Estrogen depletion and vaginal atrophy: Low estrogen levels in menopause cause vaginal tissue to become dry, less elastic, more fragile and susceptible to tearing, bleeding or pain during sex or during a pelvic exam. For many women, narrowing of the vaginal opening can cause pain at the entry.
Vaginal pH imbalance and infections: Low vaginal estrogen in menopause causes the vagina to become less acidic, shifting away from a protective lactobacillus-dominant microbiome. This makes the vagina more susceptible to urinary tract infections (UTI's) and overgrowth of pathogenic bacteria (BV) and yeast infections that cause irritation, itching, burning, discharge and odor.
Vaginal and pelvic muscle tonus: Low estrogen levels impact the strength and tonus of vaginal and pelvic muscles that support and keep the uterus, bowel, bladder in place. Up to 40% of women will experience pelvic organ prolapse (POP), due to loss of support from the connective tissue, in menopause.