MANAGING MENOPAUSE SYMPTOMS

Labial Changes in Perimenopause and Menopause

As oestrogen levels decline during the menopause transition, the tissues of the vulva—including the labia majora and labia minora—may undergo noticeable changes. Reduced oestrogen leads to thinning, decreased elasticity, and loss of collagen and fatty tissue, resulting in tissue shrinkage, increased sensitivity, dryness, and altered appearance.

These changes form part of the broader Genitourinary Syndrome of Menopause (GSM), which affects up to 84% of post‑menopausal women and encompasses alterations in the vulvovaginal, urinary, and pelvic tissues

Typical Signs

Women commonly report:

  • A reduction in the size and plumpness of both labia minora and majora.
  • Thinning, wrinkling or sagging of the vulval skin, often described as less firm or elastic.
  • Dryness, itching or irritation in the genital area, particularly with friction from clothing or sexual activity

Such tissue modifications may impact body image, self-esteem, and sexual comfort 

Underlying Mechanisms

  • Declining oestrogen diminishes blood flow, collagen, elastin and hyaluronic acid within the vulval tissues. The fatty pad beneath the labia majora may also reduce, leading to noticeable volume loss.
  • Vaginal and vulval atrophy—inclusive of labial changes—is a hallmark of GSM and may affect bladder function, vaginal microbiota, and increase susceptibility to infection.

Self‑Care and Supportive Measures

  • Vaginal moisturisers: Non‑hormonal and fragrance‑free moisturisers can hydrate labial and vulval tissues, easing discomfort.
  • Lubricants during sex: Use water‑based lubricants to reduce friction and irritation.
  • Pelvic floor activity: Kegel exercises may enhance pelvic blood flow and support genital health.
  • Good hygiene: Choose gentle, fragrance‑free cleansing products; avoid douching, perfumed soaps or harsh cleansers.
  • Breathable clothing: Loose, cotton underwear avoids friction and overheating.
  • Maintain general hydration and a balanced diet to support tissue health and circulation.

Medical Treatments

  • Local oestrogen therapy: Vaginal creams, pessaries, tablets or rings deliver low-dose oestrogen directly to the affected tissues, restoring elasticity, moisture and microvascular function—without systemic absorption. NICE and British Menopause Society endorse this approach as effective and safe.
  • Systemic HRT: Hormone replacement therapy in oral, patch or gel form may help, particularly when GSM symptoms co‑exist with other menopausal effects. However, labial tissue often requires added local oestrogen for optimal effect.
  • Selective oestrogen receptor modulators (SERM) such as ospemifene, or vaginal DHEA (prasterone), are approved alternatives when hormonal creams are unsuitable.
  • Laser therapy: Some clinics offer vaginal rejuvenation using fractional CO₂ lasers. Evidence remains limited, and NICE recommends use only in research settings.


Bottom line:

While labial atrophy is not fully reversible, appropriate treatment with topical oestrogen can significantly improve tissue thickness and comfort over time. Most women experience improvement, especially with sustained use.



Seek medical advice if:

  • You notice shrinking or changes of colour, firmness or texture in your labia.
  • Symptoms such as pain, persistent dryness, irritation, bleeding or urinary changes accompany these changes.
  • Over-the-counter moisturisers or self-care are insufficient or discomfort persists

A clinician can assess for GSM and rule out dermatological conditions such as lichen sclerosus or inflammatory skin disorders