If you’re currently going through perimenopause, the 8 to 10 years leading up to when your periods stop and menopause officially hits, it’s probably no surprise when hot flashes, mood swings, and insomnia threaten to ruin your day. These symptoms are, after all, infamous when it comes to the big hormonal transition. What might catch you off guard is noticing that your labia looks a bit…different—in color, shape, or even size.
If you’ve checked yourself out in the mirror lately and swear that your private parts seem to have shrunk, it’s not your imagination. 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 often happen when your estrogen levels start to decline, which typically happens during perimenopause and menopause.
GSM is common—it affects 27% to 84% of postmenopausal women. Yet, Dr. Beshear says many don’t discuss these problems with their doctors, and only about 7% of women are actively receiving treatment for them. Here’s what you should know about the condition and what to do if you have it.
A drop in estrogen levels during perimenopause can cause a range of vulvar changes—some of which can be visible.
During your reproductive years, estrogen helps protect vulvovaginal tissues, which encompasses your vulva (the external genitalia that includes the labia majora and labia minora and urethral opening) and vagina, the internal canal that connects the vulva to the uterus, Dr. Besehar says. Estrogen keeps everything in these areas healthy, lubricated, and moist, and even preserves the skin’s thickness.
As you get older, your estrogen starts to drop, but exactly when (and how quickly) varies from person to person. The average age of menopause (which is when you go 12 months without a period) is 52 in the US, but perimenopause can start up to a decade earlier. And for many, GSM symptoms come right along with it.
“When estrogen levels decline, 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. One thing that can happen as a result is that your vulva can start to look different—for instance, your labia minora, the inner lips of your vulva, can start to shrink or even disappear, Dr. Beshear says. They might also start to fuse together or become paler in color, Dr. Markman adds. And the clitoral hood (the small piece of skin protecting the clitoris) can also get smaller.
Besides being alarming, these vulvar changes can be uncomfortable to deal with. The area may feel irritated or itchy, and its changing appearance might make you feel self-conscious and impact your body image, Jean Marino, APRN-CNP, a senior women’s health nurse practitioner at University Hospitals in Cleveland, Ohio, who specializes in gynecology, perimenopause and menopause, and sexual health, tells SELF.
GSM can also cause changes and symptoms beyond the vulva, including in the vagina and urinary tract.
Lower levels of estrogen can also make the lining in both your vagina and urinary tract thinner, drier, and less elastic. On top of that, it can even alter your vaginal pH. All of these changes can lead to some very uncomfortable symptoms, and even increase your risk of certain types of infection. Here are some of the more typical symptoms of GSM that this tissue thinning can cause:
