Understanding these changes is empowering. Especially if you are experiencing painful sex, itching vagina, vaginal dryness, or even bleeding during or after sex. Or if you have lost your interest in sex. But there’s good news – you can overcome these challenges and rediscover a fulfilling and healthy sex life.

Symptoms of Menopause: Estrogen’s Effect on the Vagina, Bladder and Urethra

Let’s explore the incredible self-regulating and self-cleaning abilities of the vagina. Understanding this is key to caring for this vital part of your body.

Estrogen and progesterone are crucial for the vaginal microbiome. The vaginal microbiome refers to the bacteria environment in the vagina. It serves to protect the vagina from infections and maintain its health. This is particularly important during various life events.

Estrogen helps vaginal wall cells grow and store glycogen, while progesterone aids in shedding vaginal cells and releasing glycogen.

Glycogen isn’t just a sugar; it’s a vital source of energy for the good bacteria in our vagina. These bacteria produce lactic acid, maintaining an ideal acidic environment that keeps harmful bacteria, yeast, or viruses in check.

If your vaginal pH changes from its normal range of 3.8 to 4.5, you may experience symptoms. These symptoms can include smell or changes in discharge. Along with burning when urinating, itching, and redness in the vagina – indicating problems like yeast infections.
Estrogen levels decrease just before your period starts, during breastfeeding, and as you go through perimenopause. The permanent decrease of estrogen occurs during premature menopause, menopause and post-menopause. The reduction in estrogen causes the tissue in and around your vagina to become thin, dry, and fragile. With reduced flexibility and lubrication, there may be bleeding during sex, which can be either painless or painful.
If not addressed, prolonged estrogen loss can lead to genitourinary syndrome of menopause (GSM). GSM includes a range of symptoms from a slight annoyance or to intense pain. Symptoms can include dryness, irritation, burning, and itching of the labia, clitoris, vaginal opening, and urethral opening. Pain during sex and a decrease in arousal and desire may also occur.

In later stages, there are more noticeable and profound changes. These changes include the narrowing of the vaginal opening and the shrinking of the labia and clitoris.

GSM can harm parts of the body related to urinating. Symptoms may include a strong need to urinate, urinating often, pain while urinating, urinary incontinence (unable to control urination), and recurring bladder infections.

Additionally, uterine prolapse occurs when the uterus falls into the vagina. Vaginal prolapse happens when the vagina falls out of the body. Urethral prolapse is when the urinary hole sticks out, and the reversal of the urinary tract.

Although previously termed vulvovaginal atrophy or atrophic vaginitis, GSM better captures the number of symptoms women experience. However, it’s important to note that these symptoms do also occur in younger women during the perimenopause stage.

The physical transformations brought about by GSM can deeply impact self-esteem and feelings of desirability. This can cause low sex drive because of pain, lack of confidence, embarrassment, emotional distress, and fear of intimacy.

GSM Effects on Sex Life

The influence of GSM on mental health, sexual activity and emotional health is profound. The pain and discomfort during intercourse, combined with other symptoms of GSM, significantly reduce sexual desire and satisfaction. Physical problems and mental illness can negatively impact one’s self-esteem, body image, and relationships.

These challenges can make it difficult to feel good about oneself and can affect how one perceives their own body. Additionally, they can also make relationships more challenging.

A U.S. survey revealed that less than half of women aged 57 to 73 remain sexually active.

So, it’s important to understand and deal with the many parts of GSM to have a satisfying sex life after menopause.

The Under-diagnosed Issue of GSM

GMS is a condition that gets worse over time and affects many biological females, but few know this.

A study in Spain reported a 70% prevalence rate. Just one year after menopause 25% of women reported having GSM, and at six years after menopause that number reached 84%. This includes individuals who stop menstruating before age 40 (primary ovarian insufficiency) and experience menopause between ages 40 and 44 (premature menopause).

Even though it is so common and seriously affects women, only one in four ask for help. Unlike passing symptoms like hot flashes and night sweats, GSM worsens if left unaddressed.

A 2021 review recommends the need for GSM treatment to be a long-term solution, not just a temporary fix.

