Vaginal Discharge & Perimenopause: Colors, Changes & Meaning

Key takeaways:

• The run-up to menopause, called perimenopause, can last years and may affect vaginal discharge over this time.
• Irregular or declining hormones associated with perimenopause can mix blood with your normal vaginal discharge.
• Other causes of discharge during menopause include infections or chronic health conditions.

Menopause is defined as having zero periods for one year. The average age of menopause in the USA is 52, but the run-up to menopause, unofficially deemed perimenopause, may take several years. During this time, you may experience vaginal discharge that shifts in appearance, volume, or consistency.

Irregular production of estrogen during perimenopause may cause irregular bleeding. Sporadic ovulation and subsequent progesterone production impact this already irregular process. Any one of these factors can cause perimenopausal vaginal discharge that is different from previous discharge. It’s also possible to experience discharge that’s caused by an infection.

Let’s take a closer look at how vaginal discharge can change during perimenopause to help you better understand whether your symptoms are worth bringing up to your doctor.

How vaginal discharge changes during perimenopause

The amount of normal vaginal discharge your body produces decreases as you approach menopause. That being said, perimenopausal discharge is still something you may experience. It can range from absent to scant to heavy, clear to white, or slippery to sticky. These changes occur for many reasons.

Ovarian dysfunction

As the phases of the menstrual cycle start to wane, their various effects may overlap or skip. Your periods may also change.

The most notable change is irregular bleeding—irregular shedding of the uterus's lining. Irregular bleeding can discolor perimenopausal discharge, which is normally clear and watery, to pink or red. In the perimenopausal years, the synchronization of the different phases ceases. Bleeding—if you have any at all—can be unpredictable.

Progesterone will usually decline more than estrogen at first, causing a discharge to be less mucousy. As estrogen declines, most women will notice less vaginal discharge. The presence of discharge, however, isn’t necessarily abnormal.

Atrophy

Estrogen has many functions, one of which is to maintain the health, thickness, and cell turnover of the vaginal tissue. When estrogen declines, you lose more vaginal cells in a phenomenon called atrophic vaginitis. This increased loss of cells can collect in your vagina; you’ll see it as a watery discharge.

Thinning of vaginal tissues makes them more fragile. Sex, or even normal non-sexual activities, may be more likely to traumatize vaginal tissues. Microscopic bleeding can result. Your vaginal discharge may have a pink tinge or, in severe cases, red or brown. Any bleeding, however, should be evaluated by a doctor.

The normal vaginal bacterial balance is dominated by lactobacilli that maintain vaginal health. Estrogen is important for continued lactobacilli presence. During perimenopause, bacterial imbalance occurs. This affects vaginal acidity, and the change can invite infections.

Abnormal vs. normal vaginal discharge during perimenopause

Normal vaginal discharge during perimenopause (aside from blood discoloration noted with irregular cycles) is clear and watery or possibly white and thick. A slippery, mucusy consistency will become watery or white.

It’s important to note that being perimenopausal doesn’t offer any special protection against infections. Any infection that can occur before menopause can also occur during its progression and cause an abnormal vaginal discharge.

Likewise, an infection can also cause inflammation of the vaginal tissues (vaginitis) or the cervix (cervicitis). Such inflammation can result in bleeding, which can discolor vaginal discharge to pink, red, brown, or black.

Causes of vaginal discharge changes during perimenopause

There are a few common causes of vaginal discharge changes during perimenopause, including the following:

Atrophic vaginitis

Declining estrogen causes vaginal tissue to become thinner due to a loss of vaginal cells. While the cells are microscopic, their collection can present to the naked eye as a watery discharge.

Bacterial vaginosis

While bacterial vaginosis (BV) can occur from sex, it can also occur without it. It is a loss of the helpful lactobacilli that constitutes the healthy bacterial balance in the vagina. It causes a gray or yellow discharge, is associated with itching and possibly burning with urination, and often has a fish-like odor.

Aerobic vaginitis

Less commonly (than BV), other bacteria (e.g., from the rectum) can enter the vagina despite scrupulous hygiene. Unlike BV, aerobic vaginitis usually causes severe inflammation with burning and itching. Its discharge is yellow and sticky and can have a fish-like odor.

Yeast infection

Vulvovaginal candidiasis is a yeast infection caused by an invasion of fungus. An overgrowth of the scant yeast already present in the vagina can also cause this infection. It causes mild-to-severe itching and burning. The discharge is white and sometimes thickens into a cream cheese-like consistency.

Trichomoniasis

This is an STI caused by the protozoan trichomonas. It is most frequently diagnosed in women during perimenopause and menopause, but it can occur at any age. The discharge is green and frothy, associated with burning, and has a fish-like odor.

