Women will lose estrogen as they approach menopause.  According to the North American Menopause Society, estrogen normally supports the health of the vaginal walls; the vaginal lining becomes thicker, and the number of mucosal folds increases.  These changes are presumably to prepare the vagina for the potential for intercourse and childbirth. 

After menopause, however, estrogen levels will fall.  The vaginal lining begins to thin, there are fewer folds, and the vagina becomes less flexible.  This condition is referred to as vulvovaginal atrophy.

The dry and fragile vulvovaginal tissues are increasingly susceptible to injury, shearing, and bleeding during intercourse.  When a woman doesn’t have intercourse or other vaginal sexual activity on a regular basis following menopause, her vagina may also become shorter and narrower.

Then, when she does try to have intercourse, she is likely to experience pain, even if she uses a lubricant. That’s because dry, fragile vulvovaginal tissues are susceptible to injury, tearing, and bleeding during intercourse or any penetration of the vagina. 

These menopause-related vulvovaginal symptoms may occur early in the menopause transition or not until after several years of reduced estrogen levels. What’s more, not all women develop troublesome vulvovaginal symptoms around menopause.

But those women who do experience vulvovaginal symptoms (dryness, irritation, burning, itchiness, pain) should not automatically assume that reduced estrogen levels are the reason for these symptoms.

Atrophic vaginitis. When “–itis” is added to a word, it generally means inflammation. Inflammation of the vagina after menopause in a woman who is not using hormone therapy is called “atrophic vaginitis.” This condition can include redness of the vagina and vaginal discharge. It’s associated with the loss of estrogen after menopause and usually improves with the use of low doses of vaginal estrogen therapy.

After menopause, however, estrogen levels will fall.  The vaginal lining begins to thin, there are fewer folds, and the vagina becomes less flexible.  This condition is referred to as vulvo-vaginal atrophy.

When a woman doesn’t have intercourse or other vaginal sexual activity on a regular basis following menopause, her vagina may also become shorter and narrower. Then, when she does try to have intercourse, she is likely to experience pain, even if she uses a lubricant. That’s because dry, fragile vulvovaginal tissues are susceptible to injury, tearing, and bleeding during intercourse or any penetration of the vagina.

Atrophic vaginitis. When “–itis” is added to a word, it generally means inflammation. Inflammation of the vagina after menopause in a woman who is not using hormone therapy is called “atrophic vaginitis.” This condition can include redness of the vagina and vaginal discharge. It’s associated with the loss of estrogen after menopause and usually improves with the use of low doses of vaginal estrogen therapy, as discussed later.

These menopause-related vulvovaginal symptoms may occur early in the menopause transition or not until after several years of reduced estrogen levels. What’s more, not all women develop troublesome vulvovaginal symptoms around menopause. But, those women who do experience vulvovaginal symptoms (dryness, irritation, burning, itchiness, pain) should not automatically assume that reduced estrogen levels are the reason for these symptoms.