Perimenopause and Discharge: What to Expect

What is Perimenopause?

Perimenopause, or the menopausal transition, is that period during which physiologic changes progress toward your final menstrual period. This phase begins with the onset of menstrual irregularities and continues until you reach menopause or one year after amenorrhea (sage with no periods) has occurred. Perimenopause can last for a variable amount of time. It typically starts in your 40s but sometimes earlier.

Hormonal changes: 

During perimenopause, estrogen levels fluctuate significantly, sometimes surging and other times dipping, which directly impacts your vaginal environment. These hormonal changes lead to irregular menstrual cycles, mood swings, and changes in vaginal discharge, among other symptoms.

Changes in your Vaginal Discharge During Perimenopause

During perimenopause, many changes are seen in your vaginal discharge. Below are some of the changes normally seen: 

Increased Vaginal Discharge

Perimenopause can cause an increase in vaginal discharge for you. Hormonal imbalances, particularly in estrogen, can cause your discharge to become:

• Clear and watery
• Sticky and stretchy

These types of discharge are odourless and generally harmless. They can be very little in quantity or so heavy that you may need a panty liner. 

Dryness or Thinning Discharge

On the other hand, you may also experience a noticeable decrease in vaginal discharge. Sometimes, you won’t even notice unless you check your underwear.

Declining estrogen levels can lead to:

• Vaginal dryness
• Irritation or burning sensations

Pain during intercourse

This dryness is a hallmark symptom for many women and can affect intimacy and overall comfort.

Color and Consistency of Discharge

1. Clear or White: This type of discharge is normal and may vary in consistency and quantity throughout your cycle.

2. Yellow or Greenish: It could be a sign of an infection, such as bacterial vaginosis, vaginitis, desquamative vaginal diseases or a sexually transmitted infection (STI).

3. Brown, pink or Blood-Tinged: It is caused by irregular menstrual cycles, which are common during perimenopause. However, if it occurs after 12 months of no periods, it can be a cause of concern, and you should immediately see a healthcare expert.

4. Greyish: This could indicate infection.

Causes of Changes in Your Vaginal Discharge 

Vaginal discharge helps keep your vagina lubricated, clean, and protected against infections. During perimenopause, there can be many changes in this discharge. Here are the most common causes: 

Estrogen  

Estrogen helps to maintain your reproductive health; however, there can be imbalances during perimenopause. These changes can cause changes in your vaginal discharge in several ways: 

• Decrease in Estrogen Levels: As estrogen levels decrease in your body, there is a reduction in vaginal discharge. This causes dryness, discomfort or irritation. 
• Rise in Estrogen Levels: An increase in estrogen increases your vaginal discharge. This discharge may appear clear, watery, or sticky. 

1. Cervical and Vaginal Atrophy 

As estrogen decreases, the tissues of your vagina and cervix can undergo atrophy.

Signs are: 

• Thinning of your vaginal walls. 
• Decreased elasticity and lubrication in your vagina. 
• Reduced secretion from your cervix. 

Infections 

During menopause, you can experience more vaginal infections due to changes in your vaginal microbiome. The changes which your vaginal microbiome goes through during this phase are explained in this research.  

Some common infections include: 

• Yeast Infections (Candidiasis) 
• Bacterial Vaginosis (BV) 
• Sexually Transmitted Infections (STIs) 
• Urinary Tract Infections (UTIs) 

1. Medications and Treatments 

Some medications and treatments can alter your vaginal discharge as follows. 

Hormonal Therapies 

• Birth Control Pills: It can make your discharge thicker, thinner, or more abundant. 
• Hormone Replacement Therapy (HRT): It may help manage your estrogen levels, hence improving lubrication in your vagina. 

Antibiotics 

Prolonged use of antibiotics can destroy your natural vaginal microbiome, thus increasing the risk of infections.

What Are the Common Types of Vaginal Discharge During Perimenopause?

Vaginal discharge is a common occurrence in women of any age. Your vaginal discharge can also help to indicate if there is any abnormality in your reproductive health. Here are some common types of vaginal discharge :

Clear and Watery Discharge

• Clear and watery discharge is light, thin, and odourless. It may increase sometimes, especially in the middle of your cycle, when estrogen levels rise.

Thick, White, or Creamy Discharge

• This is denser in texture and can appear white or creamy. It occurs due to hormonal shifts and can be seen more during times when your estrogen levels are elevated.

