Estrogens are primarily made by the ovaries but are also produced by the cervix (uterus) and then released into the vaginal tissues. Before menopause, the vagina and skin and tissues around the vagina are kept supple, thick and moist by fluids and mucus released by cervical glands under the influence of estrogen. Estrogen also stimulates vaginal cells to produce glycogen. Glycogen is a substance that supports the growth of beneficial bacteria, which protect the vagina from infections.

Most women begin menopause between the ages of 45 and 55, but it can occur earlier or later in life. The ovaries make less estrogen after menopause. Decreased estrogen production can lead to thinning of the tissues around your vagina and a reduction in the number of glands that make mucus. The hormonal changes that occur during menopause make the vagina shorter, less elastic, drier, and result in the loss of fat tissue from around the genital area. Thinning and weakening of tissues around the opening of the bladder can occur leading to symptoms of urgency, frequency, recurrent urinary infections, and stress incontinence. These changes can take months or years to develop and vary from woman to woman. Atrophic vaginitis is the medical term to describe this condition when these vaginal changes produce bothersome symptoms that warrant medical intervention.

In addition to the vaginal changes, women may experience other changes during the menopausal transition. Hot flashes, night sweats, mood changes, fatigue, urinary tract infections, urinary incontinence, acne, memory problems, thinning hair, skin discoloration, and unwanted hair growth may also occur.