Not all symptoms of perimenopause, the yearslong lead-up to menopause, are as commonly discussed as, say, hot flashes and night sweats. What might catch you off guard is if your vulva starts to feel or look different—in color, shape, or even size.
Changing labia is just one symptom of what’s known as genitourinary syndrome of menopause, or GSM, Deidra Beshear, MD, an associate professor of internal medicine and medical director of the Women’s Health Clinic at the University of Kentucky HealthCare, tells SELF. GSM is a newish term, first introduced in 2014, to describe a range of vulvovaginal, sexual, and urinary tract symptoms that can happen when your estrogen levels start to decline in perimenopause.
Exactly when (and how quickly) these hormone changes unfold varies from person to person. The average age of menopause (which marks one year without a period) is 52 in the US, but perimenopause can start up to a decade earlier.
GSM often comes right along with it, affecting as many as 27% to 84% of menopausal women. Yet Dr. Beshear says many don’t discuss the symptoms with their doctors—only about 7% of women are receiving treatment for them. And in the absence of care, GSM doesn’t usually go away, but rather tends to get worse, Karen E. Adams, MD, an ob-gyn at the Stanford Health Care Gynecology Clinic and director of the Stanford Program in Menopause & Healthy Aging, tells SELF. Read on to learn more about the condition and the solutions that can reduce symptoms or even reverse its course.
How does genitourinary syndrome of menopause affect the vulva?
“The vagina loves estrogen,” Dr. Adams says. While it’s in ample supply, this hormone keeps that internal canal as well as your surrounding vulva (which encompasses your labia majora and minora) healthy, lubricated, and moist. Once perimenopause hits and estrogen begins to dip, “the vulvovaginal tissue becomes more fragile, prone to tearing, thinning, and dryness,” Angela Markman, MD, an ob-gyn at Women’s Health Specialists of CentraState, part of Atlantic Health System, tells SELF.
Over time, the tissue loses its fullness and elasticity. “If you look under the microscope at cross-sections of vaginal tissue from premenopausal women and postmenopausal women, you can see that the postmenopausal ones have many fewer cell layers,” Dr. Adams notes. That’s what causes the shrinkage you might notice in your vulva. Your labia minora, or the inner lips of your vulva, might also start to fuse together or become paler in color, Dr. Markman says. And the clitoral hood (the small piece of skin protecting the clitoris) can also get smaller.
