Vaginal Discharge After Menopause: Changes, Colors & Meaning

Key takeaways:

• A thin, watery vaginal discharge that doesn’t come with unpleasant symptoms can be normal after menopause.
• Changes in discharge post-menopause are usually the result of a natural decline in estrogen and progesterone levels.
• Talk to your doctor if you experience vaginal discharge after menopause to rule out any potential concerns.

Going through menopause means facing a lot of changes. Nearly all parts of your body are affected by the changes in hormones that occur during this time, including the vagina. Experiencing a thin, watery discharge isn’t unusual and may not be a cause for concern. However, sometimes discharge is a sign of a condition like atrophic vaginitis, an infection, or an early sign of cancer. That’s why it’s important to check with your doctor if you’re not sure whether your discharge is normal.

How vaginal discharge changes after menopause

Menopause is medically defined as going a full year without a period. This is the time when your ovaries stop producing the hormones estrogen and progesterone.

Before menopause, estrogen plays a key role in maintaining the cells that keep the vaginal walls thick and healthy. Hormones also affect moisture levels and cervical mucus. Around ovulation, for instance, your cervical mucus thickens, which can give vaginal discharge an egg-white consistency.

However, as estrogen levels decrease, vaginal discharge tends to decrease, too. Without estrogen, your discharge may take on a clear, watery appearance. This discharge is made up of lost vaginal tissue cells that have become thin, dry, and inflamed. Symptoms like these are consistent with a condition called atrophic vaginitis.

Abnormal vs. normal vaginal discharge after menopause

A thin, watery, yellow- or gray-tinged discharge is normal after menopause, especially if accompanied by other evidence of atrophic vaginitis. Sometimes, this normal discharge may even be tinged with blood since atrophic vaginal cells are easily traumatized by sex, exercise, or even normal vaginal hygiene.

However, while microscopic bleeding is common, it’s important to note that any bleeding after menopause is worth paying attention to. Sometimes, bleeding can be a sign of cancer or precancerous changes. Therefore, a bloody, blood-tinged, or even light pink vaginal discharge after menopause can be considered abnormal.

Common causes of vaginal discharge after menopause

Experiencing a thin and watery discharge here can be a normal part of menopause. However, there are also some specific conditions and changes that can lead to the production of discharge post-menopause.

Atrophic vaginitis

Also known as vaginal atrophy or genitourinary syndrome of menopause (GSM), atrophic vaginitis is a condition that occurs when the lining of the vagina and vaginal walls thins and becomes dry. It can cause pain with sex, itchiness, dryness, and burning with urination, among other symptoms.

While it is common, to say atrophic vaginitis is “normal” is unfair. Though it may be the natural consequence of loss of estrogen, this does not mean it is harmless. Atrophic vaginitis can create a serious worsening of a person’s quality of life. Fortunately, there are many treatments for atrophic vaginitis, with and without hormone replacement.

Infection

Infections–including sexually transmitted infections–can occur after menopause, although their presentations may be slightly different. Common examples include:

• Yeast infections
• Bacterial vaginosis
• Aerobic vaginitis
• Bacterial infections, including sexually transmitted infections (STIs)
• Trichomoniasis (“trich”)—an STI caused by the parasite Trichomonas

While pregnancy may not be a concern after menopause, the risk of sexually-transmitted infections is. It’s important to practice safe sex habits even after menopause, perhaps especially if you’re experiencing signs of a condition like atrophic vaginitis.

Neoplastic changes

Neoplasm is a Greek word that means “new formation.” It also refers to cancer and pre-cancerous changes in the body’s cells. These changes can lead to vaginal discharge that takes on different colors or consistencies based on the underlying causes. They might affect the uterus, cervix, vagina, or vulva.

Common post-menopausal vaginal discharge colors and consistencies

All types of post-menopausal vaginal discharge are worth paying attention to. The color, look, and feel of your discharge can sometimes clue you into its potential cause.

• Clear vaginal discharge: Discharge consistent with atrophic vaginitis.
• Clear, stretchy vaginal discharge: Normal vaginal discharge with some mucus in it. It is more consistent with perimenopause, during which some estrogen still can stimulate the cervical mucus glands.
• White vaginal discharge: Either a normal postmenopausal discharge more concentrated from dehydration or the beginning of a yeast infection.
• Yellow or green vaginal discharge: Usually associated with a bacterial infection.
• Gray vaginal discharge: Usually associated with bacterial vaginosis, a change in the normal vaginal bacteria common after menopause.
• Brown or bloody vaginal discharge: This means blood–from somewhere. It could be harmless bleeding from traumatized atrophic vaginal cells or a warning signal for cancer risk.

