The Menopause Symptoms We Don't Talk About: Genitourinary Syndrome of Menopause

by Katrina Froome

When we talk about perimenopause and menopause, we tend to hear about hot flushes, night sweats, changing periods, mood changes and perhaps a little brain fog.

But there is another group of symptoms that many women experience, and we simply don't talk about them enough.

Vaginal dryness. Irritation. Painful sex. Bladder leakage. Needing to wee more often. Recurrent urinary tract infections. And even changes or “shrinkage” of the vulval and vaginal tissues.

These symptoms can be uncomfortable, frustrating and sometimes embarrassing to discuss. Some women assume they're simply an inevitable part of getting older and something they have to learn to live with.

But they're worth talking about. Collectively, many of these changes are known as Genitourinary Syndrome of Menopause, or GSM.

What is Genitourinary Syndrome of Menopause?

As oestrogen levels decline through perimenopause and particularly after menopause, changes can occur within the tissues of the vulva, vagina, urethra and bladder.

Oestrogen plays an important role in maintaining the thickness, elasticity, moisture and blood supply of these tissues.

As oestrogen declines, vaginal and vulval tissues may become thinner, drier and less elastic. The vaginal environment can also change, including changes to vaginal pH and the microorganisms that normally live there.

Unlike some menopausal symptoms that may eventually settle, genitourinary symptoms can persist and may become more noticeable after menopause if they're not addressed.

What can GSM actually feel like?

Every woman is different, and you certainly don't need to experience all of these symptoms.

GSM may include:

  • Vaginal or vulval dryness

  • Burning, itching or irritation

  • Increased sensitivity or tenderness

  • Changes to the appearance of the vulva

  • Thinning or “shrinkage” of vulval and vaginal tissues

  • Reduced elasticity

  • Discomfort or pain during intercourse

  • Spotting or irritation following intercourse

  • Reduced lubrication

  • Urinary urgency — suddenly needing to find a toilet

  • Needing to urinate more frequently

  • Waking during the night to urinate

  • Bladder leakage or urinary incontinence

  • Burning or discomfort when urinating

  • Recurrent urinary tract infections

Sometimes women experience these changes gradually and don't immediately connect them with menopause.

You may simply notice that things don't feel quite the same anymore.

Yes, things can actually change “down there”

This is something women are often surprised to discover. The physical tissues of the vulva and vagina can change as oestrogen declines.

The tissues may become thinner and less elastic, and changes can occur around the vaginal opening, labia and clitoral tissues. The vagina itself can also become shorter or narrower.

So if you've ever thought, “Has everything actually shrunk?”

You're not imagining that things can physically change.

And there is absolutely nothing embarrassing about asking your GP or women's health practitioner about it.

What about bladder leakage?

Another symptom women often quietly tolerate is urinary leakage. Maybe you leak a little when you cough, sneeze, laugh or exercise. Perhaps you've developed a sudden urgency where you need to find a bathroom right now. Or you've noticed you're going to the toilet much more frequently than you used to.

Hormonal changes can affect the tissues surrounding the bladder and urethra, but menopause isn't necessarily the only factor.

Pregnancy and childbirth history, pelvic-floor function, constipation, medications, recurrent infections and other health conditions can all contribute.

This is why individual assessment is important rather than simply assuming:

“I'm menopausal now, so bladder leakage is normal.”

Common? Yes.

Something you simply have to accept? No.

A pelvic-floor physiotherapist can also be an invaluable part of your healthcare team.

Why can UTIs become more common after menopause?

The vaginal and urinary microbiomes are another interesting part of this conversation.

Before menopause, oestrogen helps support an environment in which beneficial Lactobacillus species can thrive.

As oestrogen declines, changes in the vaginal tissues, pH and microbial environment may reduce some of this natural protection. For some women, this can contribute to recurrent urinary tract infections.

Recurrent burning, urgency or urinary discomfort should always be appropriately assessed, particularly because not every episode of urinary discomfort is necessarily a UTI and persistent or recurrent infections require medical care.

