When levels of oestrogen are low, vaginal tissues do not produce as many natural secretions (to lubricate and protect the vagina). The tissues can become dry, leading to soreness, burning and itch. This can cause pain during vaginal sex, discomfort when active/ moving or when having your smear test.
Lower levels of oestrogen alter the natural vaginal bacteria, which can lead to increased vaginal infections such as thrush and bacterial vaginosis.
Vaginal discharge can also increase during menopause. This can be a later sign of significant vaginal dryness; the tissues become so dry and fragile that secretions leak through the thinning vaginal walls.
If there are changes to secretions it is best to attend for examination to exclude infection before starting hormonal treatment.
Decreased oestrogen levels also lead to thinning and weakening of the tissues in the pelvic floor, so the muscles that support the bladder and the urethra become weak. This can lead to urinary symptoms:
poor bladder control (urine frequency and urgency)
recurrent urine infections
sensation of an infection (despite negative urine tests).