Dealing with the truths of menopause is never a walk in the park. Every day, it seems as if a new, weird symptom is cropping up on us.
For example, you may notice that your genital area looks different. Perhaps your labia minora — the inner skin folds or “lips” around your vaginal opening — are suddenly smaller than usual.
OMG, are they disappearing?
No, but your fears are perfectly reasonable: Your body is undergoing a natural aging process, which includes several not-so-minor, albeit common, physical changes.
What you’re experiencing is something called genitourinary syndrome of menopause (GSM), which encompasses not only shrinking labia but a whole host of other menopause-related symptoms.
And we need to talk about GSM — not just behind closed doors, but out in the open.
Do you lose your labia minora during menopause?
No, “the labia do not disappear during menopause,” assures board-certified OB/GYN Caledonia Buckheit, MD. However, she continues, lowered estrogen levels cause “changes in their appearance and structure. These changes are more noticeable in the labia minora (inner lips), while the labia majora (outer lips) are impacted to a lesser degree.”
The changes “typically include thinning, loss of elasticity, flattening, and sometimes resorption of the labia minora,” explains Dr. Buckheit. By “resorption,” she means a shrinking of the inner labia. In addition, the vulvovaginal (encompassing both the outer and inner vaginal area) skin “often becomes pale, dry, and more fragile,” says Dr. Buckheit. “These changes are due to decreasing subcutaneous fat and collagen content, “driven by low estrogen and androgen levels.”
In short, estrogen decline, which goes hand-in-hand with perimenopause and menopause, causes your genital area to undergo these physical changes.
Not to worry, though (easier said than done, right?): Bizarre as a thinning, diminishing inner labia may be, we’re here to tell you that it is absolutely normal, and even treatable.
But treating your labia minora starts with a better understanding of your body, and the transition it makes during perimenopause into menopause. The changes in your labia are all part of the larger umbrella term genitourinary syndrome of menopause (GSM).
What is Genitourinary Syndrome of Menopause (GSM)?
Genitourinary syndrome of menopause is a common condition affecting people transitioning to menopause, where the lining of the vagina becomes drier and thinner due to a — you guessed it — lack of estrogen. These changes directly affect the:
- Vulva: The genitals that consist of your inner and outer labia, clitoris, vaginal opening, and urethral opening.
- Vagina: The canal-like organ inside your body that opens to the outside of your body.
- Urinary tract: The body’s filtration system, including the kidneys, ureters, bladder, and urethra.
People who suffer from GSM experience burning, itching, pain during sex, urinary incontinence, and urinary tract infections.
Fun, right?
Once known as “vaginal atrophy,” the term GSM was recently adopted to include urinary symptoms, such as incontinence and urinary tract infections, in addition to vaginal ones. However, the fact remains that the decline in estrogen does result in vaginal atrophy, or a wasting away of a part of the body: “GSM is caused by estrogen deficiency, which causes atrophic changes in the vulvovaginal and lower urinary tract tissues,” explains Dr. Buckheit.
Unfortunately, if you’re a menopausal woman, some form of GSM is inevitable.
While Dr. Buckheit says that not every woman will experience symptoms, “it is estimated that about half to 75% of postmenopausal women end up suffering from GSM.” And at the very least, “100% of women who experience prolonged estrogen deficiency will notice changes in the genital tract tissues.”
Since estrogen plays a vital role in tissue health — we’re talking bone, skin, hair, brain, skeletal muscle, and the cardiovascular system — it’s no wonder that its decline during menopause has such an impact.
Therefore, GSM is not something to brush off: “GSM is chronic and progressive,” warns Dr. Buckheit, “and is often underdiagnosed and undertreated.” So the more you know about this condition, the better equipped you’ll be to seek treatment.
Questions Women Are Asking
GSM menopause symptoms
Since GSM encompasses changes in both your vaginal area and your urinary tract, there are several consequential symptoms for this condition.
The first symptom that you may notice is vaginal dryness. This is the result of a thinning of the tissue that lines the wall of the vagina.
Other vaginal symptoms can include:
- Burning and/or itching in your vagina.
- Pain during sexual intercourse
- Unusual vaginal discharge (usually a yellow color).
- Spotting or bleeding, especially during sex.
- Vulvar itching (aka itching around your external genitals).
- Vulvar/labial changes, including thinning, loss of fullness, and color changes
In addition, GSM can cause issues in the urinary tract, including:
- Frequent urinary tract infections (UTIs)
- Incontinence
- Urinary urgency
Since GSM symptoms can vary widely by person, and can begin during perimenopause, it’s imperative that you not ignore these physical changes, as they can worsen over time without treatment.
What may begin as a few irritating symptoms can develop into chronic vaginal dryness, recurrent UTIs, and painful sexual intercourse. All of these conditions can have a long-term impact on your quality of life, as well as your daily activities. Untreated physical GSM symptoms can also possibly lead to emotional distress, such as self-esteem and intimacy issues.
How does your labia change after menopause?
Menopause can bring noticeable shifts in how your vulva looks and feels — including changes to the labia. As estrogen levels drop, the skin and tissue around your vaginal area may become thinner, less plump, or lighter in color. It’s all part of the body’s natural response to hormone loss, but understanding what’s happening (and why) can help you feel more informed and less alarmed by what you see in the mirror. Here’s what to know about how the labia can change after menopause.
Does your labia minora shrink during menopause?
As Dr. Buckheit has already established, yes, the labia minora does commonly become thinner and smaller during menopause. This is primarily due to the loss of fat tissue and collagen (courtesy of declining estrogen levels), and can result in the labia minora’s flatter, or less prominent appearance.
