Genitourinary Syndrome of the Menopause

The reduction in oestrogen around the time of menopause can cause vaginal dryness resulting in painful sex, as well as an overactive bladder and recurrent urinary tract infections. This is because there are oestrogen and progesterone receptors on the musculature of the genital and lower urinary tract organs that are no longer activated by oestrogen, especially, causing the vagina to become thin, dry, itchy and less elastic. Vaginal mucus production decreases, further exacerbating symptoms, and causing reduced lubrication during sex. The lower urinary tract may also be affected causing symptoms such as an overactive bladder and recurrent urinary tract infections.

Genitourinary syndrome of the menopause is common, affecting approximately 50% of women. It responds well in particular to topical oestrogen which is taken vaginally. Vaginal oestrogens are very effective at relieving genitourinary symptoms and can be safely used in women who do not wish to take, or can’t tolerate, 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. It has also been endorsed by the NICE guidelines as a treatment for genitourinary syndrome of the menopause.

Non-oestrogen-based treatments are also available for vaginal dryness. Lubricants are applied before sexual intercourse, but it’s important to note that oil-based lubricants reduce the integrity of condoms. Vaginal moisturisers are longer acting, deliver continuous moisture, can be applied every few days, and don’t cause condoms to break.