The hormones produced by the ovaries include the different forms of estrogen (including estradiol), progesterone, and androgens (including testosterone). These hormones also decrease around menopause. The ovaries continue to produce small amounts of testosterone and some estrogen. The hormones produced by the pituitary gland are also decreased.

Because hormone levels fall, changes occur in the entire reproductive system. The vaginal walls become less elastic, thinner, and less rigid. The vagina becomes shorter. Secretions become scant and watery. The external genital tissue decreases and thins (atrophy of the labia).

In both men and women, reproductive system changes are closely related to changes in the urinary system.

EFFECT OF CHANGES

Prior to menopause, fertility varies depending on hormone levels. Menopause is said to have occurred when there has been one year without a menstrual period. With menopause, reproductive capacity is lost (the woman can no longer become pregnant).

Symptoms that accompany menopause vary in severity. Many of the symptoms are triggered by the hormone changes. Only about 20% to 30% of all women have symptoms that are severe enough that they seek medical attention.

Changes occur in the woman's breast tissue at the same time as other reproductive changes. A woman may experience changes in her sex drive (libido) and her sexual response may change, but aging does not prevent a woman from being able to have or enjoy sexual relationships. Most often, things such as availability of a partner, symptoms from vaginal dryness and thinning vaginal walls, and psychological and social factors affect a woman's sexual response more than direct aging changes.

COMMON PROBLEMS

The pubic muscles lose tone, and the vagina, uterus, or urinary bladder can fall out of position. This is called vaginal prolapse, bladder prolapse, or uterine prolapse, depending on which structure drops. A prolapse of any of these structures increases the risk of problems such as stress incontinence (urine leakage). Most prolapses can be treated.

Irritation of the external genitals can occur (pruritus vulvae). The vaginal walls become thinner and dryer and may become irritated (atrophic vaginitis). Sexual intercourse may become uncomfortable for some women (dyspareunia). There are changes in the levels of normal microorganisms in the vagina, and there is an increased risk of vaginal yeast infections.

Similar changes to the bladder and urethra may increase symptoms such as frequency and urgency of urination, and there is an increased risk of urinary tract infection after menopause.

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Menopause

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Aging changes in the female reproductive system Prevention

Review Date: 11/21/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)