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When a woman goes through the menopause, one of the changes she may experience is vaginal dryness. What happens in the menopause that leads to vaginal dryness?

The vagina before the menopause

Normally, before a woman goes through the menopause, also known as the 'change of life', mucus and other secretions lubricate the vagina, helping to keep it moist and supple. Glands at the neck of the womb (the cervix) produce these secretions, and as they slowly move down the vagina they also remove dead cells, helping to keep it clean. Normal vaginal secretions are slightly acidic, which also helps protect against infections such as thrush.

When a woman experiences sexual stimulation, two Bartholin's glands at the entrance of the vagina produce extra moisture that provides additional lubrication for having sex.

The hormone oestrogen has an effect on these glands as well as the tissues inside and around the vagina. Oestrogen not only helps the lining of the uterus to be more elastic and thicker but also triggers cells lining the vagina to produce a compound known as glycogen. This compound promotes 'friendly' bacteria that help to maintain an acidic environment in the vagina, which protects it from infections. 

Changes to the womb

As a woman starts to go through the menopause, the amount of oestrogen that her ovaries produce gradually goes into decline. This decline usually starts when a woman approaches perimenopause in her mid- to late-40s. One of the first signs of a drop in oestrogen levels can be a reduction in the secretions produced by the Bartholin's glands during sexual stimulation. 

With the drop of oestrogen, the glands at the cervix also don't produce as much secretion, and the skin and supporting tissues of the vulva (the lips of the vagina and the external genitals) and in the vagina begin to shrink and become thin. There can also be a reduction in fatty tissue in the genital area. The vagina can become drier, less elastic and eventually shorten.

It can take months, even years, before the symptoms of vaginal dryness occur, and the longer it has been since a woman went through the menopause, the more common the symptoms are. Over half of women between 50 and 60 years old will have some signs of vaginal dryness linked to the menopause.