What is genitourinary syndrome of the menopause?

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.

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.

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.

-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.

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.

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 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

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.

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.