Genitourinary Syndrome of Menopause
What is genitourinary syndrome of menopause?
Genitourinary syndrome of menopause, or GSM, is a term used to describe the changes that can occur in the vulva, vagina, urethra, and bladder around the time of menopause. These changes are common and affect between 40% and 90% of menopausal people.
Symptoms of GSM can occur following natural menopause or surgical menopause (surgical menopause is when someone has their ovaries removed). Unlike other symptoms of menopause, such as hot flushes and night sweats, which can improve over time, symptoms of GSM usually don’t go away and may become worse if not treated.
Simple and effective treatments are available so talk to your doctor if have any symptoms of GSM.
What are the symptoms?
Symptoms of GSM vary but can include:
Vulval and vaginal symptoms
• Vulval and vaginal irritation, pain, itching, or burning
• Vaginal dryness
• Discomfort or pain with sex
• Smelly vaginal discharge
• Shortening and tightening of the vagina
• Thinning of the skin of the vulva, including the labia(lips)
• Light bleeding as the tissues of the vagina become more fragile (if you have any bleeding after menopause, it can be a sign of a more serious problem, so it is essential that you see a doctor about this).
Urinary symptoms
• Urinary(wee) leakage when coughing, sneezing, jogging or jumping
• Pain when your bladder is full
• Needing to pass urine more often (including at night)
• Urgency when you need to pass urine (needing to rush to the toilet)
• Frequent urinary tract infections
What causes GSM?
The hormone oestrogen is produced by the ovaries. Our body’s production of this hormone decreases around and after menopause. The symptoms caused by GSM are due to the low levels of oestrogen that occur at this time.
Oestrogen is essential for the health of your vulva, vagina, and bladder. It keeps the tissue of these areas thick, moist, and elastic. When the levels of oestrogen decrease the tissues become thinner, dryer, and less elastic.
The pH of the vagina also changes with decreased oestrogen. This can lead to an imbalance in the bacteria which live in the vagina, causing a condition called bacterial vaginosis (BV) which can have symptoms such as increased vaginal discharge, which has an unpleasant smell, and vaginal and vulval irritation.
How do you treat GSM?
There are several ways that the symptoms of GSM can be managed and improved:
Vulval care
Taking good care of your vulval skin is an essential in managing GSM. Please see SHFPACT’s factsheet on Vulval Care for details.
Personal lubricants
The use of a lubricant during sex can make it significantly more comfortable. Lubricants are either water-based, oil-based, or silicone-based. Personal preference is important, and you may need to try a few to find one that works well for you.
Water-based lubricants:
Water-based lubricants can either provide lubrication only or can also function as a moisturiser for the vulva and vagina. Using a lubricant that is also a vaginal moisturiser can be helpful by reducing dryness as well as providing lubrication.
Several brands of lubricant offer both lubrication and moisturising. If irritation and sensitivity are a problem for you, you may want to use a lubricant for sensitive skin.
The pH (how acid or alkaline something is) and the osmolality (the number of particles dissolved in a fluid) are key factors in choosing a personal lubricant.
The water-based lubricants listed here* have the recommended pH and osmolality for use with vaginal sex:
- Astroglide® Ultra Gentle Gel
- Good Clean Love® water-based lubricants
- Sylk® Natural Personal Lubricant Д Sliquid® Organic H2O
- YES® Water Based Intimate Lubricant
Oils and oil-based lubricants:
You can also use natural oils such as sweet almond, coconut, or light olive oil for lubrication. Remember if you are using condoms, you need to avoid oil, as it can increase the risk of a condom breaking.
Many different commercial oil-based lubricants are available on the market, both online and in pharmacies.
The following two are just some of the ones available*:
- Olive and Bee® Intimate Cream
- YES®OB Oil Based Personal Lubricant
Silicone lubricants: Silicone-based lubricants are made from silicone polymers. Silicone-based lubricants are not absorbed by skin or mucus membranes. This can make them longer lasting. They provide excellent lubrication but do not have a moisturising effect. Silicone-based lubricants are suitable for use wit condoms. They are not recommended for use with silicone sex toys because they may interact with the surface of the toy, damaging it and causing disintegration over time.