Other labia minora appearance shifts include color changes (they often become paler or lighter), texture changes (thinner, more delicate skin resulting in a loss of their “ruffles”), and a loss of elasticity.
Changes to the labia majora (outer labia) during menopause
While Dr. Buckheit notes that GSM changes to the labia majora, or the outer skin folds/lips, are “to a lesser degree,” there are noticeable appearance shifts.
Like the labia minora, the outer labia experiences both a loss of skin elasticity and a loss of fat tissue that causes the “lips” to appear flatter or less plump than before. Additional appearance changes include skin thinning and sagging, and pubic hair thinning, graying, or loss.
Why both are affected
It all goes back to our good friend, estrogen.
Your body is making less estrogen during menopause, which means less collagen, elastin, and fat distribution in your vulvar tissues. Since both sets of labia (majora and minora) contain estrogen receptors — proteins found inside the cells of the female reproductive tissue — the loss of estrogen directly affects structural support throughout the vulva. These changes typically happen gradually over the years, but are likely more noticeable when the drop in estrogen production is significant (e.g., during perimenopause and/or menopause).
Why does this happen? The science behind GSM
The female sex hormone estrogen helps maintain tissue thickness, moisture, and elasticity. So when estrogen declines during menopause, as do the proteins collagen and elastin. Collagen provides structure and support to your skin, muscles, bones, and connective tissues. Elastin, meanwhile, helps your tissues and organs stretch.
Less estrogen results in not only drops in collagen and elastin, but, as Dr. Buckheit confirmed earlier, fat tissue. The lowered structural support and fat tissue in your genitals, as well as a reduced blood flow to genital tissues, lead to decreased natural lubrication that causes a wasting away (the literal definition of “atrophy”) of the vaginal lining.
Changes associated with GSM can begin in perimenopause, but they typically worsen around five years post-menopause. Therefore, if you’re experiencing any GSM-related symptoms, it’s a good idea to speak with your healthcare provider about your treatment options sooner rather than later.
When should you talk to a doctor about labia and menopause?
Dr. Buckheit notes that “every woman who reaches menopause will experience genitourinary changes related to estrogen deficiency — and up to 75% will develop GSM.” So if you are experiencing any of the following symptoms, and if they are causing pain and/or affecting your quality of life, make an appointment with your healthcare provider ASAP:
- Painful intercourse
- Recurrent urinary tract infections
- Significant itching, burning, or irritation
- Bleeding or unusual discharge
- Any genital or urinary changes that seem sudden or extreme
At your appointment, you can expect your doctor to conduct a pelvic exam and to engage you in an in-depth discussion of your symptoms. The doctor will examine your vagina and cervix, looking for signs of atrophy, such as:
- A shortened or narrowed vagina
- Dryness, redness, and swelling
- Loss of stretchiness
- Whitish discoloration of your vagina
- Vulvar skin conditions, vulvar lesions, and/or vulvar patch redness
- Minor cuts (lacerations) near your vaginal opening
- Decrease in the size of the labia
We get that you may be embarrassed to seek care for GSM. But remember that these conversations are routine for your healthcare providers (they’ve seen and heard it all). So if you think something weird is going on with your labia, go ahead and say so!
Can GSM be treated?
Absolutely! There are multiple treatment options available that can help significantly improve the changes and symptoms caused by GSM, thus enhancing your quality of life.
“GSM symptoms will not improve on their own,” warns Dr. Buckheit, “so talk to your doctor about any genitourinary concerns you have.”
Treatment options:
- Topical vaginal estrogen (creams, tablets, rings): This is considered the gold standard GSM treatment as it helps alleviate symptoms by working directly on tissues without increasing estrogen levels in your bloodstream.
- Non-hormonal options: There are various over-the-counter lubricants and moisturizers available that treat vaginal dryness. Vaginal moisturizers are for regular, everyday use, while lubricants specifically help reduce pain and friction during sexual intercourse.
- Oral hormone therapy: Ospemifene (Osphena®) is a daily pill that can help relieve painful sex symptoms associated with GSM.
- DHEA suppositories: Also known as Prasterone (Intrarosa), these suppositories also help ease painful sex by delivering the hormone DHEA (which helps produce estrogen) directly to the vagina.
- Lifestyle approaches: Staying sexually active helps to increase blood flow to the genital area. Also, avoiding vaginal irritants (perfumes, dyes, detergents, douching, etc.) can help GSM from worsening.
- Newer treatments: Although laser therapy is under investigation, Dr. Buckheit says it’s “not currently recommended broadly.” Radiofrequency is also another potential GSM treatment being researched.
While many of these treatments address dyspareunia (AKA pain during sexual intercourse), Dr. Buckheit explains that these options aren’t only for “intimacy concerns.” Treating GSM “can improve urinary symptoms like incontinence and prevent UTIs, which can be recurrent and serious, especially in older women.”
Menopause may reshape your vulva, not your identity
So, no, your labia don’t disappear during menopause, but changes are normal and common. Also normal and common? Genitourinary syndrome of menopause (GSM), which affects anywhere from 50% to 70% of postmenopausal women.
As alarming as GSM might seem, several effective treatments can help reduce your symptoms and thus improve your overall quality of life — so there’s no reason for you to suffer in silence. Early intervention often leads to better outcomes regarding GSM, and even though you may feel embarrassed visiting your healthcare provider over something like a shrinking labia, trust us when we say you’re doing the right thing.
Now that we’ve learned to discuss hot flashes out in the open, it’s time to normalize talking about our postmenopausal labia, don’t you think?
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist dedicated to reporting on women's health, parenting, mental health, TV, and pop culture. Her work has appeared in HuffPost, Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.