The Genitourinary Symptoms of Menopause aka the "Big Dry"
Genitourinary Syndrome of Menopause or GSM, previously known as vulvovaginal atrophy or atrophic vaginitis refers to a collection of symptoms caused by the decrease in oestrogen levels during menopause, affecting the genital and urinary tracts.
The symptoms commonly associated with GSM include:
Vaginal Dryness: Reduced oestrogen levels can lead to decreased vaginal lubrication, causing discomfort during sexual intercourse and potential irritation.
Vaginal Itching and Burning: The vaginal tissues may become thinner and more sensitive, leading to itching and a burning sensation.
Urinary Urgency: GSM can cause increased frequency and urgency of urination due to changes in the urinary tract.
Urinary Incontinence: Some women may experience involuntary leakage of urine, especially during activities like coughing, sneezing, or laughing.
Urinary Tract Infections (UTIs): The risk of developing UTIs may increase due to the changes in the urinary system.
Dyspareunia: Painful intercourse can occur as a result of vaginal dryness and thinning tissues.
Vaginal Discharge: Some women may experience changes in vaginal discharge, often due to reduced lubrication.
Shifts in the vaginal microbiome also occur…
The vaginal microbiome refers to the community of microorganisms, including bacteria, that naturally inhabit the vaginal environment. Under normal circumstances, the vaginal microbiome is dominated by Lactobacillus species, which help maintain a slightly acidic pH and create a protective barrier against pathogens.
Oestrogen plays a crucial role in maintaining the health and balance of the vaginal microbiome. When oestrogen levels decline during menopause, several changes occur in the vaginal environment, leading to an altered microbiome:
Decreased Lactobacilli: With lower oestrogen levels, there is a decrease in the production of glycogen in the vaginal cells. Glycogen serves as a nutrient source for Lactobacillus species. As a result, the population of beneficial Lactobacilli can decrease, leading to an imbalance in the microbiome.
Increased pH: The decline in Lactobacilli and glycogen leads to a rise in vaginal pH, making the environment less acidic. This change in pH creates a less favorable environment for Lactobacilli and promotes the growth of other bacteria.
Overgrowth of Harmful Bacteria: With a less acidic environment, potentially harmful bacteria, such as Gardnerella vaginalis and various anaerobes, can flourish and dominate the vaginal microbiome.
Altered Microbial Diversity: The overall diversity of the vaginal microbiome can decrease, and the composition may become less stable, which is associated with an increased risk of infections.
But how does this affect the vaginal environment?
Bacterial Vaginosis (BV): BV is a common vaginal infection characterized by an overgrowth of harmful bacteria, leading to symptoms like abnormal discharge, itching, and a fishy odor.
Vaginal Infections: The imbalance in the microbiome can make the vagina more susceptible to other infections, such as yeast infections and urinary tract infections (UTIs).
Vaginal Dryness and Irritation: The lack of Lactobacilli and alterations in the microbiome can contribute to vaginal dryness and irritation, making intercourse uncomfortable.
Increased Vulnerability to Sexually Transmitted Infections (STIs): Changes in the vaginal microbiome can compromise the natural protective barrier against pathogens, potentially increasing the risk of acquiring STIs.
What do we do about it?
There are some great natural therapies that may assist GSM and keep those microbes healthy!
Phytoestrogen Foods: such as soy (organic); flaxseeds; chickpeas and lentils may provide oestrogen like effects and help alleviate symptoms.
Omega-3 Fatty Acids: These healthy fats found in fish, chia seeds, and walnuts have anti-inflammatory properties and can support overall vaginal health.
Vitamin E: Vitamin E is thought to promote vaginal lubrication and improve dryness. Nuts and seeds, are good sources of vitamin E.
Sea Buckthorn Oil: This oil is rich in omega-7 fatty acids, which can support mucous membranes, including those in the vaginal area.
Black Cohosh (Cimicifuga racemosa): Black cohosh is a popular herb known for its potential to alleviate menopausal symptoms, including vaginal dryness. It may help balance hormone levels and improve vaginal moisture.
Lactobacillus crispatus (L. crispatus): is one of the dominant species of Lactobacilli in a healthy vaginal microbiome. It plays a crucial role in supporting vaginal health and maintaining a balanced environment.
Use a good quality, pH friendly lubricant like Simply Olive and Bee when getting intimate. Using good quality products like this helps to protect the vaginal microbiome.
I highly recommend seeing a women’s health physio to keep things in check during this time. Even if you do not have an “issues”, prevention is better than cure I say!
There is honestly so many more options, and I will often compound topical formulas like creams, balms and pessaries in the clinic to assist with these issues. But each persons requirements are very different so always check with your health professional to make sure what you are using is safe and specific for you!