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Everyone has body odor. Your vagina has it's own odor as well. When your hormones change at menopause it creates many changes in your body and you may notice changes in your vaginal odor.
Menopause and vaginal odor may not seem related, but your hormones actually impact vaginal health, including your vaginal odor.
Is Changing Vaginal Smell After 50 Normal?
Many women are concerned that their vaginal smell or odour has changed after menopause. This is a perfectly normal response to changes in vaginal hormones, vaginal health, skin integrity, vaginal microbiome, and inflammation.
Understanding the hormonal and vaginal changes are crucial in effectively managing vaginal odor.
If your vaginal odor is fishy, meaty, or just 'off', or you have a smelly vaginal discharge, it should be evaluated as it could indicate infection or other medical condition that needs addressing.
It can be embarrasing to talk about your vaginal odour or discharge, but we manage these conditions all the time and are here to help.
Low Estrogen and Changes to The Vagina During Menopause
Vaginal odor is mostly a product of the microbe composition in the vagina, the substrates produced by the cells and bacteria as well as the vaginal secretions that are produced.
During menopause changes in vaginal odour are primarily brought about due to the effects of low estrogen in the vagina.
The low estrogen levels of menopause cause significant changes to the skin lining the vulva, vagina, urethra and bladder in 60 to 80 percent of postmenopausal women.
Estrogen plays a crucial role in maintaining the thickness of the skin, collagen and elasticity of vaginal tissues and the tissues of the vulva and urethra. It also plays a role in regulating the vaginal microbiota.
As estrogen levels decrease, the vaginal lining becomes thinner and promotes the growth of different bacteria in the vagina which typically come from the perineal skin or the gut. These alternate bacteria crowd out lactobacilli, which reduces the acidity of the vagina.
These changes can also result in symptoms such as vaginal dryness, burning, and irritation as well as painful urination and pain with sex, all of which can negatively impact a woman’s quality of life.
Additionally, the loss of acidity, altered microbe balance creates an inflammatory environment where certain bacteria and pathogens can thrive, leading to an imbalance in the vaginal flora and resulting in an unpleasant odor.
Understanding the Vaginal Microbiome
Our body co-exists with large communities of bacteria, yeasts and other microbes. Each area of our body has distinct microbiomes such as our skin, bladder, gut and vagina.
The vaginal microbiome, is composed of various bacteria and microorganisms, and plays a crucial role in maintaining vaginal health.
A healthy vaginal microbiome is balanced, with beneficial bacteria such as lactobacilli dominating the vaginal flora. These bacteria help maintain the acidity of the vagina, preventing the overgrowth of harmful pathogens.
Premenopausal women have high estrogen levels that support the vaginal cells to produce lots of glycogen. These cells slough away from the vaginal wall and have high turnover. The healthy bacteria consume the dead vagina cells.
In premenopausal women bacterial communities are predominantly composed of 4 types of Lactobacilli: L. crispatus, L. gasseri, L. iners, or L. jensenii (Vaginal microbiota and menopause status 2018).
However, changes in estrogen levels during menopause disrupt this delicate balance, the vaginal cells no longer produce a glycogen-rich environment, leading to alterations in the vaginal microbiome that are often predominately Streptococcus species and Prevotella species. This change in vaginal bacteria contributes to issues like vaginal odor.
Vaginal Acidity And Menopause
Lactobacilli produce lactic acid which keeps the vaginal pH acidic. Before menopause the vagina's pH level is acidic and ranges from 3.8 to 4.5. This acidity is what helps reduce colonisation with pathogenic bacteria and yeasts and contributes to the vaginal odour.
With menopause, the loss of estrogen causes a reduction in the vaginal cell production of glycogen, reduction in cell turnover, and this reduces lactobacilli colonisation of the vagina.
With fewer lactobacilli, there is a reduction in vaginal acidity with an elevated vaginal pH level rising to around 5 and colonisation by different bacteria, contributing to changes in the vaginal odour.
Vaginal Infections and Menopause
When the imbalance of bacteria is significant, bacterial vaginosis (BV) may develop. Studies show that between 17-53 percent of postmenopausal women have bacterial vaginosis. Many women are asymptomatic but for some, the change in bacteria and acidity causes changes to a fishy odour.
Bacterial vaginosis is a vaginal infection that can occur when the following bacteria over-colonise the vaginal microbiome:
Gardnerella vaginalis
Prevotella species,
Porphyromonas species,
Bacteroides species,
Peptostreptococcus species,
Mycoplasma hominis,
Ureaplasma urealyticum,
Mobiluncus species,
Fusobacterium species and
Atopobium vaginae.
The change in vaginal odour is due to bacteria which exist in the vagina that are able to chemically change trimethylamine oxide to trimethylamine (TMA) in vaginal secretion which has a fishy vaginal odor (Trimethylamine in Vaginal Secretions 2002).
Women who remain sexually active are at ongoing risk of bacterial vaginosis after menopause.
BV is typically treated with antibiotics, emerging research suggests antibiotic and probiotic containing lactobacilli may be a successful treatment strategy. Bacterial vaginosis is also associated with some dietary patterns.
However in menopausal women, some suggest that the treatment of choice is vaginal estrogen therapy as this in itself can change the vaginal microflora back to lactobacilli dominance and limit pathogenic bacteria (Bacterial Vaginosis in Postmenopausal Women 2023).
Although less common, yeast infections or vaginal thrush can occur after menopause.
