Not all perimenopause symptomsthe years leading up to menopause are talked about as often as, say, hot flashes and night sweats. You may be alarmed if your vulva starts to feel or look different—in color, shape, or even size.
Labia changes are just one symptom of menopausal genitourinary syndrome, or GSM. Deidra Beshear, MDassociate professor of internal medicine and medical director of the University of Kentucky HealthCare Women’s Health Clinic, tells SELF. GSM is a new termfirst introduced in 2014, to describe a range of vulvovaginal, sexual and urinary symptoms that can occur when estrogen levels begin to decline in perimenopause.
Exactly when (and how quickly) these hormonal changes unfold varies from person to person. The average age of menopause (meaning one year without a period) is 52 in the United States, but perimenopause can start up to a decade earlier.
GSM often goes hand in hand with this and affects many 27-84% of menopausal women. Still, Dr. Beshear says many people don’t discuss their symptoms with their doctors—only about 7% of women they receive treatment for them. And in the absence of care, GSM usually does not disappear, but rather worsens, Karen E. Adams, MDa midwife at Stanford Health Care’s Women’s Clinic and director of the Stanford Program on Menopause & Healthy Aging, tells SELF. Read on to learn more about the condition and solutions that can reduce symptoms or even reverse its course.
How does menopausal genitourinary syndrome affect the vulva?
“The vagina loves estrogen,” says Dr. Adams. Although it has an abundant supply, this hormone keeps the inner canal and surrounding labia (which includes the labia majora and minora) healthy, lubricated, and moist. When perimenopause hits and estrogen begins to decline, “vulvovaginal tissue becomes more fragile, prone to tearing, thinning and drying.” Angela Markman, MDan obstetrician-gynecologist at Women’s Health Professionals at CentraStatepart of the Atlantic Health System, she tells SELF.
Over time, the tissue loses its fullness and elasticity. “If you look under a microscope at cross-sections of vaginal tissue from premenopausal and postmenopausal women, you can see that there are far fewer cell layers in the postmenopausal,” notes Dr. Adams. This is what causes the shrinkage you may notice in your vulva. The labia minora, or inner labia, may also begin to merge or become paler, says Dr. Markman. And the clitoris (the small piece of skin that protects the clitoris) can also be smaller.