How To Get Relief

To help you manage milder forms of discomfort such as increasing sex drive and vagina dryness, the following are things to try:

1. Gentle Vulva Care: Use warm water for cleaning, avoiding soaps and detergents can prevent irritation.

2. Quit Smoking: Researchers have linked smoking to speeding up the processing of, which can lead to vaginal atrophy.

3. Lubricants and Moisturizers: Over-the-counter vaginal lubricants and moisturizers are effective solutions for enhancing sexual comfort and addressing vaginal discomfort. Lubricants, ideal for intimacy and use during sexual activity, help reduce friction and increase pleasure. On the other hand, individuals can apply vaginal moisturizers every three days to relieve symptoms, regardless of sexual activity.

These moisturizers bond with vaginal tissues, providing lasting effects on sexual comfort by reducing symptoms like dryness and irritation. Moisturizers include water-based moisturizers, which often contain glycerin, or silicone-based, oil-based, and hyaluronic acid-based moisturizers. Additionally, there are moisturizers that are a combination of these ingredients.

To make sex more comfortable, use water-based lubricants. If you find them ineffective, try silicone or oil-based ones. But be aware that oil-based lubricants can reduce the effectiveness of condoms.

4. Maintain Regular Sexual Activity: This promotes vaginal health, by improving blood flow and natural lubrication. Sexual stimulation can be alone or with a partner.

5. Exploring Outercourse: Techniques like caressing and massage offer pleasurable alternatives to traditional intercourse and penetration.

6. Vaginal Dilators: Useful for stretching and enlarging the vagina, especially if narrowing or tightening occurs.

7. Pelvic Floor Exercises: These exercises strengthen weak pelvic floor muscles. These exercises are more than the elusive kegel.

8. Mindfulness and Relaxation: Techniques like yoga, meditation and body scanning can reduce stress, enhancing sexual well-being

If you find these tips don’t work the following medical treatments are highly effective and safe:

  1. Low-Dose Local Estrogen: Estrogen applied on and in the vagina improves tissue health, increases lubrication, and restores pH balance. Consistent use can lead to feeling improvements to vagina and bladder symptoms within a few weeks or months. Available by prescription, these products include vaginal creams, estradiol tablets or inserts, and estradiol vaginal rings. A new estrogen product – Invexxy, treats the lower vaginal area and external vulvar area.
  2. Dehydroepiandrosterone (DHEA): Place in the vagina nightly, the insert called Pasterone contains dehydroepiandrosterone (DHEA). It has proven effective in reducing vaginal dryness and discomfort. It has shown the greatest long-term compliance.
  3. Systemic Estrogen Therapy: Systemic estrogen therapy is Hormone Replacement Therapy (HRT). A safe and effective method of treating broader menopausal symptoms, including GSM symptoms.
    HRT is one of the most effective treatments for hot flashes and night sweats. The secondary benefit to HRT is it treats vaginal dryness and painful sex associated with GSM. Some individuals might need a combination of systemic and local estrogen for comprehensive symptom management.
  4. Ospemifene: An oral SERM medication (selective estrogen receptor modulator) that is effective for treating vaginal dryness and painful intercourse. Ospemifene targets estrogen receptors in the vaginal tissues, while protecting endometrial lining (the lining of the uterus). Ospemifene is an oral pill that you can take instead of inserting something into the vagina.

Is Hormone Therapy Safe?

Doctor groups recommend hormone therapy as a safe treatment for menopause symptoms in younger women. HRT is one of the most effective treatments for hot flashes and night sweats.

The secondary benefit to HRT is it treats vaginal dryness and painful sex associated with GSM. This is extremely helpful during perimenopause and early post-menopause (the first 10 years after a woman’s last period).

Organizations like the Canadian Menopause Society recommend local estrogen products for moderate to severe GSM symptoms and recurrent bladder infections. As more recent studies demonstrate, these products have balanced benefits and risks for individuals.

Back in 2002, a large study made people worried about hormone therapy. It said it might increase the risk of breast cancer, heart disease, and blood clots.

After this study, fewer women used hormone therapy – from 40% to about 5%. But the women in that study were mostly over 60. Now we know hormone therapy can be safe for younger women going through menopause.

Today, doctors look at each woman’s own health and what she needs before prescribing hormone therapy. This makes it safer and works better for managing menopause symptoms.

Embracing Feminine Power and Confidence in Menopause

Midlife brings significant changes to female reproductive health, potentially impacting their confidence and desirability. Embracing your innate power can be empowering, boosting your self-esteem and overall well-being.

By learning about women’s reproductive health, we can improve intimacy and perimenopause and post-menopause sex life. Let’s openly discuss aging and take charge of our sexual health for a joyful and satisfying life.

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