Menopause likely conjures images of hot flashes and mood swings. But have you ever thought about how the change impacts your vagina? Turns out, the decrease in estrogen that happens during menopause affects more than your mood and your cycle—it can also cause physical changes to your nether regions.

“Vaginal changes may occur throughout all stages of menopause: perimenopause, menopause, and postmenopause,” says Anna Klepchukova, MD, Chief Science Officer at Flo Health. From dryness to changes in the size and shape of your vagina, these changes can be significant but are considered normal, she notes.

Keep reading to learn exactly how your vagina transforms throughout menopause.

Estrogen helps keep your vaginal walls lubricated. With less of it, you’ll notice your vagina feels much drier. Known as vaginal atrophy, this thinning and drying of the vaginal walls may lead to other symptoms, including vaginal itching and burning, according to theMayo Clinic. Talk to your doctor about possible treatments, which may include vaginal moisturizers and lubricants.

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