What is Genito-Urinary Syndrome of Menopause?
Menopause symptom research focus a lot on hot flashes, insomnia, weight gain, mood disorders and lowered libido; which can be experienced differently for everyone. But what is genito-urinary syndrome of menopause (GSM)? Basically, GSM includes a collection of genital, sexual, urinary, and somatic symptoms that correlate with ageing and menopause. The term used to be known as Vulvovaginal Atrophy (VVA), but only had a focus on the affects of lowered sex hormones and the impact they had on the vulvar and vaginal cavity. Research has shown that there is so much more involved in the decline of estrogen, progesterone and even testoterone has on the body, and studies have found that GSM can not always be rectified with estrogen therapy (Gilbert, GG., et. al. 2023; Nappi, RE., et. al. 2019).
Symptoms of GSM
Genital: A decline in sex hormones affects the vaginal wall (all of its 4 layers) and the blood supply to the area, causing anatomical and physiological changes. these can include: shortening and narrowing of the vagina, paleness (due to lack of blood supply), thinning of epithelium, decreased moisture, and increased kertatinisation to the tissue. This can lead to symptoms of vaginal dryness, burning, irritation (itchiness), vaginal pain (vagimisis) , pain during sexual intercourse (dyspareunia), and bleeding can occur due to tearing (Gilbert, GG., et. al. 2023). A few papers stated that a vaginal pH of >5 is a good indicator of vaginal atrophy (Johnston, S.L., 2019). An alkaline pH reading (normal is 3.8-4.5) indicates vaginal dysbiosis, which can be be caused by other vaginal health conditions too.
Urinary: There are also estrogen receptors in the bladder and urethra, and with the reduced estrogen levels with menopause, urinary symptoms can consist of urgency or Over Active Bladder (OAB), recurrent Urinary Tract Infections (UTI), urinary incontinence (UI). Sometimes medication can also magnify UI symptoms (diuretics) (Johnston, S.L., 2019).
Sexual: Due to vaginal atrophy and lack of lubrication, and lowered libido can impact sexual wellbeing, arousal and orgasm. In a study of 4,000 women, 45% complained of vaginal symptoms and how the symptoms effected their quality of life, self esteem, and intimacy (Porterfield, L. et. al. 2022).
Pelvic Floor: Pelvic floor tissue responds to estrogen and can lead to structural and/or function failure (also being a cause of OAB). Pelvic Floor Dysfunction (PFD) can also lead to coital dysfunction because of the changes in the vaginal wall. Pelvic floor integrity is maintained by the muscles, nerves and connective tissue. The drop in estrogen reduces blood flow to the area and collagen synthesis decrease, tissue repair is compromised and just becomes a cascade of events that all intertwine with each other! (Johnston, S.L., 2019). There are also other causes to PFD, but the focus is on GSM related PFD for now…
One research paper (Porterfield, L. et. al. 2022), stated that 84% of women exhibit signs of GSM of up to 6 years after menopause! You don’t need to be experiencing ALL of the symptoms above to have GSM either.
What’s are the treatmentoptions?
First I will discuss the non-hormonal treatment for GSM and these include:
Lubricants, moisturisers, and pessaries: These are all useful for vaginal dryness and lubrication. I have given a list of products in the post, How Menopause can Change your Vaginal Microbiome .
Counselling: GSM impacts the quality of life, self esteem, and intimacy. Counselling can provide an environment to discuss these issues either in couple counselling or individual sessions (Nappi, RE., 2019).
Herbs: There are many herbs for perimenopause and menopause, but keeping within context and focusing on GSM symptoms there are herbs for vaginal dryness (wild yam, shatavari and black cohosh), connective tissue weakness and repair (for pelvic floor restoration) would include herbs such as gotu kola, japanese knotwood, echinacea, and withania). For low libido herbs such as shatavari, wild yam, korean ginseng, and for boosting estrogen levels (during perimenopause) can entail chaste tree, ladies mantle, peony, and shatavari. Herbs all come with their own contra-indications and required dosage. Be mindful of buying herbs online without consulting a herbalist/naturopath. The wonderful thing about herbs is that a herbal tincture can be made specific to you!
Pelvic Floor Physiotherapist: If you haven’t got a physio specialising in pelvic floor, get yourself one now! Even if you don’t have symptoms, they can give your preventative resources (trust me your future self will thank you for it). Check out this list of Pelvic Floor Physiotherapists Directory in Australia.
Laser Therapy has been studied to improve vaginal health, reduce vulvovaginal atrophy symptoms and help with sexual dysfunction (Salvatore, S. et. al. 2023).
Hormonal Treatments for GSM:
Localised (either topical or inserted into vagina): Vaginal estrogen therapy (creams, gels (estrogel) , tablets or slow release intra vaginal rings), intravaginal DHEA pessary is an androgen metabolite and is converted to estrogen and testosterone (Intrarosa), available in Australia mid 2024. Vagifem is also a slow release estradiol pessary. Any estrogen derived treatment needs to be avoided or consult your G.P for people at risk of estrogen derived cancers.
