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Menopause and Your Body: Understanding Vaginal Changes During Transition

Menopause marks a significant juncture, not only in our bodies but also in our vaginal health. As oestrogen levels decline, the intricate balance of the vaginal ecosystem undergoes profound changes, often accompanied by a range of symptoms that can affect daily life.


Symptoms and Challenges


Menopause ushers in a host of symptoms associated with vaginal atrophy, including:

  •  Discomfort during intercourse

  • Vaginal burning and irritation

  • Bleeding after intercourse

  • Lack of lubrication

  • Vaginal irritation and itching

  • Burning during urination 

  • Urinary incontinence

  • Urinary tract infections

These symptoms collectively fall under the umbrella of the Genitourinary Syndrome of Menopause (GSM). This chronic and progressive condition remains under diagnosed and under treated.


Hormonal Influence and Microbiome


The decline in oestrogen levels during menopause disrupts the delicate balance of vaginal microbiota and pH, triggering a cascade of effects.

Typically, lactobacillus species dominate the vaginal microbiome, maintaining an acidic pH (around 3.5-4.5) that prevents the growth of harmful pathogens.


With adequate oestrogen, vaginal cells proliferate and accumulate glycogen, which lactobacillus then converts into lactic acid. This acidification supports the vaginal environment, keeping it healthy and resistant to infections.

However, when oestrogen levels decrease, glycogen levels diminish, leading to a reduction in lactobacillus populations. This shift alters the vaginal pH, creating an environment conducive to the growth of other bacteria. Consequently, the vaginal epithelium may experience atrophy, manifesting as pain, dysuria, and other GSM symptoms.


Furthermore, the decrease in lactobacillus and lactic acid production allows opportunistic pathogens to thrive, increasing the risk of urinary tract infections (UTIs), vaginal vaginosis, and yeast infections. These alterations in the vaginal microbiome exacerbate symptoms associated with vaginal atrophy, contributing to discomfort and impacting overall vaginal health.


Impact on Vaginal Health


Vaginal dryness is a prevalent symptom of menopause, resulting from decreased lubrication and compromised epithelial integrity. This can lead to discomfort, pain during intercourse, and heightened susceptibility to infections. Additionally, the structural support provided by collagen diminishes with declining oestrogen levels, further exacerbating vaginal atrophy.


Risk Factors and Solutions


Various factors, including menopause, bilateral oophorectomy, POI, smoking, and cancer treatments, can heighten the risk of GSM. However, proactive measures can mitigate these risks and alleviate symptoms:


  1. Support Hormonal Status:

Topical oestrogen therapy targets symptoms locally, improving vaginal health without significant systemic absorption.


If you are unable to or don't want to take systemic HRT, this may still be a viable option and is wort considering. It is, in all honesty, probably the simplest option.


Natural foods rich in phytoestrogens and herbal supplements such as Black Cohosh and Red Clover may also provide relief. Please check that they are suitable if you are taking any other medication. Drop me a quick email.

2. Oral probiotic supplements can work well to support vaginal health. Among the options available, I regularly recommend those from reputable brands such as Invivo or Biocare for their efficacy and quality.


3. Hydration and Lubrication: Adequate hydration, coupled with vaginal lubricants and moisturisers containing hyaluronic acid, can hydrate tissues and enhance lubrication. Please see my ebook for more information.


4. Lifestyle Modifications: Adopting healthy lifestyle habits such as quitting smoking, avoiding sugar, wearing breathable cotton underwear, and steering clear of chemical douches can promote vaginal health. Pelvic floor physiotherapy and regular sexual activity can also improve blood flow and maintain tissue elasticity.


4. Medical Interventions: Prescription medications like ospemifene can offer relief in moderate to severe GSM cases.


It is so important to understand the nuances of vaginal changes during menopause. This can empower women to take proactive steps toward preserving their vaginal health and overall well-being.

It is possible to navigate this transformative phase with confidence and vitality by embracing a holistic approach that addresses hormonal balance, microbiome health, and lifestyle factors.

For a few more ideas, please do download my ebook.



Please schedule a complimentary call with me to discuss your experiences. This conversation is an opportunity to explore your symptoms and the possible ways to manage them with absolutely no obligation. Remember, understanding and then addressing your symptoms is vital to finding relief and improving your daily life.


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