Urogenital Atrophy2023-06-07T07:37:01+00:00

What is genitourinary syndrome of the menopause?

Female genitals are filled with oestrogen receptors. We have lots of oestrogen circulating around the body before the menopause and this acts on those receptors to keep the vaginal and vulval tissues healthy, plump, well lubricated and stretchy.

Female genitals are filled with oestrogen receptors. We have lots of oestrogen circulating around the body before the menopause and this acts on those receptors to keep the vaginal and vulval tissues healthy, plump, well lubricated and stretchy.

Oestrogen also maintains the vaginal environment at an acid pH which creates a barrier to infection.

When oestrogen levels fall at the menopause the tissues can become thin, irritated, often dry and fragile with splitting of the skin around the vagina and perineum being a common symptom. The natural architecture and anatomy of the vagina and vulva can change with loss of oestrogen, causing the vaginal entrance to become smaller and the clitoris either hidden or uncomfortably exposed.

There are many oestrogen receptors throughout the urinary system as well as the vagina. Consequently, the changes in the vagina around this time will almost certainly be happening alongside similar changes in the bladder and urethra. Thus urinary symptoms frequently accompany vaginal symptoms.

Common urinary symptoms are incontinence, frequency, recurrent urinary tract infections and bladder irritation.

We use the term ‘vaginal dryness’ a lot but not all women have a dry vagina at this time- in fact some women experience increased secretions with soreness and weeping which is often due to a change in vaginal flora from the loss of acidity in the vagina after the menopause.

All these symptoms can have a profoundly negative effect on intimacy, relationships and enjoyment of sex as well as overall quality of life. Even sleep can be affected- a sore itchy vagina and several trips to the loo are unlikely to result in a peaceful nights slumber

Does this occur at the same time as the menopause?2023-01-23T13:48:34+00:00

The genitourinary symptoms can take longer to develop than many of the other symptoms of the menopause and because women often feel embarrassed to bring this up with their doctor it may take many years after that for a woman to access help. Consequently it is often 10 years or more before a woman plucks up the courage to speak to someone about their symptoms.

This time gap from menopause to vaginal and urinary symptoms can mean women and healthcare professionals alike may not immediately connect the symptoms to the menopause which occurred some years earlier, and thus vaginal oestrogen replacement is often missed as the necessary treatment for the symptoms.

Women may have been recurrently treated for thrush due to an increased discharge only to find it doesn’t help or have had many courses of antibiotics for urinary tract infections. An itchy sore vulva can drive women to use lots of different products to try and alleviate their discomfort- only to find that this actually adds to the irritation and soreness.

Why is it important to diagnose genitourinary syndrome of the menopause?2023-01-23T13:49:00+00:00

Unfortunately the often late presentation of this condition means that the changes in the vagina and bladder are more advanced by this stage and thus more difficult to reverse. Like with everything, prevention is better and easier than cure!

If we can educate women about the genitourinary syndrome of the menopause- why it occurs, when it occurs, the symptoms and how to manage them, then many women will have a much more comfortable vagina and bladder 10 years+ down the line from their menopause.

How long do the symptoms last for?2023-01-23T13:49:42+00:00

A common misconception is that the symptoms will get better over time or improve quickly with treatment which can then be stopped. Unfortunately this is not the case and the changes in the vagina and bladder only worsen as women get older- unlike other menopausal symptoms which often improve after a number of years. Consequently the treatment needs to be long-term and any medication prescribed should be put on repeat. On stopping treatment symptoms will almost certainly recur.

What can I do to help myself?2023-01-23T13:50:04+00:00

-Be aware of your own anatomy- have a look with a handheld mirror so you know what changes may be occurring and can tell your doctor where you are experiencing symptoms

– Don’t put anything else on your vulva- scented products, perfumes, soaps and wet wipes can be extremely irritant to the vulva and vagina and make the situation worse. Try and stick to products recommended or prescribed by a doctor.

-Moisturise-a simple moisturiser can go a long way towards making your vagina and vulva more comfortable and there are a range of products available

-Use a lubricant during sex and use the right lubricant- see our psychosexual information for more tips on lubricants

-Keep having sex if you want to! It’s a common concern that having sex will damage the vaginal tissues permanently and that it is better to stop being sexually active altogether- but if sex is not uncomfortable and you want to, then there is evidence that continuing with an intimate relationship can help to keep the vaginal tissues stretchy and supple around the time of the menopause and beyond- see our psychosexual information for tips on comfortable sex.

-ask about medications that may be making your dryness worse- some medications for other conditions can make vaginal dryness worse and some of these might be able to be changed or stopped.

What treatments are available?2023-01-23T13:50:46+00:00

Replacing oestrogen in and around the vagina can alleviate both urinary and vaginal symptoms and can reverse some of the changes that may have already occurred.

These treatments can take up to 3-6 months to have a full effect and need to be used long term.

Vaginal oestrogen comes in lots of preparations including a cream, pessary, vaginal tablet and a vaginal ring. A discussion about your symptoms, medical history and personal preference will help to find a preparation that is right for you.

What are the risks of vaginal oestrogen?2023-01-23T13:52:24+00:00

Vaginal oestrogens are very safe for most women with minimal absorption around the body. Once the vaginal tissues begin to thicken again with oestrogen use, it is thought that absorption reduces to an even lower level and stays locally in and around the vagina.

If you have had an oestrogen receptor positive cancer you may be on certain medications that make prescribing a vaginal oestrogen more challenging but it is important that you explore the options available to you- there are always choices!

Laser therapy2023-01-23T13:52:47+00:00

Laser beams inside the vagina is a newer therapy and is thought to increase blood flow to the vagina and help to rejuvenate tissues and can be hugely helpful in some women. It is not currently available on the NHS

Will my HRT help?2023-01-23T13:53:08+00:00

Vaginal oestrogen is not generally described as a form of HRT.

HRT will improve vaginal and bladder symptoms in many women but around a third of women will need vaginal oestrogen in addition to HRT to manage their urogenital symptoms specifically.

It is very safe to take both together for most women.

Smears and my painful vagina?2023-01-23T13:53:32+00:00

It’s understandable that you may be put off your smear for fear of pain during the procedure if you are suffering from urogenital syndrome of the menopause but a course of local oestrogen for 6-8 weeks beforehand can really help to make the process more comfortable.

Take home messages

-be aware of your vaginal health- its important!

-fill your vagina with oestrogen

-the burning, itching and discharge probably isn’t thrush…

-ASK ASK ASK! If other body parts not covered by skin were suddenly exposed to the environment with no lubrication (eyes, inside your nose, mouth) you would want to see a doctor- if every speck of dust that got into your eye was causing burning and pain you would want to get it checked out. It’s the same for your vagina. Don’t be afraid to ask. We can help.


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“Very clear in her explanations and listened to my concerns. I felt very reassured that a plan is in place”

“Thank you so much for your care and attention”

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