Have you noticed vaginal discomfort and bladder symptoms, but your urine and vaginal swab tests have come back normal? This is a common scenario I see in clinic, and women are often puzzled as to what to do next if there is no obvious infection to treat.
GSM, or genitourinary syndrome of menopause, affects more than 50% of women in the second half of their life.
Initially, during perimenopause, the symptoms are often quite mild - perhaps running to the toilet to urinate a little more often, or some vaginal dryness. Things often worsen between 3 to 6 years post menopause. I sometimes have ladies in their 60’s and older look confused when I mention their symptoms are likely related to post menopause changes, and they say “But I went through that years ago!”
Unlike hot flushes, GSM does not resolve by itself with time, and progressively worsens.
So what causes it?
Your genital and bladder tissues rely on oestrogen for maintenance. As oestrogen is lost, the tissues change and become dryer, more fragile, less elastic and may even bleed. Blood flow to the area can also reduce (studies have shown between 12% and 65% less blood flow).
For your genitourinary tissues, it’s like being in a desert with no water! Everything becomes dry, hot, inflamed, sore and more irritable!
There are good treatment options. Benefits of treatment can include relief of dryness and discomfort, improved lubrication/arousal/desire, less urinary frequency and getting up to the toilet at night, and less frequent bladder infections.
In New Zealand, vaginal oestrogen (pessaries or cream) are funded and have a good safety profile. Very little is absorbed into the blood stream from the vagina, and it is considered safe to use life long (even in women who have had breast cancer in the past).
Pelvic physio has also been proven to be helpful to improve bladder function and pelvic pain.
Non-funded options include vaginal DHEA (sometimes used when women cannot tolerate vaginal oestrogen, which is rare), and a slow release vaginal oestrogen ring (Estring) which lasts for 3 months.
Currently, the research does not support the use of vaginal laser treatment or vaginal testosterone preparations for the treatment of GSM (they were found to be no better than placebo treatment).
If you are struggling with GSM and want treatment, you can see your GP, a pelvic physio, or book an appointment with me here:
Remember, regardless of your age, it’s never too late to treat GSM!
Stay happy and healthy!
Erika