Sexually transmitted infections (STIs)

STIs like gonorrhea and chlamydia are of particular concern during perimenopause. Due to decreasing fears over unwanted pregnancy, some people are less inclined to use barriers or protection. Both of these STIs can cause a foul-smelling green discharge with pain. Chlamydia, however, often has no symptoms.

Common vaginal discharge colors and consistencies during perimenopause

While any discharge in the perimenopausal period other than clear or watery should necessitate a medical evaluation, colors and consistencies of the discharge may help pinpoint the cause.

• Clear vaginal discharge: This is normal in the perimenopausal and menopausal phases of life.
• Clear, stretchy vaginal discharge: This is a normal perimenopausal discharge that indicates progesterone is still stimulating mucus production.
• White vaginal discharge: This could be merely a normal discharge with dehydration. When there are symptoms of itching or burning, it may indicate a yeast infection.
• Yellow or green vaginal discharge: If it is frothy and has a fish-like odor, it could be BV (gray or yellow) or trichomonas (green).
• Gray vaginal discharge: This is usually associated with BV, often with a fishy odor.
• Brown or bloody vaginal discharge: This means there is bleeding, which can rarely be a sign of cancer.

Read our guides on vaginal discharge colors and types of vaginal discharge for more.

How to maintain healthy vaginal discharge during perimenopause

The following tips are essential for vaginal health before, during, and after perimenopause:

Keep regular check-ups

Some infections have no symptoms and are found during regularly scheduled visits.

Don’t douche or use feminine hygiene products

Douching washes out your helpful bacteria and leaves a wet environment in which yeast can thrive. Many hygiene products have harsh chemicals that can be irritating to vaginal tissues.

Clean only your external genitalia (vulva)

You don’t need any intrusive invasions into your vagina with water, soap, or deodorants. Just clean between the labia with fragrance-free soap and warm water. Dry thoroughly to prevent yeast.

Practice safe sex

During perimenopause, you may still ovulate from time to time. This means you can get pregnant. Also, barrier contraception is necessary to prevent STIs. Use a water-based lubricant and not an oil-based one.

When you should see a doctor about vaginal discharge during perimenopause

The following advice applies to seeing a doctor about a vaginal discharge at any stage of your life.

You should see a doctor if:

Check with your doctor if you experience vaginal discharge during menopause that is:

• Heavy or contains blood.
• Accompanied by unpleasant symptoms like burning, itching, pain, foul smell, or pain with intercourse or urination.
• Associated with nausea or vomiting.

You should go to the emergency room if:

Seek immediate medical care if you have symptoms like those above and:

• You have a fever.
• You have pelvic, abdominal, or back pain.
• You are actively or heavily bleeding.
• There is tissue in your vaginal discharge.
• You have trouble having bowel movements or experience abdominal bloating.

Questions to ask your doctor about vaginal discharge during perimenopause

• Is my vaginal discharge normal, or is it a possible sign of infection?
• How will you determine the cause of my discharge?
• Is there anything I can do to reduce any of my unpleasant symptoms?
• Should my partner also see a doctor?

How a doctor may help treat abnormal vaginal discharge during perimenopause

Depending on the underlying cause of your vaginal discharge during perimenopause, your doctor may prescribe prescription or over-the-counter supplements to help.

Antifungal medication

For conditions like yeast infections, your doctor may prescribe pills, creams, or suppositories that eliminate yeast. Pills may have an advantage for two reasons:

1. External and vaginal creams and preparations have harsh chemicals that can irritate your vagina.
2. Many have re-infection from rectal yeast, which pills may eliminate.

Antibiotics

Antibiotics will almost certainly be prescribed if you have an STI or another bacterial infection, such as bacterial vaginosis.

Alternatives

Yogurt or live lactobacilli can be used to help re-establish your vaginal bacterial balance. In most cases, though, antibiotics are still the front-line treatment.

Frequently asked questions: vaginal discharge during perimenopause

Perimenopause can last from five to 10 years, which means there’s plenty of opportunities to encounter uncertainty or questions. Some of the common ones include:

Can perimenopause increase vaginal discharge?

Yes. Increased vaginal cell turnover can increase the amount of the clear, watery discharge. Vaginal discharge can also decrease.

Is vaginal discharge a sign that perimenopause is starting?

No. Although perimenopause can have a discharge, a discharge does not mean perimenopause is starting. Vaginal discharge can occur at any time in a woman’s life.

Managing vaginal discharge

The important actions to ensure vaginal health during perimenopause are essentially the same as those during any other life stage. Vigilance for STIs and pregnancy should continue. Bleeding, which can be present but irregular, may require a doctor’s visit to rule out serious causes.

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. Lane Thaut, DO.

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