Around menopause, changes in the genital organs occur rapidly. Menstrual cycles stop, and the ovaries stop producing estrogen. After menopause, the tissues of the labia minora (which surround the opening of the vagina and urethra), clitoris, vagina, and urethra thin (atrophy). This thinning can result in chronic irritation, dryness, and a discharge from the vagina. Vaginal infections are more likely to develop. Also after menopause, the uterus, fallopian tubes, and ovaries become smaller.
With aging, there is a decrease in the amount of muscle and connective tissue, including that in muscles, ligaments, and other tissues that support the bladder, uterus, vagina, and rectum. As a result, the affected organs may sag or drop down (prolapse), sometimes causing a feeling of pelvic pressure or fullness, difficulty urinating, loss of control of urination or bowel movements (incontinence), or pain during sexual intercourse. Women who have had many children are more likely to have such problems.
Because there is less estrogen to stimulate milk ducts, the breasts decrease in size. The connective tissue that supports the breasts also decreases, leading to sagging and contributing to changes in shape. Fibrous tissue in the breasts is replaced with fat, making the breasts less firm.
For most women, age-related changes in reproductive organs do not interfere with sexual activity or sexual pleasure after menopause. Some women enjoy sexual activity more after menopause, possibly because they are no longer concerned about becoming pregnant. In addition, after menopause, the ovaries and adrenal glands continue to produce male sex hormones. Male sex hormones help maintain the sex drive, slow the loss of muscle tissue, and contribute to an overall sense of well-being.