Last reviewed 02/2020
The vagina, urethra and bladder trigone are oestrogen dependent and gradually atrophy after the menopause.
Absence of oestrogen results in:
- thinning of the vaginal skin - which may cause severe superficial dyspareunia and bleeding. Many couples may avoid sexual intercourse as a result of the discomfort.
- lack of glycogen - resulting in a rise in vaginal pH - usually from pH 4.0 to pH 7.0 - and increased risk of infection.
- reduced elasticity of the bladder - producing frequency and urgency of micturition, nocturia and dysuria.
These changes are not usually apparent until several years after the menopause. Treatment is with topical oestrogen creams or a short course of oral oestrogen.
Vaginal bleeding after the menopause is an ominous sign and warrants careful investigation. Up to 10% of cases are due to malignancy.