Do You Lose Your Labia Minora During Menopause?

Your labia minora, the thin folds of skin just inside the labia majora, can undergo some physical changes during menopause, but you do not lose them altogether. Sharp declines in estrogen levels as you go through this transition mean that the tissue may shrink, flatten, or even change appearance. Physical changes to the genitals like this are known collectively as genitourinary syndrome of menopause (GSM), and although they vary among individuals, they are common as you undergo menopause. 

It’s normal to also feel emotional shifts during this time since these symptoms can impact intimacy, your body image, and self-esteem. Vaginal changes during menopause can be alarming, but it’s all part of the process and can be treated safely and effectively. Read on to find out what vaginal atrophy actually is, what it means, its symptoms, and treatment options.

What Is Menopause and How Does It Affect Genitals?

Menopause is when a woman stops having periods and her hormone levels become low. This typically occurs between the ages of 45 and 55, but it can happen earlier. For most women, menstrual periods usually stop over time. Menopause itself is not a disease, but a natural, biological stage of life. 

Menopause is a natural process where your body adjusts to hormonal changes for many years. The length of menopausal symptoms can vary significantly, everyone’s experience is different. Estrogen is a complex hormone that does many jobs, and as your body transitions to menopause, estradiol levels naturally decline. This decline can lead to thinning and drying of the vaginal and vulvar tissues, as well as reduced elasticity. Also known as atrophic vaginitis, genitourinary syndrome of menopause (GSM) can cause vaginal dryness, itching, discomfort, and painful intercourse. 

Why Is My Labia Minora Disappearing?

Although it may seem like your labia minora are doing a disappearing act, what’s actually happening is tissue shrinking, thinning, and retracting in response to lower estrogen levels. Estrogen is important for the skin, including the vaginal lining. It maintains thickness, elasticity, and moisture and supports your natural lubrication and blood flow to the area. As estrogen levels decline during menopause, these tissues gradually change in appearance and texture. While it may look like your labia minora are disappearing, they're actually undergoing a natural process of reshaping rather than vanishing altogether. 

In terms of anatomy, the tissue of your vulva and vagina has multiple receptors for estrogen, so when levels start to fall, you may see structural and functional changes in and around this tissue. In terms of vulvar and vaginal atrophy causes, declining estrogen is one of the leading causes of these physical changes. What does that look like in real time? As estrogen levels fall, collagen and elastin break down, and underlying tissue support is lost, making the skin appear thinner and paler. Reduced blood flow can also lead to a thinner epithelial lining and general changes in skin appearance. Sebaceous glands also produce less secretion, so the skin is drier and therefore more susceptible to trauma (like tears leading to vaginal atrophy bleeding). 

Declining estrogen can also lead to changes in your vaginal microbiome and an increased vaginal pH. Estrogen lowers vaginal pH, making it harder for harmful bacteria to grow and fueling Lactobacillus, the bacteria that dominate a healthy vaginal microbiome. Changes in the microbiota of the vagina mean other bacteria can increase and take over, leading to a rise in symptoms of vaginal atrophy, as the tissue responds to new microbial diversity. Severe cases can even lead to labial adhesion, a condition where the labia minora stick or seal together. Obviously, this would only happen in severe cases left untreated, but the good news is that treatment is available, and there are many changes you can make to support your vaginal health.

When hormones are in balance, cycles are more regular, vaginal tissue is elastic, and protective bacteria thrive. When hormone levels shift out of range, the body often speaks through symptoms such as vaginal dryness, unexpected bleeding, or discomfort. If you aren’t sure what your hormones are doing each month, it can be useful to test and track them with a device like the Mira Hormone Monitor. Regularly testing your hormones can help you track these changes across the cycle and provide data for more informed care. 

What Is Vaginal Atrophy During Perimenopause and Menopause?

Vaginal atrophy, also known as atrophic vaginitis, is when the vagina changes in response to low estrogen levels. Vaginal atrophy, meaning specifically physical changes to the vagina, is an outdated term as it didn’t encompass the lived experience of symptoms surrounding this condition. The updated term for this condition is Genitourinary Syndrome of Menopause (GSM) to accurately reflect a broader spectrum of symptoms. 

In addition to the common symptoms of vaginal atrophy, GSM includes vaginal changes, vulvar changes (including labia minora), and urinary symptoms. Often, the first sign of GSM is vaginal dryness, a symptom experienced by at least half of menopausal women. 

What Does Vaginal Atrophy Look Like?

Symptoms can start slowly and progress over time. You might start to notice physical changes like the following:

• Paler color

• Thinner, fragile tissue

• Reduced elasticity

• Shrinking or flattening of the tissue

• Loss of fullness or volume

• Vaginal narrowing or shortening

• Labial adhesions in advanced cases

If you are unsure about these symptoms, it’s important to seek medical advice. A physical pelvic exam by your doctor can help you clarify what you’re experiencing. 

Common Symptoms of Labial and Vulvovaginal Changes

Some common symptoms you may notice include the following:

• Vaginal dryness

• Burning or itching

• Painful sex

• Bleeding after sex

• Reduced sexual sensation

• Urinary urgency/frequency

• Recurrent UTIs

• Increased risk of vaginal dysbiosis (yeast, BV)

Some women delay treatment because of the stigma associated with discussing intimate topics with their doctor. Unlike other menopause symptoms (hot flashes, mood swings, night sweats, etc.), vaginal atrophy symptoms will persist and progressively worsen if left untreated, so it’s important to have the conversation, even if you feel uncomfortable.