What about painful sex?

Pain during sex isn't something you should feel you simply have to endure because you've reached menopause.

Reduced lubrication, dryness, tissue thinning and reduced elasticity can all contribute to discomfort or pain.

And once sex has become painful, another layer can develop.

If your body begins anticipating pain, the pelvic floor can tighten and the nervous system can become increasingly protective. This may make intimacy even more uncomfortable.

There can therefore be both a physical tissue component and a nervous-system/pelvic-floor component to consider.

This is another reason I love a collaborative approach to women's health.

There are treatment options

One of the most important messages I want women to hear is Please don't suffer quietly. Talk with your GP, Women's Health Clinic or other health care professionals that specialise in Women's Health or Menopause Health, about your symptoms.

Depending on your individual health history and circumstances, medical treatment may include local vaginal oestrogen, vaginal moisturisers or lubricants. Your GP can discuss whether these options are suitable for you.

Pelvic-floor physiotherapy may also be incredibly helpful, particularly where leakage, urgency, pelvic-floor dysfunction or painful intercourse is involved.

And naturopathic care can sit beautifully alongside appropriate medical care.

How can Naturopathy support vaginal and urinary health?

My approach is never simply, “You're dry, so take this supplement or just apply this cream.”

Instead, I want to understand what is happening within the bigger picture of your health.

Depending on the individual, naturopathic care may consider:

  • Nutrition and nutrient status - Are you getting adequate protein, essential fatty acids and the vitamins, minerals and phytonutrients required to support healthy tissues?
  • Hydration and mucous membrane support - Hydration, dietary fats and particular nutritional and herbal medicines may be considered as part of supporting healthy mucous membranes and tissue integrity.
  • Inflammation - Diet, lifestyle and nutritional strategies may help support a healthy inflammatory response where appropriate.
  • The vaginal and urinary microbiome
    Particularly for women experiencing recurrent urinary symptoms, microbiome health may form part of the broader clinical picture. This doesn't mean every woman needs vagninal microbiome testing or probiotics - treatment should be individual.
  • Gut health - Constipation, digestive health and the gut microbiome can also be relevant when we're looking at pelvic-floor and urinary health.
  • Stress and the nervous system - The nervous system can influence pelvic-floor tension, pain, sleep, libido and our experience of intimacy. Supporting nervous-system regulation can therefore be another piece of the puzzle.
  • Your broader menopausal health - Sleep, energy, mood, metabolic health, bone health, cardiovascular health, thyroid function, medications, movement and overall nutrition all matter too.

Sometimes a combination of naturopathic care + your GP + a pelvic-floor physiotherapist provides the most appropriate support.

It doesn't have to be one or the other - natural medicine or conventional medicine. Both can work in synergy. 

When should you seek medical advice?

Please don't assume every vaginal, vulval or urinary symptom is menopause.

Seek appropriate medical assessment for symptoms such as unexplained vaginal bleeding, bleeding after sex, persistent pain, unusual discharge, sores or skin changes, blood in the urine, recurrent urinary infections, significant pelvic pain or any new symptom that concerns you.

These symptoms deserve proper investigation.

Let's make the uncomfortable conversations more comfortable

For generations, women simply didn't talk about many of these changes. Thankfully, that's changing. Menopause isn't just hot flushes. It's a whole-body transition, and some of its symptoms occur in parts of our bodies we may feel uncomfortable discussing.

But vaginal dryness, painful sex, vulval changes, bladder leakage, urinary urgency and recurrent UTIs are health concerns - not embarrassing secrets.

And there are options for support.

If you've noticed changes during perimenopause or menopause and would like to explore your health from a broader perspective, naturopathic consultations are available in Springfield Lakes and online Australia-wide.

Let's make the uncomfortable conversations a little more comfortable. 🌸

Katrina Froome — Degree-Qualified Naturopath, Herbalist & Nutritionist

 

 

Back to Health Topics