Read our guides on vaginal discharge odors and vaginal discharge colors for more.

How to maintain healthy vaginal discharge after menopause

As is true before menopause, the best thing to do to support vaginal health and limit abnormal discharge is to practice safe hygiene. You can also seek appropriate medical treatment to address conditions like atrophic vaginitis.

Avoid douching and feminine products

Douching leaves a wet environment for yeast. It also disrupts the natural pH balance of the vagina, leaving it more prone to infection. Feminine “hygiene” products can likewise disturb the vaginal flora. Many also contain harsh chemicals or fragrances that can irritate delicate post-menopausal vaginal tissue.

Consider hormone replacement

Hormone replacement therapy may not be ideal for all patients, but for some people, it can help treat the cause of abnormal discharge. Hormone replacement treatments involve supplementing lost estrogen (and progesterone, in some cases) to support vaginal health and prevent changes that can lead to cancer.

Moisturizing cream

Over-the-counter moisturizers and lubricants that don’t have fragrance or harsh chemicals can help relieve discomfort. You can apply and use these as needed.

When you should see a doctor about vaginal discharge after menopause

It’s generally a good idea to talk to your doctor about any discharge that occurs after menopause. However, this is especially true if you experience other symptoms or notice blood-tinged discharge.

You should see a doctor if:

Your post-menopausal discharge:

• Is pink, red, brown, or darker, indicating blood.
• Occurs when you are on–or starting–hormone replacement therapy.
• Accompanies unpleasant symptoms, e.g., burning, itching, pain, foul smell, or pain with intercourse.
• Is associated with urination pain.
• Is associated with losing weight, nausea, or vomiting.

You should go to the emergency room if:

You experience one or more of the following:

• You are actively bleeding.
• There is what looks like tissue in your vaginal discharge.
• You have a fever.
• You have trouble with bowel movements or bloating.

Questions to ask your doctor about vaginal discharge after menopause

• Is my discharge due to atrophic vaginitis, hormone replacement, or both?
• What tests will you be doing, including those to rule out cancer?
• How quickly will you know for sure what’s causing my vaginal discharge?
• Should other specialists be involved?

How a doctor may help treat abnormal vaginal discharge after menopause

If there is blood present in your discharge, your doctor will likely begin with ruling out precancerous or cancerous causes via:

• Thorough evaluation.
• Imaging: either ultrasound or CT.
• Bloodwork for biomarkers (indicators in the blood) related to cancer.
• Bloodwork for anemia or abnormal electrolyte and enzyme levels.
• Hormone assessment if you’re on hormone replacement.
• Urine tests (urinalysis and culture for bacteria).

Once malignancy or pre-malignancy is ruled out, treatment for an abnormal vaginal discharge depends on the cause.

Antifungal medication

Your doctor may prescribe an antifungal medication like fluconazole to treat a yeast infection if it’s the cause of your discharge. Probiotics are also useful as a preventative measure.

Antibiotics

If a bacterial infection is the cause of your symptoms, your doctor will prescribe antibiotics to clear things up. Antibiotics are useful for several types of infections, including:

• Bacterial infections, such as aerobic vaginitis
• STIs like trichomoniasis
• Bacterial vaginosis

Hormonal replacement

For those with atrophic vaginitis, hormone replacement therapy may be an ideal treatment option Your doctor may prescribe estrogen pills, creams, or suppositories to treat your symptoms.

Frequently asked questions: vaginal discharge after menopause

Below are some more common questions and answers that might help you understand your symptoms:

Is it normal to have vaginal discharge after menopause every day?

Yes, a clear, watery discharge that doesn’t come with any unpleasant symptoms can be normal after menopause.

How do you know if you have excessive vaginal discharge after menopause?

You don’t. Any assessment of volume is subjective, so it isn’t reliable. However, any unpleasant symptoms (burning, itching, pain, painful urination) require proper evaluation. And any blood–even just a pink tinge–requires evaluation as soon as possible.

