MANAGING MENOPAUSE SYMPTOMS

Changes in Vaginal Discharge During Perimenopause and Menopause

As women transition through perimenopause into menopause, declining oestrogen levels can cause notable alterations in vaginal discharge. Oestrogen supports the health and lubrication of vaginal tissues; as its levels fall, the tissues may become thinner, drier and less elastic, and the vaginal pH may rise—thus increasing susceptibility to irritation or infection.


Normal Variations vs Concerning Changes


What changes might be considered normal?

  • Reduced discharge, leading to dryness due to diminished lubrication.
  • Altered consistency, from watery to thicker or creamy textures — fluctuations align with erratic hormone patterns
  • Colour variations, generally still clear or pale but occasionally slightly yellowish—especially when hormonal changes are most pronounced.


What should prompt medical review?

  • Discharge that is yellow, grey, green, brown or blood‑stained (particularly if menopausal for over 12 months) may signal infection or more serious pathology
  • A foul or fishy odour is rarely normal and often associated with bacterial vaginosis or other infections
  • Itching, burning, soreness around the vulva or vagina—especially with discharge—may indicate yeast infection, BV, desquamative inflammatory vaginitis (DIV), or genitourinary syndrome of menopause (GSM)
  • Pain during urination or intercourse, or pelvic discomfort, also warrants evaluation 



Self‑Care and Lifestyle Measures

  • Gentle hygiene: Use warm water or a mild unscented cleanser; avoid douching, scented soaps, vaginal sprays or wipes.
  • Breathable clothing: Choose loose cotton underwear and avoid tight synthetic
  • Hydration & moisturisation: Stay well‑hydrated; use non‑hormonal vaginal moisturisers to reduce dryness
  • Dietary support: A balanced diet rich in omega‑3 fatty acids and phytoestrogens (e.g. flaxseed, soy) may help support vaginal tissue health
  • Lubrication during intercourse: A water‑based lubricant can improve comfort and reduce friction

 

Medical Treatments

  • For genitourinary syndrome of menopause (GSM):
  • Topical oestrogen preparations (creams, tablets, rings) can rejuvenate vaginal tissues, restore moisture, and re‑establish a healthy pH and flora
  • For women who cannot use hormonal therapy, selective oestrogen receptor modulators such as ospemifene, or prasterone (DHEA) pessaries, are NICE‑approved options in the UK (updated November 2024)
  • Antimicrobial treatment:
  • If an infection is diagnosed, appropriate treatment for BV, yeast infection or DIV may include topical clindamycin, hydrocortisone suppositories, or antifungal therapy depending on the cause 


Prognosis and When to Seek Medical Advice

  • Reduced or altered discharge is often a benign symptom of menopause and manageable through lifestyle modifications or topical treatments.
  • However, any new, persistent or unusual discharge, especially when accompanied by burning, itching, pain or bleeding, should be assessed by a GP or gynaecologist to rule out infection or serious pathology, including in post‑menopausal women