menopause)—so if you smoke, stop!

Using certain probiotics vaginally can help. Interestingly, oral probiotics, while helpful, may not have a huge impact on the vaginal microbiome. The 2 systems are not as connected as you might think. Herbal support, teas, modifying sex positions, MLT laser, maintain healthy body weight….all of these things can help.

Using topical Oestrogen lowers pH, increases lactobacilli + more. This is the most successful method of helping, or almost finding some calm in that area.

If you can’t/don’t want to use oestrogen, using a water based lube is helpful.

A healthy vagina=a happier woman=a happier midlife experience!

There are more blogs on this site regarding your pelvic region, and I regularly run 4 week courses for Pilates for Pelvic Floor.