Estrogen deficiency

Estrogens are hormones that play an important role in maintaining the health of vaginal tissues.

When estrogen levels drop, usually during menopause, your vagina, vulva, urethra, and bladder undergo changes. The vaginal tissue may become thinner, less elastic, and produce less natural moisture, making dryness and discomfort more likely.

Low estrogen levels also alter your vaginal pH, reducing protective bacteria and increasing the risk of infections. These changes can lead to vulvovaginal atrophy (VVA), resulting in symptoms such as dryness, burning, irritation, and pain during sexual activity.

Vulvovaginal atrophy is one aspect of a condition called genitourinary syndrome of menopause (GSM).