Menopause is an inevitable stage in every woman’s life that marks the end of the menstrual cycle. BYY expert, Dr Shareefa Rahim, BYY expert Gynaecologist and Specialist Obstetrician, explains in detail some of the symptoms that cause many women to suffer in silence.
Menopause is diagnosed after a woman has gone 12 months without a menstrual period, while not on any hormone therapy. The age of menopause appears to be genetically determined (so, it’s likely that you will be a similar age to your mother when she went into menopause) and is unaffected by race, socio-economic status, age at menarche (the start of your periods), or number of prior ovulations.
Peri menopause, however, may last several year, (up to 10) and is the phase during which your hormones are changing and it comes with many varying symptoms.
Genitourinary Syndrome of Menopause, GSM, describes various menopausal signs and symptoms associated with physical changes of the vulva, vagina, and lower urinary tract. It is a broad term that includes vulvovaginal symptoms and lower urinary tract symptoms related to low level of oestrogen.
Common vulvovaginal symptoms
According to a 2019 review, the majority of women with GSM report symptoms in perimenopause and early post menopause. They include:
- Vaginal dryness
- Painful intercourse
- Vaginal burning and/or itching
- Vaginal pain
- Vaginal bleeding and/or spotting during intimacy.
These symptoms are directly related to the lower circulating oestrogen levels after menopause. Oestrogen receptors are present in the vagina, vulva, pelvic floor muscles, urethra, and bladder during reproductive period; their levels decrease with menopause.
As a result, changes occur in female genital tissues, including reduction in the content of collagen and hyaluronic acid, and in the levels of elastin, thinning of the vaginal wall. These changes reduce elasticity of the vagina, increase vaginal pH, lead to disruptions in vaginal flora, diminish lubrication and increase susceptibility to physical irritation.
These discomforts negatively affect sexual function in postmenopausal women. According to the Study of Women’s Health Across the Nation (SWAN) report, women with sexual dysfunction attributes vaginal dryness to be the most important factor.
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Lower urinary tract symptoms
Generally, there is a connection between the urethral and genital openings which exists in the embryonic stage, and then the two structures develop and separate into the urinary and reproductive tracts.
As oestrogen plays a vital role in the function of the lower urinary tract throughout the premenopausal period, oestrogen deficiency after menopause causes urinary tract symptoms such as:
- Pain and/or burning sensation during urination
- Greater sense of frequency and urgency in urination
- Urinary incontinence
- Increased risk of vaginal, urinary tract and bladder infections.
The prevalence of urinary tract infection rises markedly in postmenopausal women as they are aging and it is mainly due to anatomic changes such as bladder prolapse.
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Effect on quality of life with menopause
Low-oestrogen level in the postmenopausal state causes many health issues including vasomotor symptoms (Hot flushes) that are often improved over time. However, genitourinary symptoms are chronic and often progress if left untreated.
These symptoms may have a profound impact on the quality of life of women by affecting self-confidence and intimacy in their couple. A recent published study found that vaginal discomfort had a direct negative impact on the intimacy of both partners and resulted in loss of libido, lack of sleep and overall poor enjoyment of life.
Furthermore, GSM may also occur in induced hypoestrogenic states including surgical menopause, use of gonadotropin-releasing hormone (GnRH) agonists, or because of cancer treatments like chemotherapy, pelvic radiation, or endocrine therapy. Since, it is an abrupt menopause, this category of patients tends to be very young and cause greater sexual dysfunction and poorer wellbeing.
GSM is a chronic syndrome with various changes in the genitourinary tissues in response to the drop in level of oestrogen that comes with menopause. The severity of symptoms varies and ranges from mild to severe, with effects on the urinary function, sexual function, relationships, and quality of life.
It is highly recommended to seek help and healthcare professionals are available to sensitively discuss symptoms and offer support and treatment options.
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