What’s Going on Down There? Vaginal, Urinary and Pelvic Changes

Noticing changes "down there" during perimenopause? You're among the 50-70% of women who experience vaginal and urinary symptoms—yet it's one of the least talked about aspects of menopause. It’s also a symptom that stays with you for the rest of your life.

Key Takeaways

The changes you're experiencing are completely normal and treatable. Declining estrogen affects vaginal and urinary tissues, but effective solutions exist.

  • Vaginal dryness and discomfort affect up to 70% of postmenopausal women

  • Urinary symptoms like frequent infections or urgency are common and manageable

  • Effective treatments range from over-the-counter options to prescription therapies

You're Not Alone: What Many Women Experience

If you're feeling embarrassed or isolated by these changes, take comfort in knowing you're part of the majority. Up to 84% of postmenopausal women experience some form of vaginal or urinary symptoms, yet studies show that less than 25% seek treatment. The silence around these issues doesn't mean they're rare—it means we need to talk about them more openly.

Unlike hot flashes that often improve over time, vaginal and urinary changes typically persist and may worsen without treatment. The good news? Once you understand what's happening and explore your options, most women find significant relief.

The Changes You Might Be Noticing

These symptoms can develop gradually during perimenopause or appear more suddenly after menopause:

Vaginal Changes:

  • Dryness, itching, or burning sensations

  • Changes in discharge (less moisture, different consistency)

  • Tissue that feels thinner or more sensitive

  • Vaginal pH changes that increase infection risk

Urinary Changes:

  • Frequent urination or sudden urgent need to urinate

  • Recurring UTIs that seem to come out of nowhere

  • Burning during urination

  • Feeling like you can't completely empty your bladder

Daily Comfort Issues:

  • Discomfort when sitting for long periods

  • Irritation during exercise or physical activity

  • Sensitivity when wearing certain fabrics or tight clothing

  • General pelvic pressure or discomfort

Intimacy Changes:

  • Discomfort or pain during sexual activity

  • Decreased sensation or arousal

  • Longer time needed for natural lubrication

  • Anxiety about intimacy due to physical changes

Why This Happens: The Estrogen Connection

Estrogen is like a maintenance worker for your vaginal and urinary tissues. It keeps tissues thick, elastic, and well-lubricated while maintaining healthy pH levels and blood flow. When estrogen levels drop by 60-70% during menopause, several things happen:

  • Vaginal walls become thinner and less elastic

  • Natural lubrication decreases significantly

  • pH levels become less acidic, creating an environment where harmful bacteria can thrive

  • Blood flow to the area decreases, affecting tissue health and sensation

  • Collagen production slows, affecting tissue strength and flexibility

This process, medically called vaginal atrophy or genitourinary syndrome of menopause (GSM), affects the entire urogenital area—not just the vagina.

What You Can Do About It

Start Here: Simple Steps You Can Try Today

Stay hydrated: Drink 6-8 glasses of water daily to support overall tissue health and reduce UTI risk.

Choose cotton underwear and avoid tight-fitting synthetic fabrics that can trap moisture and create irritation.

Use gentle, fragrance-free products for cleansing. Avoid douches, scented soaps, or harsh cleansers that can disrupt natural pH balance.

Try regular, gentle movement like walking or yoga to improve blood flow to pelvic tissues.

Next Level: Over-the-Counter Options

Vaginal moisturizers vs. personal lubricants—what's the difference?

  • Moisturizers (like Gynatrof, Hyalo Gyn, or Replens) provide ongoing hydration, used 2-3 times per week

  • Lubricants are used during intimacy for immediate comfort

  • pH-balanced products help restore natural acidity levels

Look for ingredients like:

  • Hyaluronic acid for long-lasting moisture

  • Vitamin E for tissue healing

  • Aloe vera for soothing irritation

Medical Solutions: When You Need Extra Support

Hormone-Based Treatments:

  • Local estrogen therapy: Low-dose vaginal estrogen creams, tablets (Vagifem), or rings (Estring) that work directly on tissues with minimal systemic absorption

  • Systemic hormone therapy may help if you're treating multiple menopause symptoms

Non-Hormonal Prescription Options:

  • Osphena (ospemifene): Oral medication that acts like estrogen specifically on vaginal tissues without affecting other parts of the body

  • Intrarosa (prasterone): DHEA suppository that helps restore vaginal tissue thickness and lubrication

  • Laser therapy or radio-frequency treatments are promoted as options for vaginal rejuvenation. There is no definitive research that shows them to be actually effective in controlled trials. These are approved by Health Canada but not by FDA and carry potential risks of burning and scarring.

Good News: Your Sex Life Doesn't Have to End

Many women worry that menopause means the end of satisfying intimacy, but this simply isn't true. With proper treatment, many women report improved intimacy compared to the unpredictable perimenopause years.

Communication with your partner becomes more important—and often brings couples closer together. Taking time for your body to respond is normal and healthy. Many women discover that longer foreplay and different approaches to intimacy can be more satisfying than before.

Professional help is available if you need guidance. Pelvic floor physical therapists and sexual health counselorsspecialize in helping women navigate these changes.

Frequently Asked Questions

Q: Will these symptoms affect my daily activities? A: They can, but they don't have to. Many women find that even simple treatments like vaginal moisturizers significantly improve daily comfort within 2-4 weeks of consistent use.

Q: Is it normal to have pain during sex after menopause? A: Pain during intimacy is common but not something you should accept as inevitable. Up to 45% of postmenopausal women experience painful intercourse, but effective treatments can restore comfort.

Q: Why do I keep getting UTIs now? A: Declining estrogen changes your vaginal pH from acidic to more neutral, allowing harmful bacteria to thrive. Vaginal estrogen therapy can restore natural pH levels and dramatically reduce UTI recurrence.

Q: Are vaginal estrogen creams safe? A: Local vaginal estrogen has minimal systemic absorption and is considered safe for most women, even many with a history of breast cancer. Always discuss your medical history with your healthcare provider.

Q: What if I can't or don't want to use hormones? A: You have options! Non-hormonal treatments like Intrarosa or Osphena can be very effective. Even over-the-counter moisturizers and lifestyle changes help many women find relief.

Q: Can I still have a healthy sex life after menopause? A: Absolutely! With appropriate treatment and open communication, many women report improved intimacy after menopause. The key is addressing physical symptoms and being patient with your body's changes.

Q: How long do these symptoms last? A: Unlike hot flashes that often resolve within 2-5 years, vaginal and urinary changes typically persist without treatment. However, most symptoms improve significantly within 4-8 weeks of starting appropriate therapy.

Red Flags: When to Call Your Doctor

Contact your healthcare provider if you experience:

  • Persistent bleeding or unusual discharge, especially if you're postmenopausal

  • Severe pelvic pain that interferes with daily activities

  • Recurring UTIs (more than 2-3 per year) that don't respond to standard treatment

  • Any new symptoms that concern you or significantly impact your quality of life

  • Pain during urination that persists despite treatment

  • Signs of pelvic organ prolapse like pressure or a feeling that something is "falling out"

The Key Takeaway

These intimate changes are a normal part of the menopause transition, and you don't have to suffer in silence. With today's treatment options, most women find significant relief—the key is knowing you have choices and that help is available. Whether you prefer over-the-counter solutions, non-hormonal prescriptions, or hormone therapy, there's likely an approach that will work for your body and your lifestyle.

Remember: seeking treatment for these symptoms isn't vanity—it's healthcare. You deserve to feel comfortable in your body and maintain the intimacy and quality of life you want, regardless of your age or menopause status.