Hormone-Related Changes to the Labia with Aging
Yes, peer-reviewed research demonstrates that estrogen deficiency after menopause causes significant structural and molecular changes to both the labia majora and labia minora, including epithelial thinning, altered gene expression affecting tissue remodeling, and symptoms of dryness, burning, and irritation.
Documented Anatomical Changes
Labia Majora and Minora Structural Changes
The labia majora and minora undergo atrophic changes as part of the genitourinary syndrome of menopause (GSM), which encompasses changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder due to decreased estrogen and other sex steroids. 1
Histological analysis reveals dramatic epithelial thinning in the vaginal introitus (fourchette) of postmenopausal women with vaginal atrophy, with the introitus appearing exquisitely sensitive to hormone status. 2
The labia majora shows changes with menopause but is considerably less sensitive to hormone status compared to the introitus, though measurable alterations in histology and gene expression still occur. 2
Molecular and Gene Expression Changes
Postmenopausal women with atrophy demonstrate differential expression of numerous genes in the introitus that contribute to tissue remodeling, including genes associated with wound healing, angiogenesis, cell migration/locomotion, dermal structure, apoptosis, inflammation, epithelial cell differentiation, and fatty acid, carbohydrate, and steroid metabolism. 2
The gene expression changes observed at the introitus in postmenopausal women are very similar to those reported in the atrophic vagina, providing evidence that these molecular alterations are directly associated with estrogen-deficient atrophy. 2
Clinical Manifestations
Symptoms Affecting the Labia
GSM symptoms affecting the labia include genital dryness, burning, and irritation, which may present individually or in combination and must be bothersome to the patient. 1
Estrogen deficiency causes physiologic changes including vulvovaginal atrophy that leads to vaginal dryness, itching, irritation, reduced lubrication, dyspareunia, and vaginal bleeding associated with sexual activity. 3
Skin and Tissue Changes
Postmenopausal estrogen deprivation accelerates cutaneous changes including dryness, atrophy, fine wrinkling, and poor wound healing throughout the vulvar region. 4, 5
Epidermal thinning, declining dermal collagen content, diminished skin moisture, decreased laxity, and impaired wound healing characterize postmenopausal vulvar skin. 5
Hormonal Mechanisms
Estrogen Receptor Distribution
Two estrogen receptors (alpha and beta) have been identified in various tissue types, including vulvar and vaginal tissues, mediating the effects of estrogen on these structures. 5
The highest incidence of vulvar atrophic changes occurs in low estrogen physiological states, particularly in prepubertal girls and postmenopausal women. 6
Reversibility with Hormone Therapy
Hormone therapy can reverse many of the histological and gene expression changes in the introitus and labia, with treated postmenopausal women showing tissue characteristics more similar to premenopausal women. 2
Both systemic and local estrogen therapy improve vulvovaginal health, though local vaginal therapy may be more appropriate for women without other indications for systemic estrogen. 3
Important Clinical Context
The term "genitourinary syndrome of menopause" was formally endorsed by the North American Menopause Society and the International Society for the Study of Women's Sexual Health in 2014 to replace "vulvovaginal atrophy," as it more accurately describes the comprehensive nature of estrogen-deficient changes affecting the entire genitourinary tract, including the labia. 1
Unlike vasomotor symptoms that tend to resolve over time, atrophic changes to the labia and other vulvovaginal structures may persist indefinitely and often worsen without treatment. 7