Why Vaginal Odor Changes During Perimenopause and Menopause

Keeping your vagina happy can feel like a full-time job, and perimenopause and menopause add a whole new set of job requirements. You might manage to get hot flashes under control, only to be hit with vaginal dryness, chills, and night sweats. Once those settle, you might notice an unwanted vaginal odor creeping in. Can we catch a break?

Sort of. Vaginal odor changes can actually start showing up during perimenopause, as hormone levels begin to fluctuate well before your final period, and many people notice this shift even earlier than they expect. Interestingly, the odor itself tends to become less common the further you move into menopause.

Key takeaways

• Vaginal odor often shifts during perimenopause and menopause as estrogen declines, reducing protective Lactobacilli and changing your vaginal pH.
• A mild, normal vaginal smell is healthy. Sudden or noticeable changes (especially fishy or foul odors) can signal a vaginal infection.
• Interestingly, vaginal odor tends to become less common as people move further into menopause.
• Avoid douching, as it can worsen odor. Hormone therapy may help in some cases.
• If your odor changes suddenly or is accompanied by other symptoms, take the Evvy Vaginal Microbiome Test to understand what's going on.

Vaginal odor across perimenopause and menopause 

Because estrogen levels fluctuate (rather than steadily decline) during perimenopause, vaginal odor changes here can feel less predictable than in menopause itself. Some cycles might bring a more noticeable odor; others, none at all. This is largely due to the same mechanism that affects menopause: as estrogen dips, protective Lactobacilli can decrease, allowing anaerobic bacteria that produce odor-causing compounds to increase. Since hormone levels in perimenopause can swing rather than drop steadily, odor changes during this stage may come and go rather than persist.

As you approach menopause, you may notice that your vaginal odor has changed. Many women report that their vaginal smell starts to change during this transition — one study showed 24% of postmenopausal women reported noticeable vaginal smell.

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

So while menopause continues to be a lot for many, the (mildly) good news is that vaginal smell tends to decrease as people move from perimenopause into menopause and beyond.

What causes unwanted vaginal odor?

Contrary to popular belief, even a healthy vagina smells. 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 unpleasant vaginal odor: 

• A vaginal infection like bacterial vaginosis (BV) or aerobic vaginitis (AV), or a sexually transmitted infection (STI).
• 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 vaginal discharge
• Itching or burning
• Inflammation
• Discomfort or pain during sex or while peeing.

Don’t ignore a fishy or foul-smelling odor — it's often a symptom of BV or trichomoniasis 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 beneficial bacteria like Lactobacilli slowly decrease, which can create 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 an acidic pH 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 increase the risk of vaginal odor. First, they can raise vaginal pH, making the vagina more susceptible to the 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 such as 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 your genitals with soap (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 cleansers 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 vulvar area, you might need to wash this area with something that promotes moisture, such as medical-grade, unscented emollients or ointments. Just make sure you're opting for a moisturizer or lubricant with a pH similar to the vagina (between 3.8 and 4.5) and that doesn't contain ingredients that can disrupt the vaginal microbiome.

Evvy's Soothing Vulva Cream is a hormone-free option formulated with hyaluronic acid, aloe, and vitamin E, designed for external dryness and irritation. For internal dryness, Hyaluronic Acid Suppositories offer hormone-free hydration from the inside out, which can be especially helpful during perimenopause and menopause when vaginal tissue naturally loses moisture and elasticity.

There are other options for treating menopause-related dryness, like topical or oral hormone replacement therapy (HRT), which ramps up depleted levels of key hormones. Evvy's Estradiol Vaginal Cream is a prescription, low-dose topical estrogen option specifically for menopausal or perimenopausal dryness, burning, irritation, and painful sex.

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 inserted into the vagina. 

Unfortunately, there’s a lack of research that directly looks into whether HRT can manage vaginal odor. But there is a (small-ish) body of research that examines how HRT can shift the vaginal microbiome. 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 also 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. Systemic hormones like oral estrogen and progesterone pose a higher risk of breast cancer, particularly in women over 60, because they circulate throughout the 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 recurrent urinary tract infections.

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

FAQs about vaginal odor in perimenopause and menopause

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 vaginal odor is often a symptom of a vaginal infection like bacterial vaginosis and probably requires antibiotic treatment.

Do menopause and perimenopause cause bad odor?

Yes, they can. On top of vaginal odor, about 80% of perimenopausal and postmenopausal women have vasomotor symptoms like hot flashes and night sweats due to declining estrogen levels. When body temperature rises, sweat glands produce more sweat to cool the body, which can lead to more pungent body odor. Vaginal odor changes can begin in perimenopause, as hormone fluctuations start affecting your vaginal flora even before your periods stop.

Why does my period smell bad during perimenopause?

Hormone fluctuations during perimenopause can affect your vaginal pH and bacterial balance throughout your cycle, which may make period-related odor more noticeable. Blood itself has a mild, metallic smell, but when combined with shifts in your microbiome, it can become stronger. A particularly strong or fishy odor during your period is worth mentioning to your provider, since it could point to an infection like BV rather than just hormonal changes.

Does perimenopause cause foul odor?

A foul or rotten-smelling odor isn't a typical feature of perimenopause and usually indicates an infection, such as bacterial vaginosis or aerobic vaginitis, rather than hormonal changes alone. While mild odor shifts during perimenopause are common, a foul smell is a sign to check in with your healthcare provider rather than assume it's just hormones.

How long does perimenopause odor last?

There's no fixed timeline, since perimenopause itself can last anywhere from a few months to several years, and odor changes during this time tend to come and go as hormone levels fluctuate. For many people, odor becomes less noticeable as they move further into menopause, when hormone levels stabilize at a lower baseline.

Why does my discharge smell bad during menopause?

During menopause, the decrease in estrogen levels can reduce beneficial bacteria such as Lactobacilli, leading to 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.