What is Perimenopause?
Perimenopause typically begins in a person’s 40s, though it can start earlier. It is the years leading up to menopause, marked by fluctuating levels of the hormone estrogen. Menopause itself is defined as 12 consecutive months without a menstrual period.
During perimenopause, the ovaries gradually produce less estrogen, a hormone crucial for maintaining the structure and function of the reproductive system, including the vaginal walls.
What Happens to the Vagina During Perimenopause?
Perimenopause is the transitional phase leading up to menopause and it can bring about a range of changes in the body. While many people are aware of the mood swings and irregular periods that may present in this stage, there’s one area that often goes undiscussed - vaginal health. Let's eplore the anatomical changes that can happen during perimenopause, why they occur and what can be done to manage any discomfort that may arise...
Perimenopausal Vaginal Changes
Thinning of the Vaginal Walls (Vaginal Atrophy/GSM)
As estrogen levels decline, the lining of the vaginal walls becomes thinner, drier, and less elastic. This is called genitourinary syndrome of menopause (GSM), previously known as vaginal atrophy and results in;
- The vaginal epithelium (surface lining) becomes less robust
- Reduced blood flow to the vaginal tissue
- Tissue becomes more fragile and prone to tearing
Decreased Vaginal Lubrication
Reduced estrogen also means less natural lubrication, particularly during sexual arousal. This can result in vaginal dryness, discomfort during sex (dyspareunia), itching or burning.
pH Level Changes
Estrogen helps maintain a low vaginal pH that supports healthy bacteria like Lactobacilli. During perimenopause, the pH becomes more alkaline, which can lead to loss of protective vaginal flora and an increased risk of bacterial vaginosis, yeast infections and UTIs.
Shortening and Narrowing of the Vaginal Canal
Over time, reduced estrogen can cause the vaginal canal to become shorter and narrower, especially in those who are not sexually active. This change may contribute to sexual discomfort or even pain.
Loss of Elasticity and Support
Estrogen also affects collagen and elastin production. With less of these structural proteins, the vaginal and vulvar tissue may:
- Lose tone and elasticity
- Contribute to a weaker pelvic floor
- Cause symptoms like urinary leakage or heaviness
Managing Vaginal Changes During Perimenopause
These changes are natural but can be uncomfortable. Options for relief include:
- Vaginal moisturisers: Moisturisers provide regular hydration
- Lubricants: Water-based products for intimacy
- Pelvic floor exercises: Perform routine pelvic floor exercises (aka Kegels) for tone and control
- Local estrogen therapy: Creams, rings, or tablets prescribed by a healthcare provider
- Laser or RF treatments: For GSM, though research is still ongoing
Speak with your GP or gynaecologist if symptoms are affecting your comfort or wellbeing. You don’t have to suffer in silence.
The drop in estrogen during perimenopause doesn’t just impact your cycle - it directly affects vaginal tissue, hydration and resilience. By understanding these changes and seeking appropriate care, you can maintain comfort during this natural transition.
References
- North American Menopause Society (2023). Genitourinary Syndrome of Menopause
- Wells et al. (2022). Women's Midlife Health Journal
- Mayo Clinic. Vaginal Atrophy
- Kingsberg et al. (2017). Journal of Sexual Medicine
Moisturisers
Lubricants
Pelvic Floor Trainers
www.linkedin.com/in/brenda-tootell