Menopause and Intimate Health: What Changes and Why
Short answer: falling oestrogen is the whole mechanism. Oestrogen maintains glycogen in the vaginal lining, glycogen feeds the Lactobacillus bacteria that make lactic acid, and that acid holds vaginal pH at 3.8–4.5. Less oestrogen means less glycogen, fewer lactobacilli, and a rising pH.
Everything people notice — dryness, a change in scent, more frequent infections — comes off that single chain. It is not hygiene, and it is not something you caused.
The part most women are not told: this starts in perimenopause, often in your early forties, well before your final period. Which is why it so often gets attributed to something else entirely.
- Perimenopause
- The years of fluctuating hormones before periods stop. Oestrogen does not decline smoothly — it swings, which is why symptoms come and go and feel inconsistent.
- The glycogen chain
- Oestrogen → glycogen in the vaginal lining → food for Lactobacillus → lactic acid → pH 3.8–4.5. Remove the first link and the last one moves.
- What a rising pH means
- Above 4.5, anaerobic bacteria find the environment more hospitable, which is why bacterial vaginosis becomes more likely with age rather than less.
- Vaginal atrophy (GSM)
- Thinning and drying of vaginal tissue from low oestrogen. The clinical term is genitourinary syndrome of menopause. Common, treatable, and under-discussed.
- Vaginal oestrogen
- A local, low-dose treatment. It is associated with an increase in protective bacteria — the most direct way to address the cause rather than the symptoms. A conversation with a clinician, not a shelf.
- 🔴 The line worth remembering
- A strong, sudden or foul odour is not just menopause. Mild change is expected; a fishy smell, itching, burning or unusual discharge still warrants a clinician.
What it is not
Almost every woman who notices this responds by cleaning more. That makes it worse, and for a specific reason: washing strips the lactobacilli that are already depleted. You are removing the survivors of a population that is under pressure.
Warm water externally. Nothing internally. The full routine is here, and it matters more now than it did at 30.
