Sexual & Reproductive Health

Yes, Genitourinary Syndrome of Menopause Might Be Shrinking Your Labia

These vulvovaginal changes can start any time during the hormonal transition.
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If you’re currently going through perimenopause, the 8 to 10 years leading up to when your periods stop and menopause officially hits, it’s probably no surprise when hot flashes, mood swings, and insomnia threaten to ruin your day. These symptoms are, after all, infamous when it comes to the big hormonal transition. What might catch you off guard is noticing that your labia looks a bit…different—in color, shape, or even size.

If you’ve checked yourself out in the mirror lately and swear that your private parts seem to have shrunk, it’s not your imagination. Changing labia is just one symptom of what’s known as genitourinary syndrome of menopause, or GSM, Deidra Beshear, MD, an associate professor of internal medicine and medical director of the Women’s Health Clinic at the University of Kentucky HealthCare, tells SELF. GSM is a newish term, first introduced in 2014, to describe a range of vulvovaginal, sexual, and urinary tract symptoms that often happen when your estrogen levels start to decline, which typically happens during perimenopause and menopause.

GSM is common—it affects 27% to 84% of postmenopausal women. Yet, Dr. Beshear says many don’t discuss these problems with their doctors, and only about 7% of women are actively receiving treatment for them. Here’s what you should know about the condition and what to do if you have it.

A drop in estrogen levels during perimenopause can cause a range of vulvar changes—some of which can be visible.

During your reproductive years, estrogen helps protect vulvovaginal tissues, which encompasses your vulva (the external genitalia that includes the labia majora and labia minora and urethral opening) and vagina, the internal canal that connects the vulva to the uterus, Dr. Besehar says. Estrogen keeps everything in these areas healthy, lubricated, and moist, and even preserves the skin’s thickness.

As you get older, your estrogen starts to drop, but exactly when (and how quickly) varies from person to person. The average age of menopause (which is when you go 12 months without a period) is 52 in the US, but perimenopause can start up to a decade earlier. And for many, GSM symptoms come right along with it.

“When estrogen levels decline, the vulvovaginal tissue becomes more fragile, prone to tearing, thinning, and dryness,” Angela Markman, MD, an ob-gyn at Women's Health Specialists of CentraState, part of Atlantic Health System, tells SELF. One thing that can happen as a result is that your vulva can start to look different—for instance, your labia minora, the inner lips of your vulva, can start to shrink or even disappear, Dr. Beshear says. They might also start to fuse together or become paler in color, Dr. Markman adds. And the clitoral hood (the small piece of skin protecting the clitoris) can also get smaller.

Besides being alarming, these vulvar changes can be uncomfortable to deal with. The area may feel irritated or itchy, and its changing appearance might make you feel self-conscious and impact your body image, Jean Marino, APRN-CNP, a senior women’s health nurse practitioner at University Hospitals in Cleveland, Ohio, who specializes in gynecology, perimenopause and menopause, and sexual health, tells SELF.

GSM can also cause changes and symptoms beyond the vulva, including in the vagina and urinary tract.

Lower levels of estrogen can also make the lining in both your vagina and urinary tract thinner, drier, and less elastic. On top of that, it can even alter your vaginal pH. All of these changes can lead to some very uncomfortable symptoms, and even increase your risk of certain types of infection. Here are some of the more typical symptoms of GSM that this tissue thinning can cause:

All of these problems can have a big impact on your sex life and day-to-day and even cause some trickle-down effects. For example, vaginal dryness and a lack of lubrication likely will make sex uncomfortable or painful, Dr. Markman says. Because of that, you may end up also having trouble getting aroused or having an orgasm, which affects your desire and intimacy more broadly, Marino says.

Another potential issue: Recurrent UTIs can be harmful to your health long-term, Dr. Beshear says. Yes, they are painful and a nuisance in the short-term, but they can also potentially cause kidney problems, blood infections, sepsis, chronic bladder pain, or resistance to some antibiotics if you don’t treat them promptly or keep getting them over and over again.

The good news: There are a handful of ways to treat vulvar and vaginal changes during perimenopause.

Whenever you notice vulvar, vaginal, or urinary tract changes, it’s important to talk to your doctor. More than likely, they’re related to menopause or perimenopause if you’re in your 40s or older. Your doctor may also want to rule out other conditions that can resemble GSM, Dr. Markman says, such as lichen sclerosus, a condition that causes thin, white patches on the genitals.

To diagnose GSM, your ob-gyn may do a physical and pelvic exam and test your urine and vaginal pH, in addition to asking you about your symptoms. Once they confirm GSM is the culprit, they’ll go over your treatment options.

The mainstay treatment is vaginal estrogen, Dr. Beshear says. This can come in different forms, including creams, vaginal suppositories, or a vaginal ring that’s replaced every 90 days. Vaginal estrogen is something you’ll need to use long term, she adds, especially if it’s helping your symptoms. Over-the-counter vaginal moisturizers and vaginal suppositories containing hyaluronic acid can help with dryness too, Dr. Beshear says. You can also try using a lubricant that’s water- or silicone-based or even just coconut oil during sex to add some moisture and reduce discomfort.

Another option is an oral medication, called ospemifene (Osphena), that’s FDA-approved to treat vaginal dryness and painful sex caused by menopause. It’s a drug called a selective estrogen receptor modulator (SERM), which works by mimicking estrogen in certain tissues of the body.

If you have other menopause symptoms, such as hot flashes or night sweats, along with GSM, your doctor may recommend systemic hormone therapy (HT), Dr. Markman says. This can take the form of a pill, patch, or gel, and it works by releasing estrogen into your bloodstream so that it reaches the organs and tissues that need it. While hormone therapy will usually relieve GSM symptoms, Dr. Beshear says many women don’t seem to receive enough systemic estrogen in their vaginal tissues specifically, so they choose to use vaginal estrogen as well to optimize treatment.

Vaginal and vulvar symptoms are common during perimenopause and menopause—and solutions do exist—so it’s crucial to speak up if they’re bugging you. This can prevent complications of UTIs, boost intimacy, improve your sex life, and “restore a healthy vaginal environment,” Dr. Markman says. It can also just make you feel more comfortable and confident, and improve your quality of life—all of which are great reasons to seek care.

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