The skin and tissues around the vagina are kept supple and moist by fluids and mucus that are made by glands at the neck of the womb. Oestrogen (the female hormone) affects these glands. Oestrogen also affects the tissues in and around the vagina, causing the lining of the vagina to be thicker and more elastic. Oestrogen also stimulates the cells that line the vagina to produce glycogen, a protein which encourages the presence of 'helpful' bacteria which help to protect the vagina from infection.

After the menopause (the 'change') the ovaries make less oestrogen. The lack of oestrogen leads to a thinning of the tissues around the vaginal area, and a reduction in the number of the small glands that make mucus. You also lose some fat tissue from around the genital area. This causes the vulva and vagina to look slightly different than before the menopause.

As a result, the vagina can become shorter, less elastic, and dryer with less lubricating mucus. The genital skin looks paler. These changes usually take months or years to develop following the menopause, and vary between women. Atrophic vaginitis is the medical term for the condition when these changes produce troublesome symptoms.

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