Vaginal infections such as trichomonas, chlamydia and gonorrhoea can still occur after menopause so if your vaginal odor changes, it is important to be evaluated for this.
Inflammation and Its Impact on Vaginal Health
Inflammation can also play a significant role in the development of vaginal odor during menopause.
Chronic inflammation within the vaginal tissues mostly results from a lack of estrogen and testosterone that supports the tissues. Additionally an imbalance in the microbiome, infection, irritating chemicals or autoimmune conditions can cause inflammation.
Inflammation not only contributes to discomfort and pain but can also disrupt the normal functioning of the vaginal microbiome, exacerbating issues such as odor and discharge.
How does using vaginal estrogen change the vagina and reduce vaginal odour?
When postmenopausal women use vaginal estrogen, vaginal Lactobacillus species increase. are optimized in postmenopausal women on estrogen replacement therapy (MHT and the Vaginal Microbiota 2020).
Estrogen stimulates the proliferation of the squamous epithelial cells that line the vaginal wall. These cells are able to increase glycogen production. When glycogen is hydrolysed into glucose, maltose, and maltodextrins they support the proliferation of vaginal lactobacilli.
In summary:
Vaginal estrogen -> healthier cells and thicker vaginal lining -> cellular production of glycogen -> hydrolysed to glucose, maltose, maltodextrins -> lactobacilli proliferation -> reduced pH/greater acidity of the vaginal environment -> fewer pathogenic bacteria can survive -> impacts vaginal odour.
Are there Other vulva/vaginal Symptoms that are Caused by menopause hormone changes?
Many women may also experience the following changes due to loss of estrogen and testosterone in the pelvic region with menopause:
vaginal dryness and vulva dryness and itching,
vaginal discomfort or pain,
urethral irritation/burning sensation when passing urine
recurrent urinary tract infections
recurrent BV or vulvo-vaginal thrush
bladder irritation and urgency
stress and urge incontinence/urine leakage
How to Treat Vaginal Odor During Menopause
Managing vaginal odor during menopause involves addressing its underlying causes and promoting overall vaginal health. Here are some strategies that menopausal women can adopt to help alleviate vaginal odor:
Vaginal Estrogen: Vaginal estrogen is a key component to manage vaginal odor. It helps restore both the thickness of the vaginal lining, the lactobacilli bacteria, the acidic environment that lactobacilli thrive in and vaginal lubrication. These are all signs of a healthy vagina. Vaginal estrogen comes in creams, pessaries or rings and should be an essential part of your menopausal skin care routine for the vulva/vagina.
There are very few side effects from vaginal estrogens, but if you do experience an issue with one type of preparation, changing to another version could improve things for you.
Gentle Cleansing and Care: Wash the vulva with warm water and only mild soap if needed. Wearing breathable cotton underwear.
Avoid douching. The vagina is self-cleaning.
Lubricants and Moisturisers: Only use vaginal lubricants or moisturisers that are pH balanced for the vagina.
Stay Hydrated: Adequate hydration is essential for maintaining the elasticity and moisture of vaginal tissues.
Support Vaginal Microbiome: Consuming probiotic-rich foods or supplements can help promote the growth of beneficial bacteria in the vagina.
Practise Safe Sex: If you have new, casual or changing sexual partners it is still important to use barrier birth control such as condoms to prevent sexually transmitted infections.
Seek Medical Advice: If vaginal odor persists or is accompanied by other symptoms such as itching, burning, or unusual or stinky vaginal discharge, consult a healthcare provider for a proper diagnosis. They can check for a sexually transmitted infection, other vaginal infections and provide evaluation and treatment.
The Takeaways: Menopause and Vaginal Odor
Unwanted vaginal odor changes can be distressing, but understanding that hormones impact your vaginal cell wall, microbiome, and pH and can contribute to vaginal odor during menopause is essential for effectively managing this common concern.
Addressing vaginal skin healthcare with vaginal topical estrogen treatment - this first step will go a long way to improve vaginal health, skin integrity, microbiome balance, and reduce inflammation.
Treatment of vaginal infections are important and any persisting vaginal odor especially if you experience a fishy smell or meaty or foul smell, should be medically evaluated.
By addressing the root causes of vaginal odor during menopause and prioritising vaginal health, you can navigate this phase with confidence and comfort.
Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you to navigate perimenopause and menopause.
She is a menopause specialist and women's health doctor. She has a passion for supporting women adapt to their changing female physiology for optimum health and wellbeing.
Book an appointment with Dr Deb Brunt | Ōtepoti Integrative Health | Book now
Join our Meno Thrive program to optimise your health and wellbeing during perimenopause and menopause.
References
Stewart LL, Vodstrcil LA, Coombe J, et al. Prevalence of bacterial vaginosis in postmenopausal women: a systematic review and meta-analysis. Sex Health. 2022;19(1):17–26.
Wolrath H, Borén H, Hallén A et al. Trimethylamine content in vaginal secretion and its relation to bacterial vaginosis. APMIS. 2002 Nov;110(11):819-24.
Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018;25(11):1321–30.
Geng L, Huang W, Jiang S, et al. Effect of Menopausal Hormone Therapy on the Vaginal Microbiota and Genitourinary Syndrome of Menopause in Chinese Menopausal Women. Frontiers in Microbiology. 2020;11.
Van Gerwen OT, Smith SE, Muzny CA. Bacterial Vaginosis in Postmenopausal Women. Curr Infect Dis Rep. 2023 Jan;25(1):7-15.
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