Genitourinary syndrome of menopause
I see many women around the time of perimenopause and menopause that are feeling uncomfortable with itching, dryness or burning around their vulva and vagina.
Many women also mention that sex is painful or not enjoyable anymore. Even if women are not sexually active, if the tissues are very irritated and sore, pain can be present when sitting down, horse riding or riding a bike.
Most women who book an appointment with me might have bladder, bowel or prolapse issues. When questioned they also might have repeat episodes of cystitis too. Some of these symptoms can be related to hormonal changes affecting the vaginal and vulval tissues.
In fact, 84% of women have genitourinary syndrome of menopause (GSM) (Sarmento, 2021) but many just put up with it as they feel it might be just part of aging.
Why does this happen?
Oestrogen and testosterone receptors are in the tissues around the vagina, vulva, base of the bladder and pelvic floor. Therefore, all these areas can be affected when hormone levels drop during perimenopause and menopause.
What would I see if I examined you?
· The vaginal and vulva might look less plump than expected
· The skin might look pale due to reduced blood supply or red and dry
· The vaginal skin might appear to be thinner with loss of rugae (ridges that can be felt within the vagina) and less elastic
Why would I possibly need to ask you to have further investigations with your GP?
· You have a vaginal discharge
· If you have symptoms of urinary tract infection
· If you have abnormal vaginal bleeding
What can be done to help?
Vaginal moisturisers and lubricants
Vaginal and vulval moisturisers and lubricants can really help if someone has mild symptoms of GSM and in combination with hormonal treatments. Some women can’t use hormonal treatments as they have been advised against it or prefer to not use topical hormone, so the vaginal moisturisers and lubricants provide a good alternative.
It is important for the moisturiser or lubricant to match the osmosis and pH of the vaginal and vulval skin and do not contain potential irritants that can lead to cystitis or thrush. My favourites are YES or Sylk products.
YES Vaginal Moisturiser (VM) is a moisturiser, can balance the vaginal pH, reduced sensitivity and dryness and can be used alongside hormonal treatment but at a different time or a different day.
YES Water Based (WB), Sylk and YES Oil Based (OB) can be useful as it can reduce pain during sex. It is important to realise that YES OB is not compatible with condoms.
I have samples of YES products to give out in my clinic.
Vaginal hormones
There are many types of vaginal hormones which come as creams, gels, pessaries and vaginal tablets or a vaginal ring. Most are oestrogen based by one type is a DHEA pessary which converts to Testosterone and Oestrogen.
The level of hormone is very low but can restore the vaginal pH and thickens and restore blood vessels to the skin of the vagina which makes the skin of the vaginal and vulva more comfortable. It can also decrease episodes of vaginal infections.
Most vaginal hormonal treatment is prescribed by a GP but there is an over-the-counter vaginal oestrogen called Gina. The pharmacist would check to make sure that Gina is suitable by asking specific questions as it is not okay for all women.
If you would like to know more, please ask me in clinic!
Resources:
https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. Sarmento ACA, Costa APF, Vieira-Baptista P, Giraldo PC, Eleutério J Jr, Gonçalves AK. 2021, Front Reprod Health., p.15; 3:779398. doi: 10.3389/frph.2021.779398. PMID: 36304000; PMCID: PMC9580828.