Emotional and Relationship Impact of Labial Changes

Vaginal changes during menopause (and vulvovaginal changes) can affect far more than just your physical anatomy. The physical changes can affect your self-esteem and, in turn, how you feel about intimacy. If you’re experiencing discomfort during intercourse, it can even lead to reduced desire and even avoiding intimacy altogether. Whether you’re dealing with a mind-body mismatch, sexual avoidance due to pain, or even partner misunderstandings, symptoms of vaginal atrophy can take their toll. 

Obviously, this can impact your relationship with your partner, especially if you aren’t being forthcoming about what’s really going on. Open communication with both your partner and doctor can help strengthen your emotional connections and help you navigate a sexual relationship that is mutually satisfying. You don’t have to accept that this is just how things are, and there are things you can do about it. 

How to Treat Vaginal Atrophy

There are several treatment and intervention options for vulvovaginal atrophy, including hormonal and non-hormonal options. 

Non-Hormonal Options

Local Hormone Therapy

Vaginal atrophy treatment also includes options like local hormone therapies. These may come in the form of prescription creams, rings, or tablets to deliver estrogen directly to the vaginal tissue in a topical form. Another option for treatment includes the use of intravaginal DHEA (dehydroepiandrosterone). DHEA is known as a “precursor hormone” since your body converts it into estrogen or testosterone. In other words, it helps the body produce sex hormones, and when applied locally, it can act directly on the vaginal tissue and limit whole-body hormone exposure. There is minimal systemic absorption, and it is generally well tolerated by most women as it works to restore elasticity and fullness to the vaginal tissues. 

Systemic Hormone Therapy

Systemic hormone therapy is typically used for women with broader menopausal symptoms (e.g., severe hot flashes). It’s often a higher dose than topical treatment and goes to all cells of your body rather than staying localized. There are many benefits to this type of hormone therapy, and together with your healthcare team, you can decide the best choice for treatment. 

If you’re experiencing menopausal symptoms, it can be helpful to keep track of them as your hormone levels naturally fluctuate and then drop. In Mira’s free app, we have something called Menopause Transitions Mode to help you track symptoms and see how they change over time. Our Hormone Monitor for Perimenopause tracks four key reproductive hormones (FSH, E3G, PdG, LH) to define your current reproductive stage and anticipate approaching menopause. Using our testing wands, you can test for FSH, which provides insight into ovarian functioning and reproductive age. With regular tracking, you can see how your cycle and hormones are changing and be able to identify your Menopause Transitions Stage thanks to the Menopause Transitions Mode in the Mira App. 

Can Vaginal Atrophy Be Reversed?

Although vulvovaginal atrophy can be significantly improved and controlled, it cannot be permanently cured. Tissue thickness and hydration can be restored with estrogen therapy, and symptoms can be managed. Early treatment prevents the cascade of health complications that can come from declining estrogen levels and helps prevent irreversible changes. If symptoms are left untreated, permanent damage can happen, such as the vaginal opening narrowing or even tissue fusing. Early treatment not only improves outcomes for vaginal atrophy but can also prevent irreversible vulvovaginal changes during menopause. 

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When to See a Healthcare Professional

As women, we’re often told to just deal with the pain of our reproductive organs, but it doesn’t have to be that way. If you notice any of the following symptoms, it’s definitely time to see a doctor or healthcare professional for further evaluation:

• Postmenopausal bleeding

• Severe pain

• Labial fusion

• Growths or lesions

• Persistent urinary symptoms

• OTC remedies failing after several weeks of use

Vulvovaginal symptoms in menopause are common, but if left untreated, they can have long-lasting consequences. Women do not need to suffer in silence, and there are plenty of evidence-based solutions to support you. If your doctor is not listening to you or dismissing your symptoms, find a provider who will take you seriously. 

Key Takeaways

The sharp decline in estrogen you experience during your menopause transition can cause a number of physical symptoms, including changes to your genitals. While you do not “lose” it altogether, your labia minora undergo several physical changes during menopause. Declining estrogen levels can cause structural changes such as tissue shrinking, flattening, or changing appearance as a part of genitourinary syndrome of menopause (GSM). Without treatment, your symptoms will likely worsen, so it’s important to get checked out by your healthcare team. Effective and evidence-based treatments are available. And since early intervention improves quality of life, it’s important not to ignore your symptoms as you go through this transition. 

Frequently Asked Questions

Does the vagina become unusable after menopause?

No! Physical vaginal changes during menopause, like thinning, dryness, and sensitivity, can happen (and be treated), but the vagina remains functional and usable after menopause. 

Does your labia really shrink during menopause?

Yes. Lower estrogen levels mean physical changes like shrinking and thinning can happen to the labia because this tissue is so highly sensitive to estrogen. 

Where does the labia minora "go" after menopause?

After menopause, the tissue of the labia minora undergoes several changes and may look visibly different due to a loss of collagen, fat, and decreased blood flow. When tissue loses volume and elasticity, it can appear smaller or flatter.