Is there a link between vaginal atrophy, leaks and UTIs?

Many women refer to atrophy as 'vaginal dryness', but it's important to know it's a very common symptom of menopause . Like so many symptoms - it's not something women generally feel comfortable discussing, even with our close friends. Let's face it, we have a big problem in society with the the idea of dryness as a sign of lack of sexual interest, fertility and youth, but it's something that can strike at any time of hormonal imbalance - whether related to your cycle, or pregnancy, or menopause.

What's even less discussed is the link between vaginal atrophy, the bladder and pelvic floor health. That's why recently, the term vaginal atrophy has been swapped out for 'GSM', or Genito-urinary Syndrome of Menopause as this more accurately covers the issues that affect our entire pelvic health as a result of the hormonal changes that occur from perimenopause to postmenopause. We'll use the updated term, GSM, in this article.

So what is GSM?

First off,  let's get one thing straight here: GSM isn't a rare, weird, hush hush condition that you need to feel shameful about. In fact, it's so common that it affects 50% (that's right, FIFTY percent!) of women during the menopausal phase, from perimenopause to post menopause. Unfortunately, we don't feel that it's as common as it is because we've been conditioned as women not to talk about our vaginas - and a lot of that is because discharge, and being 'wet', not dry, is a sign of being sexually available and society is, of course, created around the notion that women are sexually ready for men at the drop of a hat.

But that means there is a huge swathe of women in the world suffering with vaginal atrophy in silence. Not cool. Vaginal dryness isn't just about not being 'wet' in the moment though. It's dryness that occurs at any time, and frustratingly, it rarely goes away on its own without any treatment.

What symptoms should I look out for?

Symptoms wise, vaginal atrophy causes a burning, sore feeling. You might first notice it causes painful sex - before or after, and sometimes it can cause bleeding too. If you use tampons during your period, you might also feel it when taking or inserting a tampon into your vagina (if you do, ditch anything internal until the symptoms have cleared up or you have seen your physician).

But, it can also manifest as bladder leaks, UTIs and bladder infections. That's because GSM affects our pelvic floor when oestrogen levels decline. In turn, with less oestrogen to moisturise and keep the muscles strong and supple, the pelvic floor weakens, as do your bladder muscles and the urethral tissues become drier.

All of this can contribute to an increased susceptibility to UTIs as your natural defenses against infections and altering the pH balance of the vagina decrease, making it more prone to UTIs.

So it's another thing linked to low oestrogen?

Unfortunately... yes. As with all of these annoying (let's say) and frustrating (definitely) issues that come part and parcel with perimenopause, GSM is caused by estrogen levels dropping. This causes the tissues in your vagina to get thinner, more sensitive and more vulnerable to tearing, especially during sex if it's a little, exuberant. It's estrogen's job to keep everything thick, juicy and stretchy in there, so if things are feeling a bit sore, itchy and sensitive, it's worth having a check up in case.

Menopause isn't the only time you might get a case of vaginal dryness though. Anything that causes a hormonal imbalance can cause it. That includes post pregnancy, or health conditions like breast cancer treatment where our lady parts take the hit as a result of estrogen being affected.

Are UTIs related to GSM treatable?

Good question. The reality is that if you have been suffering with UTIs and you suspect that your hormones are a bit out of whack then you are probably on the money. You've likely been through round after round of antibiotics too and feel like you are stuck in a rut of constantly worrying about when the next infection will strike.

Familiar? If so, it's time to have a frank chat with your GP. The good news is that there is treatment for UTIs linked to GSM, which is topical vaginal oestrogen. You use this internally, either via a cream or gel, or by inserting a pessary or ring. HRT can also bring relief for GSM as your hormone levels start to stabilise. You can also use vaginal or vulval lubricants and moisturisers, which are available over the counter in your pharmacy.

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