What's actually happening.
The vaginal, vulval, and urinary tissues are densely populated with oestrogen receptors. As oestrogen falls, these tissues thin, become drier, lose elasticity, and become more vulnerable to infection. The result is a constellation of symptoms grouped as genitourinary syndrome of menopause.
Unlike hot flushes, urogenital symptoms typically worsen with time if untreated. The good news is that they respond well to local treatment, including in women for whom systemic HRT is not appropriate.
Common signs
- · Vaginal dryness and discomfort during sex
- · Recurrent urinary tract infections
- · Urinary urgency and frequency
- · Vulval itching or burning
- · Discomfort sitting or wearing tight clothing
How I approach this.
I take a careful sexual and urinary history. Most women find this conversation easier than expected once a clinician opens the door to it. There is no embarrassment in the room.
Vaginal oestrogen, in cream, pessary, or ring form, is the cornerstone of treatment and is safe for almost everyone, including most women with a history of breast cancer. It is not absorbed systemically in any meaningful amount and can be used long-term.
For recurrent UTIs specifically, vaginal oestrogen substantially reduces frequency in postmenopausal women. Standard antibiotic prophylaxis carries downsides, and is worth considering only after vaginal oestrogen has been tried.
Ready for this to stop being a quiet problem?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.