The Hidden/Least talked about Menopausal Symptom

The Hidden/Least Talked About Menopause Symptom…

 We have all heard of the hot flashes, night sweats, brain fog and weight gain associated with menopause, however the “genitourinary symptoms of menopause” often get overlooked because of its’ frequent later onset of symptoms, many of which can be embarrassing  and many clinicians gloss it over and unfortunately don’t ask about it….

While all menopausal symptoms can have a significant impact on the quality of life, the genitourinary symptoms of menopause GSM (formally known as “Genitourinary atrophy”) can perhaps be the most overlooked and distressing symptoms women encounter during the “change”.  If women are not asked, they often don’t share about their distress and it’s important to encourage women to share and questions regarding this, should be part of the review of systems history form and also verbally addressed.

GSM symptoms can include, vaginal and vulvar irritation, dryness, pain with sex, and urinary burning, urgency, frequency, leakage and an increased risk or urinary tract infections. The physiological cause is related to decreasing amounts of estrogen and influence on estrogen receptors which diminishes collagen, hyaluronic acid, and elastin which are essential for vaginal health and elasticity.  As a result, the vaginal epithelium thins causing sensitivity and pain.

Because the genital and urinary systems are embryologically related and derived, the muscle atrophy which occurs resulting from thinning epithelium, impacts the bladder, urethra and pelvic floor muscles’ ability to contract properly as well. These symptoms can all alter the genitourinary tract integrity by decreasing the vaginal lactobacilli in the vagina (which normally make acid, keeping the PH low) however, their absence increases the vaginal PH, increasing the risk of vaginitis, sexually transmitted and urinary tract infections by altering the normal protective vaginal microbial biome/environment.   Women may be embarrassed to discuss their inability to hold their urine which can impact their desire to have sex as well as painful, dry, intercourse and diminished capacity to climax, can all impact the ability to experience pleasure with sex.

These symptoms affect between 25-75 % of women in the peri and menopausal states.  Having to endure and deal with GSM can affect one’s quality of life including increasing the risk for depression and anxiety and can affect a woman’s relationship with their partner; Therefore, evaluation and assessment of a patient’s emotional and relationship well-being, screening for decreased libido, pain with sex and intimate partner violence is imperative.  The management of any GSM symptoms these must be individualized and based on patient preference, values and should consider symptom severity and impact on the individuals’ quality of life.  

The good news is that once identified, many of the symptoms of GSM can be managed through lifestyle changes, or/and often small amounts of local bioidentical estradiol in the form of a cream, vaginal tablet or ring, can do wonders and does not increase the risk of cancer because of the tiny amount used. Unfortunately, the black box warning on these products remains inappropriate as was taken from and related to higher dose oral estrogen preparations and past studies. No studies to date have revealed that these small amounts of vaginal estrogen cause harm and risk and many health professionals from the American College of OB/GYN as well as and the National Menopause Society have gone to the FDA to have this inappropriate, unsubstantiated warning, removed from approved FDA manufactured vaginal estrogen preparations. This is an ongoing battle that concerns all women and most clinicians caring for women as it creates unnecessary and unsubstantiated fear for women. In fact, women are more likely to get a urinary or kidney infection from the genitourinary symptoms of menopause and become septic and die compared to the risks from local vaginal estrogen use.!!  Two other drugs, Tibolone and Ospemifene have been shown to have helpful effects on the bladder vagina and bladder.

A word of necessary caution: Ideally as a clinician,  I  prefer to see women and evaluate them BEFORE they start any vaginal estrogen preparation, However,  it is reasonable that most women if screened properly via history,  could wait a bit but ideally most women should have an in person well woman pelvic exam within a short period of time (like 3 months) of starting vaginal estrogen as there may be other causes of certain genitourinary symptoms at this time. These can include uterine or bladder prolapse, lichens sclerosis et atrophicus or vulvar intraepithelial neoplasia (precancer) or Paget’s disease.  Any bleeding whatsoever, even spotting, must be evaluated to determine if it comes from the bladder, rectum, vagina or vulva and is a contraindication to vaginal estrogen until this is determined and understood.

Effective lifestyle changes include non -hormonal water, oil, silicone or hyaluronic acid based lubricants may be beneficial for sex and general comfort. Also, the use of vulvar balms utilizing natural based, olive and non-GMO seed oils that are paraben, wax and petroleum free can help. Sleeping bare bottomed and either only using water or Cetaphil bar soap for vulvar and vaginal hygiene is key. Wearing 100% cotton underwear and avoiding panty liners if possible, for incontinence, can help soothe vulvar and vaginal irritation. Staying hydrated, eliminating Citrus, caffeine and artificial sweeteners can aid with urinary frequency, irritation and incontinence.

There are many more things that can benefit women at this time increasing their quality of life. We here at Women Wise Holistic Healthcare and Wellness are available to address your issues with our peri and menopause consult. Call our office and find out more about how we can help you live your healthiest and happiest life post -menopausal.  It’s truly possible!!!

Don’t give up trying to find the right clinician that cares listens and is a responsive partner.  We are right here for you!!  You deserve at least that and more!!!!   We practice Soul Centered Wellness focusing on your whole self, physically, emotionally and spiritually! We care for your inside (what’s going on in your life) as well as the outside and know that one’s state of mind and how we deal with stress and life impacts us physically and emotionally and spiritually. Women Live one third of their lives post- menopausally. Why not make it the best and healthiest and happiest time of your life??!!!  Take care, Wishing abundant blessings to all. Nameste!