The arrival of the menopause brings about significant changes in a woman's body. And while hot flushes, insomnia and mood swings are often discussed, other equally important aspects tend to be overlooked - specifically, the changes that occur in the intimate area. Why, for instance, do we experience more dryness? Why does the odour change? And what exactly does the decrease in oestrogen have to do with recurrent vaginal infections? Well, one of the main functions of oestrogen is to maintain the delicate balance of the vaginal microbiome. This vital ecosystem, composed primarily of beneficial bacteria known as lactobacilli, acts as a natural barrier that protects against infections, irritation and overall imbalance.
However, with the hormonal drop typical of the menopause, this entire balance is fundamentally altered. "Oestrogens stimulate the production of glycogen in the vaginal cells, and that glycogen is what feeds the lactobacilli," explains gynaecologist Dr Marta Sánchez-Dehesa. "When oestrogen levels drop, so does glycogen production, and that causes a decrease in lactobacilli, which directly affects vaginal pH."
In simpler terms, the intimate environment becomes less acidic, which in turn facilitates the proliferation of unwanted bacteria and significantly increases the risk of infection.
To make matters worse, these hormonal changes also cause the vaginal epithelium (the inner lining of the vagina) to become both thinner and less lubricated. Added to this is a decrease in local immunity, which leaves the vagina much more vulnerable to irritation and external aggressions.
The result is a cocktail of physical discomfort that can, regrettably, affect not only a woman's physical health but also her emotional well-being and self-esteem.
Is a change in vaginal odour normal? When to worry about menopausal smell
The topic of intimate odour is one of the most frequent concerns at this stage. Many women feel self-conscious noticing that their natural scent has changed, even if there are no obvious symptoms of an infection. Naturally, the questions arise: Is this normal? And should we be concerned?
"The vagina has its own unique scent and a change alone doesn't signify a problem," clarifies the gynaecologist. In fact, it is entirely normal for that scent to shift throughout the menstrual cycle, and with diet, sweat, stress, the type of clothing worn or following sexual intercourse. During the menopause, this shift can absolutely be attributed to the drop in oestrogen and the subsequent changes in the microbiome.
"The vagina has its own unique scent, and a change alone doesn't signify a problem"
When should we genuinely start to pay attention? "When the odour is accompanied by itching, burning, an increase in discharge or an unusual colour, then an infection may well be present and it is highly advisable to consult a doctor." In the absence of these other symptoms, a change in odour should not cause alarm, though it can certainly cause emotional discomfort.
The relationship with our own body is seldom straightforward, and even less so when changes occur in such a sensitive, intimate area. Many women, on noticing a different scent, increased dryness or recurrent discomfort, feel insecure, start avoiding sexual relations or simply isolate themselves. "The impact is logically negative," notes Dr Sánchez-Dehesa. And often, in an attempt to remedy the situation, women resort to solutions that only worsen the underlying problem. "It's common that women, due to shame or discomfort, dramatically increase the frequency of washing. But, far from helping, this can actually accentuate dryness and further damage the delicate microbiota."
A vicious circle is thus initiated, where physical discomfort fuels emotional distress and vice versa. That is precisely why it is so important to address these changes armed with information, without guilt, and with the appropriate help. "Correct intimate care reduces this negative impact. And today, thankfully, we have highly effective tools to regain comfort and well-being during this new stage."
The gynaecologist's choice: Best probiotics for menopausal health
One of the most effective tools available today is probiotics, which have proven to be significant allies for women's intimate health in recent years. Specifically during the menopause, they can help improve daily comfort, reduce dryness, prevent urinary infections and maintain the delicate balance of the vaginal ecosystem.
"The most highly recommended probiotics at this stage are Lactobacillus crispatus, rhamnosus, or gasseri, among others," details the gynaecologist. They can be administered either orally or vaginally, depending entirely on the individual needs of each woman. "By reintroducing these 'good' bacteria into the intimate environment, we help the pH stay at healthy levels and, crucially, strengthen the vagina’s natural protection."
The use of these supplements is not limited solely to women who are actively experiencing symptoms. They can also be taken preventively, forming an important part of self-care during this new stage of life. "It's a straightforward, safe, and highly effective way to feel better," assures Dr Sánchez-Dehesa.
Intimate care mistakes: Products to AVOID after menopause
As we mentioned earlier, with the arrival of the menopause, the skin in the intimate area becomes thinner, more sensitive and less lubricated. This inevitably forces a review of many long-standing habits, as what once worked well can now become irritating or even harmful.
To simplify your regimen, it is highly advisable to follow some core recommendations:
- Avoid perfumed or overly aggressive soaps
- Choose specific cleansers with a protective pH (around 4).
- Refrain from using vaginal douches.
- Opt for cotton underwear, which avoids irritation and prevents moisture build-up.
In cases of severe dryness or persistent discomfort, the use of vaginal moisturisers or even regenerative medicine techniques, such as vaginal laser therapy, may be discussed. "However," the gynaecologist cautions, "this should always be explicitly indicated by a specialist, following a detailed and personalised gynaecological review that considers all available evidence-based treatments."
Beyond hygiene: What is 'genital awareness' and why it matters now
Gynaecologist Dr Belén Gómez explains a crucial concept that can benefit women's intimate health at any time in their lives. As she defines it, genital awareness is "the ability to perceive and recognise sensations and changes in their genitals. This encompasses both physical and emotional sensations, which impact personal and intimate relationships in such a way that they can leave lasting effects, directly influencing a person's general well-being."
"Correct intimate care can foster self-confidence by making us feel healthy and well looked after, which is highly beneficial for feeling more secure and comfortable in sexual relations"
As Dr Gómez points out, genital awareness and intimate hygiene are dynamically related and influence one another. "Having good genital awareness will make it easier to recognise changes or negative symptoms that may be related to possible infections, which will, in turn, lead you to place greater emphasis on correct intimate hygiene," she says.
The reverse is also true: intimate hygiene positively affects genital awareness. "Maintaining good intimate hygiene protects our genital area from external agents, preserves the balance of the vaginal microbiota and safeguards us against infections. That is to say, it directly contributes to improving our overall feeling of comfort in our bodies.
"Correct intimate care can foster self-confidence by making us feel healthy and well looked after, which is highly beneficial for feeling more secure and comfortable in sexual relations," concludes the gynaecologist.