Genitourinary Syndrome of the Menopause

The reduction in oestrogen around the time of menopause can cause the vagina to become thin, dry, itchy, and less elastic which can also result in painful sex,. It can also affect the bladder resulting in an overactive bladder and recurrent urinary tract infections. These symptoms are known as genitourinary syndrome of the menopause ( GSM).

GSM is common and is estimated to affect up to 50-80% of women depending on different studies. Vaginal moisturisers and lubricants are an important aspect of menopause care, reducing vaginal dryness, irritation, and pain on intercourse. Vaginal moisturisers are usually long acting and applied every few days. They don’t affect the integrity of condoms. Lubricants are usually applied prior to intercourse and can be oil-based or water-based. Water-based lubricants should  be used if a condom is required.

In addition to lubricants and moisturisers, vaginal oestrogens can be extremely effective at relieving symptoms of GSM. Vaginal oestrogens are inserted into the vagina as a pessary, cream, gel, or ring. They can usually be used by women who do not wish to take, tolerate, or have a contraindication to systemic HRT. There is no need for endometrial protection with a progesterone in this instance as vaginal oestrogens act on the vagina and lower urinary tract directly with minimal absorption into the bloodstream thereby not affecting the lining of the womb.

GSM will usually require life-long treatment.