Just like the rest of your body, your vagina ages, and dryness, drooping, and a lack of lubrication are all issues at this stage of life.
These changes are natural, though they affect you may not be welcome.
This is the first thing most women are aware of at menopause and it is falling levels of oestrogen behind this. This hormone keeps the tissues of your vagina healthily plump and moist.
Dryness is one of the more distressing symptoms of menopause and can make sex uncomfortable or even painful.
Your doctor may prescribe additional oestrogen if the condition warrants it, or you could try a water-based lubricant to reduce friction.
A combination bioidentical cream with both progesterone and oestrogen can also be helpful, and have sex regularly to keep up the moisture you still have.
Less hair, and colour changes
Your hair goes through natural cycles where it grows for a period of time and then falls out. As your hair gets older, its growth cycle shortens.
At the same time, a drop in hormone levels makes testosterone your body’s dominant hormone and this can fuel hair loss. When more hair falls out than your body can replace, you’ll start to see areas of thinning. It happens on your scalp, and it happens to your pubic hair, too.
You might expect the hair on your head to go grey as you get older but finding your first grey hair down there can come as a big shock but your pubic hair turns grey for the same reason that the hair on your head does.
As you age, the pigment cells inside each hair follicle die and stop producing the chemical melanin that gives your hair its colour. As melanin production slows, your pubic hair turns grey or white.
Also affected at menopause is your vulva — the opening and outer lips of your vagina – and that definitely also sees some changes.
Firstly it’s probably paler than it used to be. The lighter colour is due to reduced blood flow and the inner lips have shrunk because of declining hormone levels, and they may be drier than they were before.
Looser skin everywhere
Skin tone gets worse because of the age-related loss of elastin and collagen — proteins that once kept it tight.
That’s true for the skin on your face as well as your labia — the folds on either side of your vagina.
It also affects the vagina itself as with declining oestrogen levels the once-stretchy tissues of your vagina become thinner and less elastic.
This is definitely a case of “use it or lose it” because if you don’t have sex often enough, your vagina can get shorter and narrower. So when you do have sex, it will hurt.
Maintaining a healthy sex life will keep your vagina loose and limber.
Pelvic floor problems
The muscles of your pelvic floor act like a sling that supports your uterus, bladder, rectum, and the top of your vagina.
Childbirth and menopause weaken these muscles, which can make the organs in your pelvis droop – a prolapse – and sometimes an organ falls all the way into the vagina and creates a bulge.
This generally needs help, either from exercises in mild cases, to give your pelvic organs a lift, or a surgical procedure to treat prolapse.
Dryness plus thinning of tissues in the vagina add up to painful penetration. Over time, the delicate tissues can tear and bleed.
Don’t let fear of pain keep you from a healthy sex life because when you avoid sex, it can make the problem worse.
Use a lubricant or vaginally applied oestrogen or progesterone and oestrogen to make it easier.
Your vagina is home to lots of bacteria — some good, some bad — and the hormone drop around menopause changes the climate down there, leaving more bad bacteria than good.
You may experience sudden urges to use the bathroom, or pain when you pee, and these could be signs of a urinary tract infection (UTI).
That’s why women have more UTIs as they age and keeping your hormones balanced can increase helpful bacteria and reduce the number of infections you get.
Change is inevitable, but please don’t put up with pain or discomfort and investigate any changes that are affecting your quality of life.
Hormone balance is essential so whether you need some extra oestrogen, or the balancing effect of bioidentical progesterone, do check for signs you need a little help.
Which hormone or hormones might you need?