From Pleated Skirts to Pencil Skirts
Apr 07, 2023By Kim Vopni, The Vagina Coach — Certified Pelvic Floor Fitness Specialist · Published April 7, 2023
Direct Answer
In menopause, falling estrogen thins and narrows the vaginal tissue — going from a soft, folded “pleated skirt” to a tighter “pencil skirt.” This can cause dryness, irritation, painful sex, and urinary urgency or leaking, now grouped under Genitourinary Syndrome of Menopause (GSM). Over 80% of women experience it, but with vaginal estrogen, moisturizers, and pelvic floor training, suffering is not mandatory.
Key Takeaways
- Falling estrogen thins the vaginal walls and the folds (rugae) — the “pleated skirt to pencil skirt” change.
- Symptoms include dryness, irritation, chafing, painful sex, and urinary urgency or leaking.
- These are now grouped under Genitourinary Syndrome of Menopause (GSM), formerly called “vaginal atrophy.”
- Over 80% of women experience vaginal dryness in menopause — but it is treatable, not inevitable.
- Local vaginal estrogen, a good vaginal moisturizer, and pelvic floor training together are the most effective approach.
The best description of the vagina in menopause is that it can go from a pleated skirt to a pencil skirt. I have heard this from Michelle Lyons of Celebrate Muliebrity and Julia Di Paolo, Reg. PT of PhysioExcellence
What happens to the vagina in menopause?
Our Vagina
We have folds in the walls of the vagina called Rugae that can thin as we have less circulating estrogen. The walls of the vagina can thin & narrow too.
With these changes, women may experience dryness, irritation, chafing, painful sex & urinary urgency or leaking.
What is Genitourinary Syndrome of Menopause (GSM)?
The term vaginal atrophy has been replaced with the term Genitourinary Syndrome of Menopause (GSM).
Over 80% of women will experience vaginal dryness as they transition through menopause...but suffering is not mandatory.
How is GSM treated?
Local vaginal estrogen is incredibly beneficial and may be started around the time of Menopause. Be proactive. Rather than waiting for it to happen, help support your vagina and pelvis with estrogen!
The book Estrogen Matters is a great evidence-based book on all the benefits associated with estrogen. Read it, then speak to your doctor or naturopath about the right estrogen options for you.
Vaginal moisturizer is also fantastic to be used in conjunction with estrogen. For some great options, visit Menopause Chicks.
Does menopause cause bladder leaking?
Bladder leakage (incontinence) is very common and can worsen in menopause. Estrogen can help and is best used in conjunction with pelvic floor physio and daily pelvic floor exercise (ideally using a whole-body approach that uses breath and bone loading, muscle building and release work, too!).
Menopause doesn't have to suck!
What does Kim do for her own menopause?
I struggled in my 40s with an undiagnosed autoimmune condition (Hashimoto's) that is now in remission. A big factor in my healing has been reducing inflammation which has set me up for a smoother transition into Menopause.
I use local vaginal estrogen. I also moisturize my vagina. I do hypopressives and pelvic floor exercises 5-6 days a week. I walk and do yoga and lift weights too. I was off alcohol for over a year and now indulge in only one glass every few months at most. I eat very little sugar and no gluten and feel better than I did through all of my 40s!
The 28-Day Challenge and Buff Muff Membership
I recommend checking out my comprehensive pelvic health education and fitness programs on my Buff Muff App. The most complete Pelvic Floor & Kegel exercise App.
The Buff Muff 28-Day Challenge (housed in the App) gets you started, and the Annual membership keeps you progressing so you can laugh, run, jump, and lift without the pesky leaks and annoying discomfort of menopause symptoms. Oh, and did I mention better sex?
On the first of each month, we run our Buff Muff Challenge. With thousands of success stories, it provides you with 28 days of daily workouts - each roughly 10 minutes long - designed to help you overcome incontinence and prolapse.
Join the thousands of women who have eliminated their incontinence, prolapse, back pain, and menopausal symptoms.
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If you enjoyed this article, you might also like our episode:
Perimenopause Solutions with Dr Mariza Snyder
Listen to the episode
Frequently Asked Questions
Is vaginal dryness in menopause normal, and can it be treated?
Yes. It is very common — over 80% of women experience vaginal dryness in menopause — but it is not something you have to live with. Local vaginal estrogen, vaginal moisturizers, and pelvic floor training can relieve dryness and related symptoms. Being proactive early tends to work better than waiting.
What is Genitourinary Syndrome of Menopause (GSM)?
GSM is the current term for the vaginal and urinary changes of menopause, replacing the older term “vaginal atrophy.” As estrogen falls, the vaginal walls and folds (rugae) thin and narrow, which can cause dryness, irritation, painful sex, and urinary urgency or leaking.
Is vaginal estrogen safe?
For most women, local vaginal estrogen is considered safe and effective, and it can often be started around the time of menopause. It works directly on the vaginal and urinary tissues with minimal absorption. Always discuss your personal health history with your healthcare provider before starting.
Why does bladder leaking get worse in menopause?
Lower estrogen affects the tissues of the bladder and urethra as well as the vagina, which can increase urgency and leaking. Vaginal estrogen can help, and it works best alongside pelvic floor physiotherapy and daily pelvic floor exercise using a whole-body approach.
What is the difference between vaginal estrogen and a vaginal moisturizer?
Vaginal estrogen is a treatment that restores the tissue by replacing local estrogen; a vaginal moisturizer hydrates the tissue for comfort. They work well together — estrogen addresses the underlying change while the moisturizer provides ongoing relief.
Can pelvic floor exercises help menopause symptoms?
Yes. A whole-body pelvic floor approach — using breath, bone loading, muscle building, and release work — helps with the urinary urgency and leaking that often worsen in menopause and supports overall pelvic health. It pairs well with vaginal estrogen for the best results.