Final thoughts on vaginal discharge after menopause

After menopause, your hormones have changed, so your vaginal discharge will, too. If you have any discharge at all, it’s likely to be clear and watery. However, other types of discharge after menopause may be abnormal and a sign of infection, a chronic condition, or even cancer. If you experience discharge after menopause or aren’t sure if yours is normal, it’s always best to check with your doctor.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Pallabi Sanyal-Dey, MD.

Sources

National Institute on Aging. “What is Menopause?” National Institute of Health, 16 Oct. 2024, https://www.nia.nih.gov/health/menopause/what-menopause.

Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. “The Genitourinary Syndrome of Menopause: An Overview of the Recent Data.” Cureus. 2020 Apr 8;12(4):e7586. doi: 10.7759/cureus.7586. PMID: 32399320; PMCID: PMC7212735. https://pmc.ncbi.nlm.nih.gov/articles/PMC7212735/

Mac Bride MB, Rhodes DJ, Shuster LT. “Vulvovaginal atrophy.” Mayo Clin Proc. 2010 Jan;85(1):87-94. doi: 10.4065/mcp.2009.0413. PMID: 20042564; PMCID: PMC2800285. https://pmc.ncbi.nlm.nih.gov/articles/PMC2800285/

Centers for Disease Control and Prevention (CDC). “Symptoms of Gynecologic Cancers.” CDC, 5 Sept. 2024, https://www.cdc.gov/gynecologic-cancer/symptoms/index.html.

Benini V, et al. “New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review.” Medicina (Kaunas). 2022 Jun 6;58(6):770. doi: 10.3390/medicina58060770. PMID: 35744033; PMCID: PMC9230595. https://pmc.ncbi.nlm.nih.gov/articles/PMC9230595/

World Health Organization (WHO). “Menopause.” 16 Oct. 2024, https://www.who.int/news-room/fact-sheets/detail/menopause.

Stemmer SM, Mordechai E, Adelson ME, Gygax SE, Hilbert DW. “Trichomonas vaginalis is most frequently detected in women at the age of peri-/premenopause: an unusual pattern for a sexually transmitted pathogen.” Am J Obstet Gynecol. 2018 Mar;218(3):328.e1-328.e13. doi: 10.1016/j.ajog.2017.12.006. Epub 2017 Dec 13. PMID: 29247635. https://pubmed.ncbi.nlm.nih.gov/29247635/

National Cancer Institute. “Study Provides Closer Look at Postmenopausal Bleeding and Endometrial Cancer.” National Institute of Health, 29 Aug. 2018, https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom.

National Cancer Institute. “Menopausal Hormone Therapy and Cancer.” National Institute of Health, 25 Sep. 2023, https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom.

Centers for Disease Control and Prevention (CDC). “Diseases characterized by Vulvovaginal Itching, Burning, Irritation, Odor or Discharge.” Sexually Transmitted Infections Treatment Guidelines, 2021, 22 Jul. 2021, https://www.cdc.gov/std/treatment-guidelines/vaginal-discharge.htm.

Kim JM, Park YJ. “Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article.” J Menopausal Med. 2017 Dec;23(3):139-145. doi: 10.6118/jmm.2017.23.3.139. Epub 2017 Dec 29. PMID: 29354612; PMCID: PMC5770522. https://pmc.ncbi.nlm.nih.gov/articles/PMC577052

Shen J, Song N, Williams CJ, Brown CJ, Yan Z, Xu C, Forney LJ. “Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis.” Sci Rep. 2016 Apr 22;6:24380. doi: 10.1038/srep24380. Erratum in: Sci Rep. 2016 Nov 29;6:34119. doi: 10.1038/srep34119. PMID: 27103314; PMCID: PMC4840317. https://pmc.ncbi.nlm.nih.gov/articles/PMC4840317/

Sturdee DW, Panay N; International Menopause Society Writing Group. “Recommendations for the management of postmenopausal vaginal atrophy.” Climacteric. 2010 Dec;13(6):509-22. doi: 10.3109/13697137.2010.522875. Epub 2010 Sep 30. PMID: 20883118. https://pubmed.ncbi.nlm.nih.gov/20883118/

Elisheva R. Danan, Catherine Sowerby, Kristen E. Ullman, et al. “Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review.” Ann Intern Med.2024;177:1400-1414. [Epub 10 September 2024]. doi:10.7326/ANNALS-24-00610. https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610

“Menopause.” Family Doctor, Oct. 2023, https://familydoctor.org/condition/menopause/.