What Really Happens To The Labia After Menopause?

The Truth Behind The Viral Claim

Photo by charlesdeluvio on Unsplash

A few weeks ago, a video by my friend and colleague Dr. Rachel Rubin went mega-viral. In it, she explained something that took the internet by storm: that the labia can change dramatically after menopause.

The public reaction? Shock. Disbelief. Grief. Millions of women commented, “Why didn’t I know this could happen?”

As a menopause specialist, I wasn’t surprised by the content of the video. I was surprised that it struck such a nerve, because this topic has been swept under the rug for far too long. The reality is your labia do not completely disappear after menopause, but they absolutely can change in ways that are distressing, confusing, and almost never talked about.

This is not about vanity. This is not a cosmetic issue. This is genitourinary syndrome of menopause (GSM), and it's time we bring it out of the shadows and into routine care.

What Exactly Happens to the Labia in Menopause?

Thinning and Atrophy
The labia majora and minora become thinner and less elastic as estrogen declines. This process is called atrophy, and it reflects a breakdown in the collagen and elastin framework of the tissue. Histological studies have confirmed epithelial thinning and a decrease in fibroblast activity and extracellular matrix production (Factors, 1962; Galęba et al., 2015; Gass & Portman, 2014a; Farage et al., 2019; Phillips & Bachmann, 2015).

Loss of Volume and Moisture
The labia majora lose adipose tissue (lipoatrophy), becoming less plump and more lax. Reduced sebum and sweat gland activity lead to dryness. Over time, pigmentation fades and hair follicles miniaturize, resulting in a pale, smooth appearance (Galęba et al., 2015; Farage et al., 2019).

Structural Changes
The labia minora may flatten or adhere to adjacent tissue due to chronic inflammation and epithelial thinning. The labia majora may retract inward, especially in individuals who also have sarcopenia or general body fat loss (Galęba et al., 2015; Farage et al., 2019).

GSM and Beyond
These vulvar changes are only one aspect of GSM. Patients may also experience vaginal dryness, burning, irritation, pain with intercourse, urinary urgency, recurrent UTIs, and incontinence—all due to the same underlying cause: estrogen deficiency (Gass & Portman, 2014a; Gass & Portman, 2014b; Phillips & Bachmann, 2015).

What Causes These Changes?

Estrogen is essential for maintaining urogenital health. It supports tissue thickness, vascularity, hydration, pH regulation, and epithelial repair. When estrogen declines after menopause, the epithelial lining of the vulva and vagina becomes thin, fragile, and prone to microtrauma. Histological analysis shows reductions in collagen, elastin, and hyaluronic acid, alongside changes in gene expression related to wound healing and immune signaling (Farage et al., 2019).

These changes are not anecdotal. They are measurable, well-documented, and deeply impactful. And yet, most women are never told about them until they’re already suffering.

What Actually Reverses These Changes?

Let’s be clear: lubricants and over-the-counter moisturizers do not restore the labia (no matter what the ads claim on social media). They may reduce friction or provide temporary comfort, but they do not treat the underlying atrophy.

The only interventions that directly target the root cause are:

• Prescription vaginal estrogen (estradiol creams, tablets, rings)

• Prescription vaginal DHEA (prasterone)

These therapies have been shown to:

• Increase epithelial thickness

• Improve collagen and elastin synthesis

• Restore moisture and barrier function

• Reduce urinary symptoms

• Improve sexual function and comfort

Medical Backing: The 2025 AUA Guidelines

In 2025, the American Urological Association (AUA) released updated guidelines that strongly endorse vaginal estrogen therapy for GSM. These guidelines emphasize not only the safety of low-dose vaginal estrogen but also its necessity. For the first time, a major non-gynecologic specialty acknowledged that GSM is underdiagnosed, undertreated, and incredibly disruptive to quality of life, and in some cases, life threatening.

The AUA called on all specialties, not just OB-GYN, to take responsibility for recognizing and treating GSM. Because these symptoms don’t just show up in the gynecology office. They show up in urology, primary care, dermatology, rheumatology, and mental health.

Why This Matters

I’ve had patients cry in my office, devastated that no one warned them this could happen. They were shocked at the transformation of their own anatomy. Some felt ashamed or broken. Others were simply frustrated that it took them years to get an answer, and even longer to get a treatment that worked.

This is why the viral video mattered. It lit a match. It told women, “You are not alone. This is real. And it is treatable.”

Anything that brings attention to what happens after menopause is welcome. Because we can’t treat what we don’t acknowledge. And we cannot allow another generation of women to suffer in silence because medicine decided vulvas weren’t worth the research.

Final Thoughts

If you’ve noticed changes to your labia after menopause, you are not alone. These changes are real, rooted in hormone loss, and treatable. It’s time we stop dismissing vulvar changes as cosmetic or trivial. They are the visible signs of a broader physiological shift, one that affects bladder function, sexual health, and pelvic stability.

You deserve to understand what’s happening to your body. You deserve to feel empowered to ask for treatment. And you deserve clinicians who are trained to help.

To find a menopause-educated clinician, download our free Menopause Empowerment Guide.

References

Factors, N. (1962). VII. Predisposing Factors. Acta Radiologica, 58(S217), 24–29. https://doi.org/10.1177/0284185162058S21708

Galęba, A., Bajurna, B., & Marcinkowski, J. (2015). The Role of Cosmetic Gynecology Treatments in Women in Perimenopausal Period. Open Journal of Nursing, 5, 153–157. https://doi.org/10.4236/OJN.2015.52018

Gass, M., & Portman, D. (2014a). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause, 21(10), 1063–1068. https://doi.org/10.1097/GME.0000000000000329

Gass, M., & Portman, D. (2014b). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy. Climacteric, 17(5), 557–563. https://doi.org/10.3109/13697137.2014.946279

Farage, M., Sharma, K., Wang, Y., et al. (2019). Histological and Gene Expression Analysis of the Effects of Menopause Status and Hormone Therapy on the Vaginal Introitus and Labia Majora. Journal of Clinical Medicine Research, 11(10), 745–759. https://doi.org/10.14740/jocmr4006

Phillips, N., & Bachmann, G. (2015). Vaginal health prescription: possible next step in the management of genitourinary syndrome of menopause. Menopause, 22(2), 127–128. https://doi.org/10.1097/GME.0000000000000414