Yellow or Greenish Discharge

• This discharge appears yellow or green, with an unpleasant odour. It can also have a thick, pus-like consistency. This discharge is usually a sign of infection or STI. It is essential to consult a healthcare provider if you see these symptoms.

Brown or Bloody Discharge

• Brown discharge is also a normal and harmless occurrence and happens due to hormonal shifts especially when it occurs at the time of menstruation. 

But if it happens outside of a period when your menstruation has ended, then it can indicate an underlying health issue.

When to Seek Medical Attention

Changes in your vaginal discharge during perimenopause are linked to hormonal changes. They are mostly normal, but certain symptoms need immediate medical evaluation. You must understand when to consult a healthcare provider as it will ensure early diagnosis and treatment.

Signs to Watch Out For

• Persistent or Unusual Discharge
• Unpleasant Odor
• Abnormal Texture or Color
• Excessive Amounts
• Persistent Nature

1. Accompanying Symptoms

Changes in your vaginal discharge may also indicate infections, inflammation, or more serious underlying conditions.

Additional Symptoms to Look Out For

• Lower abdominal pain
• Itching and Burning
• Swelling or Redness

1. Postmenopausal Bleeding

If you have vaginal bleeding or spotting after menopause requires immediate medical evaluation.

Key Concerns

• Even if you have minimal blood-tinged discharge post-menopause, it is not considered normal.
• If you have brown discharge after menopause.

Potential Causes

• Uterine Fibroids
• Endometrial Hyperplasia
• Uterine or Cervical Cancer

How to Manage Your Vaginal Discharge During Perimenopause and Menopause

The hormonal imbalances during menopause and perimenopause phase can cause changes in your vaginal discharge. 

1. Handling these can be easier with lifestyle adjustments, hygiene practices, and medical treatments whenever necessary.

Some recommendations are as follows: 

1. Practice Good Hygiene 

• Clean Daily with Mild Soap 
• Keep your vaginal Area Dry 
• Wear Breathable Fabrics like cotton  

1. Use Lubricants and Moisturizers 

2. You may face vaginal dryness during perimenopause and menopause due to decreasing estrogen levels. Lubricants can provide you relief and reduce discomfort. Options available are

• Water-Based Lubricants  
• Silicone-Based Lubricants 

1. Hormonal Treatments 

3. Due to reduced estrogen levels, there can be dryness, thinning of vaginal tissues, or discomfort. Hormonal treatments can be highly effective for this. Topical Estrogen Creams and Rings: These creams help to restore moisture and thickness to your vaginal tissues. You can apply it directly. 

4. Probiotics are healthy live bacteria that help to create a healthy microbiome in your body. It helps to balance your vaginal microbial environment, which helps prevent infections.  

How Probiotics can Help you.

• Restore pH Balance: Probiotics help maintain your vagina’s naturally acidic pH,  making it less likely to cause infections. If there is any disturbance in this balance, there is an increased chance of infections.     
• Prevent Infections: Regular use can help create and maintain a healthy microbiome to prevent infections.

Sources of Probiotics 

• Supplements 
• Dietary Sources: Yogurt, kefir, sauerkraut, and other fermented foods. 

Maintain a Balanced Diet and Stay Hydrated 

A nutritious and healthy diet can help improve your vaginal health and also your overall health, reducing symptoms like vaginal dryness. 

Key Nutrients and Sources:

• Omega-3 Fatty Acids: Fatty fish, walnuts, and flaxseeds. 
• Vitamin E: Almonds, sunflower seeds, and spinach. 
• Hydration: Lack of hydration can further worsen your vaginal dryness. Drinking at least 7-8 glasses of water daily helps prevent dehydration and dryness. 

1. Avoid Douching 

Douching is a method to wash out your vagina. Douches that are sold in drugstores and supermarkets contain antiseptics and fragrances. Douching can often do more harm than good as it disturbs your vaginal environment.

Why Douching Can Be Harmful?

• Disrupts Natural Flora: Douching removes good bacteria, increasing the risk of infections like bacterial vaginosis or yeast infections. 
• Irritates Vaginal Tissues: The chemicals in douches can irritate your vaginal tissues during perimenopause.

Conclusion

Changes in your vaginal discharge are a part of perimenopause and menopause; being informed about what’s normal can help you to manage this phase. Most changes can be managed with lifestyle adjustments and proper care.

However, it’s crucial to seek medical advice if you notice persistent unusual symptoms, such as a foul odour, itching, or postmenopausal bleeding. By adopting healthy habits, practising safe sex, and scheduling regular check-ups, you can maintain vaginal health and overall well-being during perimenopause.