As if the hot flashes and mood swings weren’t enough, women commonly deal with troubling urinary symptoms at menopause.
“Genitourinary syndrome of menopause (GSM) is a term that encompasses all the symptoms associated with loss of estrogen in the vaginal and urethral areas. It gives a broader definition of the symptoms women face,” said Matthew Barker, MD, Avera urogynecologist with Avera Medical Group Urogynecology in Sioux Falls. “Women may not realize the correlation between menopause and the urinary symptoms they’re experiencing.”
What Causes Genitourinary Syndrome of Menopause?
“We have estrogen and androgen receptors around the genitourinary (GU) tract and inside the vagina. As hormone levels decline, the tissue gets more fragile and more easily irritated,” said Katie Soodsma, CNP, with Avera Urogynecology. There may be natural bacterial changes happening at the same time.
Common symptoms include a burning sensation with urination, itching and painful intercourse, as well as frequency and urgency in urination. “Forty to 60% of menopausal women will experience GSM,” Barker said. It’s chronic in that it won’t go away with a course of treatment, but rather requires ongoing management.
GSM should be diagnosed by a medical professional, because it’s important to rule out conditions like an infection or pelvic organ prolapse.
Treatment Options for Urinary Symptoms at Menopause
One easy solution is a vaginal moisturizer and/or lubricant. These might take the form of a gel, cream or suppository. Helpful ingredients may include silicone, hyaluronic acid and/or vitamin E.
Topical estrogen cream can be strategically placed around the urethra. Estrogen rings deliver estrogen directly to the vagina.
Typically, other symptoms of perimenopause and menopause start sooner than GSM. If women are on hormone replacement therapy such as pills or a patch for symptoms like hot flashes, it won’t address GSM.
So if you’re on hormonal therapy for symptoms of menopause, you can safely add topical estrogen cream to address urinary symptoms, Barker added.
“Vaginal estrogen is extremely safe. Research has dispelled the myth that estrogen therapy causes breast cancer. The only time estrogen therapy was linked with breast cancer is when it was used with a certain progesterone in a formulary that is no longer used,” Barker said. “Taking estrogen alone has never been shown to cause any type of breast cancer.” In fact, the FDA recently requested that manufacturers remove the “black box warning” on hormone replacement therapy (HRT) estrogen in reference to risks of breast cancer.
Before using any new medication, including topical estrogen, women who have had breast cancer should talk with their oncologist.
Help From the Specialty of Urogynecology
Within the specialty of urogynecology, related issues including pelvic pain and/or urinary frequency, urgency or incontinence can be treated in various ways, including minimally invasive surgery, physical therapy, nerve stimulation therapy and Botox treatments.
Women may be too embarrassed to bring up urinary symptoms with their physician, or just believe it’s just one more effect of aging they have to live with.
“But if it leads to relationship issues due to painful intercourse, contributes to mental health issues like depression or anxiety, or causes a woman to stay close to home because she’s afraid of having an accident in public, it becomes a quality of life issue,” Barker said. “For women who live a normal lifespan, one third of their life will be spent in menopause. The right treatments can help women be more comfortable and confident so they can enjoy what are supposed to be their golden years.”
This is one in a series about women’s health before and after menopause. Other topics include hormone therapy, weight gain, sleep, bone loss and more.
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