Aging changes in the female reproductive system

Aging changes in the female reproductive system result mainly from changing hormone levels. One clear sign of aging occurs when your menstrual periods stop permanently. This is known as menopause.

The time before menopause is called perimenopause. It may begin several years before your last menstrual period. Signs of perimenopause include:

More frequent periods at first, and then occasional missed periods
Periods that are longer or shorter
Changes in the amount of menstrual flow

Eventually your periods will become much less frequent, until they stop completely.

Along with changes in your periods, physical changes in your reproductive tract occur as well.

AGING CHANGES AND THEIR EFFECTS

Menopause is a normal part of a woman’s aging process. Most women experience menopause around age 50, though it can occur before that age. The usual age range is 45 to 55.

With menopause:

The ovaries stop making the hormones estrogen and progesterone.
The ovaries also stop releasing eggs (ova, oocytes). After menopause, you can no longer become pregnant.
Your menstrual periods stop. You know you have gone through menopause after you have had no periods for 1 year. You should continue to use a birth control method until you have gone a whole year without a period. Any bleeding that occurs more than 1 year after your last period is not normal and should be checked by your health care provider.

As hormone levels fall, other changes occur in the reproductive system, including:

Vaginal walls become thinner, dryer, less elastic, and possibly irritated. Sometimes sex becomes painful due to these vaginal changes.
Your risk for vaginal yeast infections increases.
The external genital tissue decreases and thins, and can become irritated.

Other common changes include:

Menopause symptoms such as hot flashes, moodiness, headaches, and trouble sleeping, which can persist for years
Problems with short-term memory
Decrease in breast tissue
Lower sex drive (libido) and sexual response
Increased risk for bone loss (may lead to osteoporosis)
Urinary system changes, such as frequency and urgency of urination and increased risk for urinary tract infection
Loss of tone in the pubic muscles, resulting in the vagina, uterus, or urinary bladder falling out of position (prolapse)

MANAGING CHANGES

Hormone therapy with estrogen or progesterone, alone or in combination, may help menopause symptoms such as hot flashes or vaginal dryness and pain with intercourse. Most women who have a uterus will require progesterone as well as estrogen. Women without a uterus may take estrogen only. Hormone therapy has risks, so it is not for every woman. Discuss the risks and benefits of hormone therapy with your provider.

To help manage problems such as painful sexual intercourse, use a lubricant during sexual intercourse. Vaginal moisturizers are available without a prescription. These can help with vaginal and vulvar discomfort due to the drying and thinning of tissues. Applying topical estrogen inside the vagina may help thicken the vaginal tissues and increase moisture and sensitivity. Your provider can tell you if any of these measures is right for you.

Getting regular exercise, eating healthy foods, and staying involved in activities with friends and loved ones can help the aging process go more smoothly.

OTHER CHANGES

Other aging changes to expect:

References

Aleksic S, Bartke A, Lamberts SWJ, Milman S. Endocrine function and aging. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 26.

Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Santoro N, Neal-Perry G. Menopause. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 222.

Effects of Early Menopause

When your ovaries are removed or stop working, they no longer make estrogen. This causes the same symptoms as natural menopause.

Vaginal dryness or tightness
Hot flashes
Mood changes
Lower sex drive
Problems sleeping

In some cases, these symptoms may come on strong and can be severe.

Less estrogen in your body also increases your risk for certain health conditions, such as:

Heart disease
Osteoporosis (thinning of bones)

How to Ease Symptoms

Many treatments can help ease the symptoms of early menopause. They include medicines and lifestyle treatments you can do at home.

Some medicines that may help include:

Hormone therapy. In some cases, your provider may prescribe female hormones to help with hot flashes and other symptoms. But, there are some risks with hormones, and you may not be able to take them if you have had certain types of cancer.
Vaginal estrogen. Even if you cannot take hormone therapy by mouth or skin patch, you may be able to use small amounts of estrogen in or around your vagina to help with dryness. These hormones come in creams, gels, tablets, and rings. You need a prescription from your provider for these medicines.
Other medicines. If you cannot take hormones, your provider may prescribe another type of medicine to help with hot flashes, such as certain antidepressants (even if you are not depressed) or other medicines. Because of their chemical effects, these are effective for hot flashes even if you are not depressed.
Lubricants or moisturizers. These products can help make sex more comfortable if you have vaginal dryness. Look for a water-based lubricant, such as K-Y Jelly or Astroglide. Or, try using a vaginal moisturizer like Replens every few days.
Medicines for bone loss. Some women take medicines to help reduce bone loss after menopause. Ask your provider if this type of medicine may be right for you.

Treatments you can try at home include:

Staying active. Getting regular exercise can help with mood swings, sleep problems, and mild hot flashes.
Healthy sleep habits. Getting enough sleep may help ease mood swings. But, if you are having trouble sleeping at night, try skipping naps during the day. You should also avoid caffeine late in the day, and do not have large meals or do anything too active right before bedtime.
Dressing in layers. This can help with hot flashes, since you can remove layers when you feel hot. It can also help to dress in loose, cotton clothing.

Ask your provider what treatments might work best for you.

Protecting Your Bones and Heart

Since early menopause can affect your bone and heart health, it’s important to take steps to keep them healthy. Here is how:

Eat healthy foods. Focus on fresh fruits and vegetables, whole grains, lean meats, fish, nuts, beans, and low-fat dairy products.
Get enough calcium and vitamin D. These nutrients help build bones. Foods rich in calcium include yogurt and milk, spinach, and white beans. Your body makes most of its vitamin D from the sun, but you can also get it from salmon, eggs, and milk that has vitamin D added. Ask your provider if you need to take supplements.
Get exercise. The best kinds of exercise for your bones are weight-bearing exercises that work your body against gravity. Some ideas include walking, yoga, hiking, dancing, lifting weights, gardening, and tennis.
Do not smoke. Smoking raises your risk for both osteoporosis and heart disease. If you need help quitting, ask your provider.
Ask about a bone density test. This is a test that checks for osteoporosis. This is a recommended test for all women at age 65, but you should consider one earlier if you have early menopause.
Keep track of your numbers. Make sure your provider checks your blood pressure, cholesterol, and blood sugar levels regularly. These simple tests can help tell you if you are at risk for heart disease or stroke.

References

Mitsis D, Beaupin LK, O’Connor T. Reproductive complications. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 43.

National Cancer Institute website. Sexual health issues in women with cancer. www.cancer.gov/about-cancer/treatment/side-effects/sexuality-women. Updated December 29, 2022. Accessed November 8, 2024.