Highlights from this article:
- Estrogen levels plummet during menopause, which causes Lactobacillus (protective bacteria) levels to decrease. This can allow harmful, anaerobic microbes, that produce “smelly” molecules, to thrive within the vaginal microbiome.
- Infections like BV, which are more likely during vaginal microbiome shifts, also involve odor producing molecules and bacteria (G.vaginalis).
- Hormone therapy might help with unpleasant vaginal odor during menopause, but there isn’t any research that looks at this directly.
- We’re actually less likely to experience unusual vaginal odor by the time we’re menopausal.
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 odd vaginal odor. Can we catch a break?
Sort of. We might be less likely to experience unusual vaginal odor post-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!
How common is odor during menopause?
If you’re on the verge of or going through 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 odor.
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 odor might decrease as people with vaginas age and move from perimenopause to menopause.
What causes vaginal odor outside of, and during, menopause?
Menopausal or not, an unsusual or foul-smelling vaginal odor is usually explained by one of two things:
- a vaginal 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 abnormal discharge, itching, inflammation, or other irregular symptoms. Don’t ignore a strong fishy smell, a foul rotting odor, or a fresh baked bread smell—that means it’s likely time to check in with your OB-GYN. If this sounds like you, we’re your accountability buddy saying, schedule your appointment now while it’s top of mind!
If you have 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!
Either way, if you’re noticing a change, a great place to start is with an Evvy test kit to get a full picture of all the bacteria and yeast down there. Even better is an Evvy membership that lets you track changes over time.
Ok but what does a change in my vaginal microbiome have to do with odor in menopause?
Lower levels of lactobacilli create more room for disruptive bacteria (and smelly microbes) to thrive. By the time we reach menopause, we no longer have enough ovarian follicles to produce much estrogen. And when estrogen levels drop, the amount of Lactobacillus in the vagina can decrease.
Anaerobic microbes do two things which create more opportunity for vaginal odor.
First, they can cause a rise in vaginal pH, making the vagina more susceptible to an overgrowth of disruptive microbes. Second, they produce chemicals known as ‘biogenic amines’, which give off unpleasant odors when combined together.
The most common microbes that researchers suspect produce smelly molecules, found within the vagina, include:
P.S. Putrescine, cadaverine and tyramine (smelly molecules themselves) are more abundant in Community State Type IV (non-Lactobacillus dominant) vaginas. Head over to our Vaginal Microbiome Community State Types explainer for more on the different types of vaginal microbiomes.
Will douching or using a feminine hygiene wash help with my vaginal odor?
While we totally get the temptation to clean out down there (thanks to decades of sexist marketing aimed at making women think their hoo-ha should smell like roses), the answer is that washing out your vagina will likely do more harm than good.
In fact, 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 BV.
The vagina is a powerful, self-cleaning organ. Not only does giving it “a good clean out” derail your vagina’s swanky “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.
Your vulva is made up of skin (among other things, obviously), but it’s more delicate than normal skin. If your vulva feels irritated (not the vaginalcanal, 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 vulva and vaginal dryness, that’s menopause related, like topical or oral hormone therapy (HT) which rampup depleted levels of key hormones.
Will hormone therapy (HT) help with my vaginal odor?
Hormone therapy (HT) 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). HT 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 levels of odor producing vaginal microbes with hormone therapy. But, there is a (small-ish) body of research that looks into how HT 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 HT) had a significantly higher abundance of Lactobacillus compared to women not receiving hormonal treatment. Those not receiving hormonal therapy also had a higher amount of anaerobic bacteria (remember earlier, we explained that these microbes tend to produce more smelly molecules than Lactobacillus). So this could indicate that HT might help to decrease vaginal odor. However, there are many caveats here. This is one study that looked at one of multiple HT options, and smell itself was not directly assessed.
If you’ve read our other content, you can probably guess what we’re going to say— more studies on HTs effect on vaginal symptoms, including self-reported changes in odor, are needed.
If you do want to give HT a try, always start with speaking to your OB-GYN.
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 carries a decreased risk for breast cancer and usually has fewer side effects compared to other hormonal treatments. Topical treatment has been proven to help with vaginal dryness and preventing urogenital infections like UTIs.
The decision is yours, but make sure to weigh up the (potential) risks and benefits with your OB-GYN.