There are many silicone-based lubricants available in pharmacies, supermarkets, and online.
Vaginal moisturisers
As discussed above, there are water-based vaginal lubricants and natural oils which also function as vaginal moisturisers. There are also products designed specifically as vaginal moisturisers, such as YES VM ® * These are available online and in pharmacies.
Vaginal oestrogen
Oestrogen is available as a cream or pessary. These are inserted into the vagina and can be highly effective at reducing or relieving the symptoms of GSM. There is almost no absorption of oestrogen into the body, so it only acts on the local tissues.
Both the cream and pessaries are available on prescription from your doctor. They are usually used every night for the first two weeks, then ongoing 2 to 3 times weekly. Vaginal oestrogen can be used alone or in combination with Menopause Hormone Therapy.
Menopause hormone therapy
Menopause Hormone Therapy (also known as hormone replacement therapy or HRT) is the use of hormones (usually oestrogen and progestogen) in the form of a patch, gel, or tablet. Menopause hormone therapy is most often used to relieve the other symptoms of menopause, such as hot flushes and night sweats. It can also be effective in reducing the symptoms of GSM. It is only available on prescription from a doctor.
If you are interested in Menopause Hormone Therapy, you need to discuss it with your GP. You can also make an appointment with one of the doctors at the Canberra Menopause Centre.
What about vaginal laser treatment?
Laser treatments for GSM have been available in Australia for a few years. However, there is currently little evidence for the effectiveness of these treatments.
What about sex after menopause?
Although GSM can affect your sex life, you can continue to enjoy a pleasurable and satisfying sex life with good management of your symptoms and to have and enjoy penetrative sex if you wish to. Penetrative sex has been shown to help in keeping the vagina healthy and the vaginal tissues more elastic.
It’s also important to remember that penetrative sex is only a part of sex and intimacy. If penetration is too uncomfortable, then there are many other ways to enjoy sexual pleasure and closeness with a partner. Cuddling, massage, stroking, and mutual masturbation are just some of the ways to do this.
Open communication between you and your partner is essential, of course, and can be the key to keeping intimacy and a pleasurable sex life for many years to come.
You may find Dr Rosie King’s books Good Loving, Great Sex, and Where Did My Libido Go? useful. They address many of these issues and have some helpful suggestions.
If you find that you are having ongoing difficulties around sex, then talking to a sex therapist may be helpful. SHFPACT doctors and nurses can give you further information about this and about sex therapists in the Canberra region.
What about the urinary symptoms?
If you have any of the urinary symptoms listed above, it is important to discuss them with your GP or a SHFPACT doctor. Some of the treatments discussed above can improve urinary symptoms, and there are also medications available that can help. However, if symptoms don’t improve or are severe, you may need referral to a pelvic floor physiotherapist or a doctor specialising in this area.
*Please note, SHFPACT does not necessarily endorse individual products. The products listed here are just a few of the personal lubricants that are available.
The Canberra Menopause Centre
The Canberra Menopause Centre is based at Sexual Health & Family Planning ACT and is a dedicated service for those seeking information, support, and medical management of menopause. It is staffed by experienced female doctors who have a special interest in this area.
You may self-refer to the service or request a referral from your GP. We ask that you complete a medical information questionnaire prior to attending the first doctor’s appointment. To ensure that our doctors with a special interest in menopause have the opportunity to discuss your concerns, we offer longer appointments.
For more details contact us during office hours on 02 6247 3077 or email This email address is being protected from spambots. You need JavaScript enabled to view it.
References:
- Australian Menopause Society menopause.org.au
- Jean Hailes for women’s health: jeanhailes.org.au
- RACGP. 2017 AFP: Genitourinary Syndrome of Menopause
FOR OTHER HEALTH SERVICES AND INFORMATION This email address is being protected from spambots. You need JavaScript enabled to view it. OR CALL 02 6247 3077
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