Systemic: Hormone Replacement Therapy (HRT) for more information on types the Australasian Menopause Society has an overview, or there are Bio-identical Hormones
References
Gilbert G.G. Donders & Francesca H.W.V. Donders (2023) New developments in the management of vulvovaginal atrophy: a comprehensive overview, Expert Opinion on Pharmacotherapy, 24:5, 599-616, DOI: 10.1080/14656566.2023.2194017
Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, Brambilla E, Bosoni D, Cassani C and Gardella B (2019) Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front. Endocrinol. 10:561. doi: 10.3389/fendo.2019.00561
Porterfield L, Wur N, Delgado ZS, Syed F, Song A, Weller SC. Vaginal Vitamin E for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review of Randomized Controlled Trials. J Menopausal Med. 2022 Apr;28(1):9-16. https://doi.org/10.6118/jmm.21028
S. L. Johnston (2019) Pelvic floor dysfunction in midlife women, Climacteric, 22:3, 270-276, DOI: 10.1080/13697137.2019.1568402
S. Salvatore, A. F. Ruffolo, C. Phillips, S. Athanasiou, L. Cardozo, M. Serati & the EUGA Working Group (2023) Vaginal laser therapy for GSM/VVA: where we stand now – a review by the EUGA Working Group on Laser, Climacteric, 26:4, 336-352, DOI: 10.1080/13697137.2023.2225766
Supporting Your Mental Health
As things start to return to normal for us folk in Perth , Western Australia, there are other places in Australia and the rest of the world that are still feeling the pinch of Coronavirus.
Today I visited my local beauticians. I am not generally one for waxing and spending money on such things, but I guess it is the usual feeling of when things are suddenly taken away from you- you miss them!
There have been many a funny meme on social media of image of (mostly women) people that had regrowth, broken nails and hairy legs and eyelashes falling of their faces. You honestly have to laugh of the first world problems that we live in.
While many businesses have their staff working from home, I am back at taking face to face clients. It was so lovely to step back into the space that I know and love - EarthPoint Energy Centre in East Perth. It is a combination of the smell, the amazing women that I work along side with and the atmosphere that does something supportive to your nervous system.
I hindsight, I hope this pandemic has made more people aware about the importance of mental health during these times. Fortunately for me I have been one of the lucky ones. But for many, the home environment can be volatile and unsafe. Or the workplace can be for some people their only interaction with others and gives them a sense of belonging.
Has this time been a positive or negative experience for you?
The amount of online services supporting people’s wellbeing has increased greatly from free mediation sessions, online yoga classes and Zoom meetings.
My 3 pillars to health: MIND, MOVEMENT & MICROBIOME are always at the forefront of my mind for creating an ideal life for my clients. For if we don’t have a balance of all of these components, then we can become out of balance and experience low mood or digestive upsets.
I know living or even attempting to live a healthy lifestyle can be daunting and overwhelming. Knowing where to start can be off putting and can often lead to no action at all.
My approach is always taking one step at a time and focus on what is the easiest for you. No use in setting you up for failure before you have even started!
If you feel you need support with your mood or your tummy troubles….fill out my online enquiry form and see if I can help you.
Know Your Stress Triggers
There is one culprit that has a lot to answer for, and that my friends is stress. Many times I will have a client in front of me that has symptoms due to long term stress. And they will often reply 'But I don't feel stressed!'
There is one culprit that has a lot to answer for, and that my friends is stress.
Many times I will have a client in front of me that has symptoms due to long term stress. And they will often reply 'But I don't feel stressed!' Then 3 months later I will see them again and they may have made some significant changes in their life such as quitting their job or reducing their daily load. And many of them will reflect and say...'Yeah, I feel so much better now I think I was under a lot of stress back then.'
By all means I don't want you to race out and quit your day job (unless you really want to). But it's when we finally slow down and STOP, that we realise how busy we are and what for?
Our bodies are very adaptable vehicles and will adjust your responses to stress in a way that we can adapt without noticing. Think about all of the little 'stresses' we have in our daily lives......
24/7 access to notifications (email, texts, group chats, social apps and calendar reminders) from your mobile (don't forget the 'pings and dings' that can come with those notifications)
Work demands
Health demands- Fitness, diet and lifestyle
Community demands- Clubs, schools, business, friends all expecting a piece of you
Future concerns
Past conversations going over in your head
Financial worries
Relationship concerns
Expectations that you need to fit it ALL in with ease.....
How does our body respond to these little stressors?
Your adrenals will release cortisol and adrenaline to get ready to fight the threat. You see, our mind has no way of differentiating between a real stress (the Saber tooth tiger kind) or the answering your daily email stress- it's all the same!
With this added adrenal spark, your sympathetic nervous system will kick into action- your pupils will dilate, heart beat will increase, blood pressure will rise, digestion will slow down, sugar will stay in your blood stream (so you have enough energy for action) and your immune system will kick in to put out the potential fire threat.
Have you ever gone on holidays and then on the first couple of days you end up getting sick? Argh! So frustrating! This happens because when you are busy at work, your adrenals are in full swing- putting out the fire with all the anti-inflammatory guys (a.k.a immune system). As soon as the fire goes away (work), so does your cortisol levels. And then bingo! A bug comes in from the back door and you get sick from exhaustion.
