Vaginal Health in Perimenopause: What You Need to Know

Vaginal health is a crucial yet often overlooked aspect of perimenopause. Many women experience symptoms but feel uncomfortable discussing them. This post is longer than usual because it’s an important topic that deserves an open and honest conversation.

As estrogen levels decline during perimenopause, many women notice changes in their vaginal and urinary health that can affect comfort, intimacy, and overall well-being. These changes are part of what’s known as Genitourinary Syndrome of Menopause (GSM)—a condition that impacts both the vagina and urinary tract. Now, let's be honest here, there are no good perimenopause symptoms. However, the ones that affect your genitals and urinary tract are particularly difficult to manage. Understanding what’s happening and what you can do about it can significantly affect how you feel.

What Happens to the Vagina During Perimenopause?

Estrogen plays a vital role in maintaining vaginal health and the natural decline from perimenopause leads to a thinning of the vulva-vaginal wall, the urethra, the bladder, and changes in the pH (acid-base) balance of the vagina and urethra. As these tissues get thinner, they can lose elasticity and blood flow, contributing to these symptoms, and these tissues become more susceptible to infection.The vaginal microbiome also shifts, making infections more likely, while the urinary tract becomes more susceptible to irritation and increased urgency.

Our pelvic floor muscles tend to get weaker as we age, especially if we've gone through a natural childbirth. These muscles support your bladder, bowels, vagina, and uterus. You may also notice changes in the appearance of the vulva (external female genitals). The clitoris may shrink, and the labia may become less full, potentially changing in color and starting to sag. A decrease in collagen can contribute to sagging skin all over the body, including the vulva, and can weaken pelvic floor muscles.

There is one symptom that almost all perimenopausal women share. It doesn't have much to do with your perimenopausal type, and that is decreased libido. Even though it tends to be included in this range of symptoms, it's one of the most common perimenopause symptoms. Your estrogen increases your sex drive during your fertile years. And when it begins to decline, so does your libido. And as the vaginal walls become thinner, drier and less elastic, discomfort, irritation, and even pain during intercourse can occur.

Common Symptoms & Why They Happen

Many women don’t realize that the changes they’re experiencing are related to perimenopause. Some of the most common vaginal and urinary symptoms include:

Vaginal Dryness & Irritation: Less estrogen means less natural lubrication, leading to persistent dryness and discomfort. You might notice a burning sensation, especially after urination or physical activity.

Thinning of Vaginal Walls: Reduced estrogen decreases elasticity, making the tissue more fragile. This can make vaginal tissue more prone to irritation or even minor tearing.

Changes in pH & Microbiome: The vaginal environment becomes more alkaline, increasing the risk of infections like bacterial vaginosis or UTIs. A balanced vaginal microbiome is essential, much like gut health, and probiotics may help restore beneficial bacteria.

Pelvic Floor Weakness & Incontinence: The muscles supporting your bladder, bowels, vagina, and uterus naturally weaken with age, especially after childbirth. This can lead to leakage when sneezing, coughing, or laughing.

Changes in Vulva Appearance: Estrogen and collagen loss can cause the labia to appear less full, color change, and sag over time. The clitoris may also shrink due to hormonal shifts.

Pain During Intercourse: With less lubrication and elasticity, sexual activity may become uncomfortable or even painful, a condition known as dyspareunia.

Vaginal Odor Changes: Hormonal fluctuations and changes in vaginal pH can make natural vaginal odor stronger. Diet also plays a role—foods like garlic, onions, red meat, and alcohol can contribute to stronger smells.

Urinary Symptoms: Increased urgency, frequency, or recurrent UTIs can occur due to the weakening of vaginal and urinary tissue.

What You Can Do to Support Vaginal Health

The good news is that there are plenty of ways to support vaginal health and manage these symptoms. Combining lifestyle changes, natural remedies, and medical treatments can provide significant relief.

Natural Remedies & Lifestyle Adjustments

Support Your Vaginal Microbiome: Just like gut health, vaginal health relies on good bacteria. Probiotic-rich foods (like yogurt, kefir, and fermented vegetables) or probiotic supplements designed for vaginal health can help maintain balance. Often associated with gut health, Lactobacilli can also promote overall vaginal health. Look for a probiotic supplement with the Lactobacilli strain.

Stay Hydrated: Drinking plenty of water helps keep tissues hydrated and supports overall vaginal health.

Eat Phytoestrogens: Foods like flaxseeds and soy contain plant-based estrogens that may help with hormonal balance.

Use Vaginal Moisturizers: Unlike lubricants, which are used during intercourse, vaginal moisturizers are designed for daily use to maintain hydration and comfort.

Choose Gentle Hygiene Products: Avoid harsh soaps and scented products that can disrupt vaginal pH and cause irritation.

Engage in Regular Sexual Activity: Whether with a partner or solo, sexual activity helps improve blood flow to the vaginal tissues, keeping them healthy and elastic.

Strengthen Pelvic Floor Muscles: Kegel exercises can help prevent or improve incontinence, support vaginal health, and enhance sexual function.

Vitamin D: Vitamin D can improve vaginal pH, dryness, sexual functioning, reduced libido, and decreased urinary tract infections. Try vitamin D supplements or indulge in fatty fish, canned tuna, and eggs - all great sources of vitamin D.

Monitor Your Diet: Certain foods can contribute to vaginal odor—reducing processed foods, alcohol, and red meat while increasing leafy greens and citrus fruits can help maintain a balanced scent.

Medical Treatments for GSM

If lifestyle changes aren’t enough, medical treatments can provide effective relief.

Vaginal Estrogen Therapy: Available as creams, rings, or tablets, this treatment delivers estrogen directly to the vaginal tissue, restoring moisture and elasticity with minimal systemic absorption.

Hormone Replacement Therapy (HRT): Systemic HRT can help manage a range of perimenopausal symptoms, including vaginal dryness and urinary issues.

Non-Hormonal Treatments: Options like vaginal laser therapy or prescription medications can also be effective for women who can’t or don’t want to use hormones.

When to See a Doctor

While vaginal changes during perimenopause are normal, some symptoms warrant medical attention. You should speak to a healthcare provider if you experience:

• Severe discomfort that interferes with daily life or intimacy.

• Unusual bleeding after menopause, which could indicate an underlying issue.

• Persistent dryness that doesn’t improve with over-the-counter treatments.

• Unusual discharge or odor that might signal an infection

Vaginal health is a key part of your overall well-being, and there’s no reason to suffer in silence. By making small adjustments, exploring treatment options, and discussing these changes, you can take control of your health and feel more comfortable in your body. Perimenopause may bring challenges, but with the right knowledge and support, you can confidently navigate this transition.