Why Vaginal Odor Changes During Menopause

Keeping your vagina happy can feel like a full-time job. By the time you reach menopause, there’s an extra host of job requirements. You might manage to get those hot flashes under control, only to be hit with a bout of vaginal dryness, chills, and night sweats. Once those finally settle, there might be momentary calm before you notice an unwanted vaginal odor. Can we catch a break? 

Sort of. We might be less likely to experience unpleasant vaginal odor after menopause. But menopause itself isn’t exactly a walk in the park. So a lack of vaginal odor might pale in comparison. But, if you have noticed a shift in vaginal odor during menopause, we’ve broken down what might be happening below. 

Vaginal odor & menopause

If you’re on the verge of menopause and notice that your odor down there has changed, it’s not in your head. Many people report that their vaginal smell starts to change during menopause — one study showed 24% of menopausal women reported noticeable vaginal smell. 

And while some experience the intensification of odor in an unpleasant direction, interestingly researchers also found that the incidence of vaginal odor decreases with age; 31% of women under 55 years old reported odor, whereas only 13% of women over 75 reported odor. 

So, while menopause continues to be a hellscape for many, the good (ish) and optimistic news is that it looks like vaginal smell might decrease as people with vaginas age and move from perimenopause to menopause.

What causes vaginal odor?

Contrary to popular belief, it's normal and healthy for your vagina to have a slight smell. It's a body part, after all. But any sudden or drastic changes in vaginal odor could be a sign that something's not quite right. Menopausal or not, one of two things is causing vaginal odor: 

• a vaginal infection (like bacterial vaginosis or aerobic vaginitis, or a sexually transmitted infection)
• a shift in your vaginal microbiome. 

If an infection has shown up on your vagina’s doorstep, it’s likely brought along a few uninvited guests including:

• unusual discharge
• itching or burning
• inflammation
• discomfort or pain during sex or while peeing.

Don’t ignore a strong fishy vaginal odor or a foul rotting smell — it's often a symptom of bacterial vaginosis (BV) and a sign that it's time to check in with your healthcare provider.

If you’ve embarked on the journey that is menopause and notice a vaginal odor but have no other signs of an infection (pain, irritation, inflammation, changes in discharge) then you’re likely experiencing a change in your vaginal microbiome. 

The vaginal microbiome is a highly dynamic environment and can adapt to hormonal changes, whether they're due to your menstrual cycle, pregnancy, or menopause.

As you go through menopause, the levels of healthy bacteria like Lactobacilli slowly decrease, which can lead to more opportunities for harmful bacteria to thrive. This happens because as you age and reach menopause, your body produces less estrogen due to a decrease in ovarian follicles.

Estrogen plays a key role in vaginal health by helping to maintain vaginal thickness, lubrication, and elasticity. Additionally, estrogen increases the available glycogen in the vaginal wall, providing an energy source for Lactobacilli to produce lactic acid — which helps keep the vaginal pH acidic to prevent harmful bacteria or other pathogens from taking over. When estrogen levels drop, the amount of Lactobacillus in the vagina can also decrease.

Most Lactobacillus species play a protective role within the vagina. When the amount of these Lactobacilli drops, other anaerobic bacteria can bloom. 

Anaerobic microbes do two things that create more opportunities for vaginal odor. First, they can cause a rise in vaginal pH, making the vagina more susceptible to bacterial growth of disruptive microbes. Second, they produce chemicals known as ‘biogenic amines’, which give off unpleasant odors when combined.

The most common microbes that researchers suspect produce smelly molecules, found within the vagina, include:

• Dialister
• Prevotella
• Parvimonas
• Megasphaera
• Peptostreptococcus
• Veillonella

Some people are also more likely to have smelly microbes living in their vagina than others. While a healthy vagina is dominated by Lactobacilli, Community State Type IV (non-Lactobacillus dominant) vaginal microbiomes are more abundant in compounds like putrescine, cadaverine, and tyramine (smelly molecules). 

Will douching or using a feminine hygiene wash help with my vaginal odor?

While we totally understand the temptation to clean out down there (thanks to decades of sexist marketing aimed at making women think their vagina should smell like roses), the answer is that washing out your vagina will likely do more harm than good. 

Using douches, wipes, and feminine washes is more likely to make things worse or spark off an infection where there wasn’t one. On top of that, there’s more than enough evidence that shows douching straight up increases the risk of bacterial vaginosis. 

The vagina is a powerful, self-cleaning organ. Not only does giving it “a good clean out” derail your vagina’s “self-clean” feature, but using these products is a huge no-no if you are prone to vaginal infections.

