Our Women’s Wellness Evenings are wonderful nights of learning and connection, and a powerful reminder that we’re all navigating our own trials and tribulations when it comes to health and wellbeing. Talking openly and sharing experiences helps break down stigma and reminds us, we’re not alone.

This month’s focus was Genitourinary Syndrome of Menopause (GSM), though our conversation also touched on menopause more broadly, HRT, libido, and intimacy.

Here’s a recap of some of the key takeaways:

GSM symptoms are wide-ranging

These can include vaginal dryness, burning, itching, painful intimacy, pelvic pain, bladder urgency/frequency, incontinence, and recurrent UTIs. These changes are caused by a drop in estrogen post-menopause, which leads to thinner, drier, and more fragile vaginal and vulval tissue. If left untreated, symptoms often worsen. They can become very debilitating and impact on quality of life.

Early treatment matters

Vaginal estrogen (eg Ovestin and Vagifem) is considered the gold standard for treating most GSM symptoms. It works locally and is typically safe even for women who can’t use systemic estrogen, including many with a history of breast cancer. Intrarosa is another option. It is a vaginal pessary that is converted into both androgens and estrogens which then work locally to restore vaginal tissue and lubrication. Unfortunately, it is not currently PBS-listed and therefore more costly but generally seen as the gold standard for postmenopausal women.

UTIs and long-term health

Recurrent UTIs can become more common with age. Vaginal estrogen has been shown to reduce UTIs in older women by up to 50%, and may even help prevent severe complications like sepsis.

Pelvic floor physiotherapy

Women’s health physios are invaluable for GSM support. They can help address many symptoms such as incontinence, bladder irritation, prolapse, or pelvic floor weakness or tightness. Past traumatic births (ie tearing, forceps deliveries) may also make some women more susceptible to GSM symptoms during perimenopause and menopause.

Libido and intimacy

GSM can significantly impact libido. Testosterone can help some women, but desire isn’t only about hormones. It also involves stress levels, emotional connection, and relationship dynamics. A relationship therapist may be an important part of the solution.

Blood flow matters

Keeping blood flow to the vaginal area helps maintain healthy tissue. If you’re not sexually active, using a vibrator or other form of stimulation can be really beneficial. And if intimacy feels difficult, it’s so important to talk about it, there are many ways to reconnect with yourself and your partner.

Reading Recommendations

A few books that were recommended by the experts (and one recommended by me!) that you may love:

The Awakened Mind – Lisa Miller
This Is Why You Dream – Dr Rahul Jandial
Tantric Sex and Menopause – Diana Richardson & Janet McGeever
You Are Not Broken: Stop “Should-ing” All Over Your Sex Life – Kelly Casperson (Highly recommend! I’ve even made my daughter and husband read parts. It completely shifts how we think about sex.)

Genitourinary Syndrome of Menopause, libido, intimacy and wellbeing