Is this normal?

Vaginal discharge can change with age. Here's how to spot signs of a problem that might warrant a trip to the doctor.

Vaginal discharge and bleeding can change during different stages of life, and what's typical for you might not be typical for your sister, your daughter, or your friend. "When it comes to vaginal discharge, a wide range of 'normal' can be considered," says Dr. Kristin Hung, instructor in obstetrics, gynecology, and reproductive biology at Harvard Medical School.

Not only is there natural variation between women, but what's normal for your own body may also change over time. So how can you tell when something is wrong, or if the changes you're noticing are just the result of aging or hormonal shifts? "Typically, most women know their own bodies, and anything new, unusual, or persistent is a reason to seek evaluation," says Dr. Hung. That said, she adds, there are some changes that are pretty typical and others that might warrant a little more scrutiny through a visit to your doctor. Here's how to tell the difference.

Q. What's the normal range of vaginal discharge that most women experience?

Some women may experience vaginal discharge daily, others less frequently, and it may become heavier or lighter at different points during a woman's menstrual cycle. Most commonly, typical vaginal discharge is a small amount and white or clear without a strong odor.

Q. How do vaginal discharge and bleeding change as women age?

As women enter perimenopause, menstrual cycles can change, with some women experiencing bleeding that's heavier than normal and irregular, and others noting a gradual lessening of flow and less frequent bleeding. Any bleeding that is heavier than normal should be brought to the attention of a physician, as a very small percentage may indicate an underlying issue.

The same is true if you've gone through menopause, defined as a full 12 months without menstruation, and suddenly you experience vaginal bleeding. "If you haven't had a hysterectomy, any vaginal bleeding, no matter how scant, must be evaluated by a physician," says Dr. Hung. "In postmenopausal women, vaginal bleeding can be the first sign of an abnormality in the lining of the uterus, and sometimes, this is a sign of cancer."

Q. Are there other problems that can arise during menopause that can cause changes in discharge?

In menopause, the lack of estrogen often leads to thin, dry skin in the vulva and vagina and a vaginal environment that prevents "good" bacteria from flourishing. In such a situation, other bacteria can grow, sometimes resulting in increased or bothersome vaginal discharge that is not necessarily dangerous but can affect quality of life. "Any vaginal discharge that is persistent, copious, or foul-smelling should be evaluated by a physician," says Dr. Hung.

Q. What can women do to relieve bothersome symptoms that may stem from these vaginal changes?

Good hygiene principles can help if you have skin that is already irritated, dry, and thin. Wearing only loose cotton underwear or clothing; avoiding all soaps, douches, and other products in the vagina; and going without underwear when you sleep are all good first steps to take.

Taking a probiotic can help balance your body's general bacterial ecosystem, but whether probiotics can successfully and clinically improve the vaginal ecosystem is not known, and this is currently being studied. Your doctor may be able to recommend or prescribe other products to help.

Q. What other signs should prompt a visit to your doctor?

Vaginal discharge that is fishy in odor or that is associated with itching in the genital area may indicate the overgrowth of certain bacteria or yeast. This kind of problem often responds to a simple course of treatment prescribed by your physician.

Q. Do you have any overall advice for women?

If a change to your vaginal discharge is bothersome or persistent, consider having it evaluated. When it comes to your vulvovaginal health in menopause, don't hesitate to speak up. "For centuries, women have been taught many myths about their own bodies and were encouraged to stay silent when they may have been better served by speaking up," says Dr. Hung. "If anything bothers you or concerns you, just ask your physician — you are not alone."

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