Short term this is okay, but long term stress can disrupt your bodies natural response and end up getting what is called cortisol resistance. Your body starts to not respond because the stress is there ALL THE TIME. Your immune system will drop and inflammation gets out of control...
How do you react to stress?
I know when I have a full schedule on the things that are good for me and would actually support me in times of stress (or even busyness), are the first to get dropped.
Exercise? Who has time for exercise when your chasing your tail?
Eat well? (scoff), Let's just be thankful that the family gets some form of food into them (even if it is just from one food group and the same colour). No prizes for best phyto nutrient dish in this house that's for sure!
And generally that's not where it ends. Because your day is so time poor you end up staying up later = less sleep.
You may reward yourself with a bickie or two. You may even feel the need to 'unwind' with a glass of wine...
At the time these stress releases may seem ideal, but you will end up burning the candle at both ends and disrupting your circadian rhythm and increase more of your sympathetic nervous system by adding stimulants as your coping mechanisms.
We have all done it. But how can you make better choices to support your stress response?
The most difficult part is identifying your stress triggers. Most of the time we just continue in the rat race thinking this is normal. Think about your actions AND your emotions (sometimes this is the easiest at the end of the day- but whatever works for you). Make a little self note of you might be reacting to a situation instead of responding to it.
Like I said, this is not easy. Even if you do know what your triggers are, the hardest part can be changing your reaction. Short term rewards that aren't beneficial to your health may seem great at the time (otherwise we wouldn't do them!), but how are they affecting you long term.
Are you stimulating your nervous system instead of supporting it? (eating sweets, staying up late, watching copious amounts of T.V, drinking coffee or alcohol, eating take away foods with little nutritional value).
These go-to's can be okay as a one off. But repeating this behaviour is not helping you in the long run. Try replacing these responses or actions with things that will nourish you. Here are some examples:
Go for a walk
Read a book
Put your T.V watching on a timer (30 minutes)
Have a bath
Go in a quiet room, close your eyes and notice the sensations of your breath as you breath in and out
Ring a friend or relative - sharing (or venting) does wonders for your soul)
Unplug- yep you heard me!
Schedule some joy into your life
To help you identify your triggers, download my Know Your Triggers Work Sheet here
If you would like to ask a question regarding your health, please contact me.
What is a naturopath?
I often get a puzzled look when someone asks me what 'I do'. So I thought there must be a lot of people that don't know what a naturopath is. And it's kinda tricky to say too, isn't it?
What a naturopath studies...…
A naturopath student requires four years of studying to get their degree. And over this time we are taught many things such as:
Herbal medicine- how to use herbs to treat common health conditions that will enable your body to regain balance, support and tonify any weakened systems.
Nutrition- nutritional bio-chemistry was one of my favourite subjects when I was studying. I loved learning all about the vitamins and minerals (it doesn't just end there either) and what foods they are found in, how your body processes them and what functions they have within our body. Food and what you eat is such an integral part of what naturopaths do!
Body systems- from the immune to reproductive, naturopaths learn all about the body and how the systems work together (and perhaps not work together).
Diseases- yep, we know the basics AND the not so easy ones too. This is when you might come across a naturopath that 'specialises' in a particular area. Just like you find specialists like a gynaecologist in main stream health care.
Diagnostic Testing- to help get a better picture on your health, a naturopath might ask you to go for extra testing. This can be from bloods to stool or even your hair! Naturopaths will have a general understanding of any previous tests that you may have had done in the past too.
Naturopaths treat the whole person, not just the symptoms.
Case taking- Your first consultation with a naturopath will be generally the longest. We take your full health history, talk about what is happening in your body systems and what has been working for you or not working for you. Some naturopaths might even do a little bit of 'in house' testing such as, take your blood pressure, weight or blood glucose.
Iridology- Naturopaths have studied iridology as a student. this is where a microscope is used to look at your iris and see if there are any weakened areas within your body. Did you know your organs are represented in your eyes?
Tongue and nail analysis- checking your tongue and nails give naturopaths extra clues on how your body is functioning. Every little bit of information helps.
Emotions- How you are as a person is very important to us. Are you sensitive? Do you get stressed easily? Do you loose your temper? Sometimes this can take a little bit of time to work out, especially in the early days.
Lifestyle- How do you live your life? Do you work full time? do you care for others? How do you destress? Your lifestyle plays a huge part in your current health status. Diet and lifestyle advice is always given.
Evidence Based Research- Naturopaths use critical based research to support their treatment protocols.
Treatment- Naturopaths will generally offer herbal and nutritional support to help with your healing. Diet advice is given and if this is not enough supplements are prescribed when needed. Short term and long term treatment plans are established, so you don't feel overwhelmed. After all, we just really want you to feel great again!
In a nut shell...…..
A naturopath offers support, education and treatment that you want to do. Our job is to empower you and take control of your health, so that you can achieve your health goals.If you would like to book an appointment to reach your health goals, check out what is available in the online booking system below. var initResizer = function() { iframes = iFrameResize({}, "#widget-inline-embed"); }