Splashing the vulva with water is (probably) all you need

Even the “healthiest” vagina won’t smell like a bouquet, a juice pack, or Chanel No. 5. And if you think about it, wouldn’t it be kind of weird if it did?

Like we said before, keep cleanses and water out of your vagina. Only the vulva needs to be hand-washed and warm water will work just fine for most of us. 

The skin on your vulva is more delicate than normal skin. If your vulva feels irritated (not the vaginal canal, or entrance to the vagina), an OB-GYN or dermatologist can point you towards the right creams.

Adding moisture if things are feeling irritated or dry

If you’re prone to dryness, dermatitis, itching, or irritation in the vulva area, you might need to wash this area with something that promotes moisture.

Like medical grade, unscented emollients, or ointments. Just make sure you’re opting for a moisturizer or lubricant that has a pH similar to the vagina (between 3.8-4.5) and doesn’t contain ingredients that can disrupt the vaginal microbiome. 

There are other options for treating menopause-related dryness, like topical or oral hormone replacement therapy (HRT) which ramp up depleted levels of key hormones.   

Will hormone therapy help with my vaginal odor?

Hormone replacement therapy is a phrase you’ll come across a lot when searching around for general menopause symptom relief, or treatments — but probably not specifically for menopausal vaginal odor. HRT means taking doses of sex hormones (usually estrogen and/or progesterone) to help ease symptoms of menopause. 

There are two main types of menopausal hormone therapy: 

• Systemic hormones: usually taken as a pill or a patch, similar to birth control pills. 
• Local therapy: usually applied topically as a cream, or to be inserted into the vagina. 

Unfortunately, there’s a lack of research that directly looks into whether HRT can treat vaginal odor. But, there is a (small-ish) body of research that looks into how HRT can shift the vaginal microbiome environment overall. And from this, we can make a few informed guesses about what the impact of hormone therapy on vaginal odor could be. 

In one study, researchers found that menopausal patients receiving premarin topical cream (a combined estrogen and progesterone HRT) had a significantly higher abundance of Lactobacillus compared to women not receiving hormonal treatment. 

Those not receiving hormonal therapy also had higher amounts of anaerobic bacteria (remember earlier, we explained that these microbes tend to produce more smelly molecules than Lactobacillus). So this could indicate that HRT might help to decrease vaginal odor. However, there are many caveats here. This is one study that looked at one of multiple HRT options and smell itself was not directly assessed. 

More studies on HRT’s effect on vaginal symptoms, including self-reported changes in odor, are needed. 

If you do want to give HRT a try, always start by speaking to your healthcare provider. 

Estrogen is a proven therapy to prevent not only hot flashes but vaginal dryness and other physical symptoms of menopause. However, we understand that a lot of people are concerned about the link between hormone therapy and the risk of breast cancer. 

Breast cancer risk is very personalized and evaluating your risk should be a conversation between you and a trusted healthcare provider. The TLDR is that systemic hormones like oral estrogen and progesterone pose a higher risk of breast cancer, particularly in women over 60, because they circulate hormones throughout your body. 

Whereas topical treatments have been shown to have very low absorption into the bloodstream and therefore carry a decreased risk for breast cancer and usually have fewer side effects compared to other hormonal treatments. Topical treatment has been proven to help with vaginal dryness and prevent urogenital infections like UTIs.

The decision is yours, but make sure to weigh up the (potential) risks and benefits with your healthcare provider. 

FAQ

How do I get rid of feminine odor during menopause?

It’s perfectly normal for your vagina to have a mild smell, but any sudden change in vaginal odor should warrant a trip to your healthcare provider — especially if it's accompanied by other symptoms, like burning, stinging, or vaginal discomfort. A strong or fishy smell is often a symptom of a vaginal infection like bacterial vaginosis and probably requires antibiotic treatments. 

Does menopause cause bad odor?

Yes, it can. On top vaginal odors, about 80% of women experiencing perimenopause and menopause experience vasomotor symptoms such as hot flashes and night sweats, due to decreased estrogen levels. When our body's temperature rises, the hypothalamus (a gland in the brain that regulates body temperature, among other things) signals sweat glands in the body to produce more sweat to help cool down, which can come with a more pungent body odor.

Why does my discharge smell bad during menopause?

During menopause, the decrease in estrogen levels can lead to a reduction in good bacteria like Lactobacilli, causing an elevated vaginal pH and significant changes in the vaginal microbiome. This can make you more susceptible to vaginal infections, as well as changes in the type and smell of vaginal discharge.