A few weeks ago, a video by my friend and colleague, Dr. Rachel Rubin, went viral. In it, she explained something that took the internet by storm: that the labia can change dramatically after menopause.
“These labia minora, when you’re a baby, you don’t have them. You grow them in puberty and you lose them in menopause,” she says in the TikTok.
The public reaction? Shock. Disbelief. Grief. Millions of women commented, “Why didn’t I know this could happen?”
As a menopause specialist, I wasn’t surprised by the content of the video. I was surprised that it struck such a nerve, because this topic has been swept under the rug for far too long. The reality is your labia do not completely disappear after menopause, but they absolutely can change in ways that are distressing, confusing, and almost never talked about.
This is not about vanity. This is not a cosmetic issue. This is genitourinary syndrome of menopause (GSM), and it’s time we bring it out of the shadows and into routine care.
@beyondbasicspt What do we know about the labia minora? The existing research is mostly tied to cosmetic surgery, not health, function, or aging. Dr. Rachel Rubin in on a mission to learn more and we’re so luck to have her sharing her knowledge. What we know: 🌸 When you’re born, you do not have it 🌸 They develop during puberty 🌸 They diminish during menopause But here’s the thing, we know almost NOTHING actually about them. ❓Is it estrogen or testosterone that influences these changes ❓Does everyone lose them the same way ❓Can they grow back #pelvichealth #sexualmedicine #womenshealth #labia #vulva #hormones #medicalprofessional #womenshealthcare
♬ vlog, chill out, calm daily life(1370843) – SUNNY HOOD STUDIO
What exactly happens to the labia in menopause?
Thinning and atrophy: The labia majora and minora become thinner and less elastic as estrogen declines. This process is called atrophy, and it reflects a breakdown in the collagen and elastin framework of the tissue. Studies examining the microscopic structure of these tissues confirm a thinning of the lining and a decrease in the production of cells that give the labia majora and minora their shape.
Loss of volume and moisture: The labia majora loses adipose tissue, or fat, becoming less plump and more lax. There’s also a reduction in sebum, an oily substance produced by sebaceous glands, and sweat, which leads to dryness. Over time, pigmentation in the area fades, and the hair follicles become smaller, resulting in a pale, smooth appearance down there.
Structural changes: The labia minora may flatten or adhere to the surrounding tissue due to chronic inflammation and a thinning of the lining, like we discussed earlier. The labia majora may retract inward, especially in individuals who also have sarcopenia or general body fat loss.
These vulvar changes are only one aspect of GSM. Patients may also experience vaginal dryness, burning, irritation, pain with intercourse, urinary urgency, recurrent UTIs, and incontinence — all due to the same underlying cause: estrogen deficiency.
What causes these changes?
Estrogen is essential for maintaining urogenital health. It supports tissue thickness, vascularity — or, the degree to which a tissue contains blood vessels — hydration, pH regulation, and tissue repair. When estrogen declines after menopause, the epithelial lining of the vulva and vagina becomes thin, fragile, and prone to microtrauma. Histological analysis shows reductions in collagen, elastin, and hyaluronic acid, alongside changes in gene expression related to wound healing and immune signaling.
These changes are not anecdotal. They are measurable, well-documented, and deeply impactful. And yet, most women are never told about them until they’re already suffering.
What reverses these changes?
Let’s be clear: lubricants and over-the-counter moisturizers do not restore the labia (no matter what the ads on social media may claim). They may reduce friction or provide temporary comfort, but they do not treat the underlying atrophy.
The only interventions that directly target the root cause are prescription vaginal estrogen (estradiol creams, tablets, rings) and prescription vaginal DHEA (prasterone).
In 2025, the American Urological Association (AUA) released updated guidelines that strongly endorse vaginal estrogen therapy for GSM. These guidelines emphasize not only the safety of low-dose vaginal estrogen but also its necessity. For the first time, a major non-gynecologic specialty acknowledged that GSM is underdiagnosed, undertreated, and incredibly disruptive to quality of life, and in some cases, life-threatening.
The AUA called on all specialties, not just OB-GYN, to take responsibility for recognizing and treating GSM. Because these symptoms don’t just show up in the gynecology office, they show up in urology, primary care, dermatology, rheumatology, and mental health.
Why this matters
I’ve had patients cry in my office, devastated that no one warned them this could happen. They were shocked at the transformation of their own anatomy. Some felt ashamed or broken. Others were simply frustrated that it took them years to get an answer, and even longer to get a treatment that worked.
This is why the viral video mattered. It lit a match. It told women, “You are not alone. This is real. And it is treatable.”
Anything that brings attention to what happens after menopause is welcome. Because we can’t treat what we don’t acknowledge. And we cannot allow another generation of women to suffer in silence because medicine decided vulvas weren’t worth the research.
If you’ve noticed changes to your labia after menopause, you are not alone. These changes are real, rooted in hormone loss, and treatable. It’s time we stop dismissing vulvar changes as cosmetic or trivial. They are the visible signs of a broader physiological shift, one that affects bladder function, sexual health, and pelvic stability.
You deserve to understand what’s happening to your body. You deserve to feel empowered to ask for treatment. And you deserve clinicians who are trained to help.
To find a menopause-educated clinician, download our free Menopause Empowerment Guide.
This post first appeared on Dr. Mary Claire Haver’s Substack. You can subscribe here.
