I cannot tell you how often women almost fall over when they learn about what happens to their lady parts starting in mid life in my clinical practice… Everyone knows what’s coming with puberty but to this day, most women are just completely steam rolled in the perimenopausal transition. Like, mind-blown!

I am doing my bit in the sea-change of the menopause narrative both by educating but also by contributing to reframing how we think, feel and act about it. We didn’t come this far just to feel demoralized ladies, we truly didn’t.

To that end, knowledge is power and this piece puts a much needed spotlight on vaginal & bladder changes that you need to know about so that you do NOT suffer. 

Understanding the Genitourinary Syndrome of Menopause (GSM)

Genitourinary syndrome of menopause (GSM) is the medical term used to define changes arising from decreased estrogen in the vaginal area, pelvic floor and urinary tract. These changes can start well before menopause or well after menopause; it is different for everyone.

Symptoms of GSM

  • Vaginal dryness, irritation, itching,  burning, or discharge
  • Decreased lubrication 
  • Pain during sex, bleeding after sex
  • Delayed or diminished orgasm
  • Urinating frequently, urgency, peeing more at night, recurrent UTIs
  • Thinning pubic hair, decreased volume of labia
  • Thinning or fusion of labia minora (inner lips)
  • Clitoral hood shrinkage, retraction
  • Vaginal canal becomes thin, less hydrated

Of all the challenges that menopause can bring, vulvovaginal atrophy (VVA), which falls under GSM, is among the most common, impacting up to 90 percent of women. And unlike other symptoms that can abate over time, vaginal pain, dryness, and irritation doesn’t disappear and often worsens because it results from physical changes in those tissues. Our vulvar tissues lose elasticity, collagen and hydration resulting in some shrinkage, tissue laxity and dryness resulting in pain. For some women this is just with sex, for some they cannot get a PAP or pelvic exam, for some it is so bad that they can’t even wear jeans. 

Don’t Fret… There are Treatments:

Estrogen

Vaginal estrogen is the gold standard treatment for GSM because it is the loss of estrogen that is the root cause of these changes. It improves the quality of the tissues in and around the vagina, thickens the skin of the canal, increases natural lubrication,  restores normal pH of the vagina and reduces the risk of UTIs. It is safe for ALL women, even those who have had breast cancer. Note, you will likely need local estrogen even if you’re already on systemic estrogen aka menopause hormone therapy.

Hyaluronic Acid (HLA)

For women who need extra hydration and support in addition to local estrogen therapy, HLA-based products are your best bet. They can also help reduce vulvovaginal symptoms like itching, burning, and dryness.

Work With Me

If you are struggling with GSM and other peri and menopause-related symptoms, I am a board-certified Naturopathic Doctor with 15+ years of experience in women’s health and hormones. I can help! 

Book a consultation with me today.

Helpful articles:

https://www.acog.org/news/news-releases/2016/02/acog-supports-the-use-of-estrogen-for-breast-cancer-survivors

https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf