Genitourinary syndrome of menopause

Genitourinary syndrome of menopause (GSM) is a common disorder that results as a consequence of reduced oestrogen levels during the later stages of menopause.

GSM may affect the vulva, vagina & lower urinary tract causing atrophy (thinning) of reproductive & urinary tract tissue, making daily activities uncomfortable impacting quality of life. Symptoms include: vaginal dryness, itching, burning, stinging, painful intercourse, low libido, prolapse, urinary frequency, incontinence & increased susceptibility to urinary tract infections (UTI). It is worth further investigation if you are experiencing recurrent UTI symptoms that do not resolve with repeated antibiotics, as this may be associated with GSM.

Similar symptoms may also present after surgical removal of the ovaries, cancer treatments including pelvic irradiation, chemotherapy & some medications as these can affect hormone production.

Natural treatment strategies of GSM are targeted towards optimising the health of the epithelial cells that line the vagina & urinary tract, along with enhancing the beneficial bacteria that reside within the vagina (vaginal microbiome). Optimising vaginal microbiome health can help prevent Bacterial Vaginosis & UTI’s along with alleviating GSM symptoms. Interestingly low species diversity reside in a healthy vaginal microbiome (predominantly Lactobacillus species) conversely to greater species diversity in a healthy gut microbiome.

Lifestyle recommendations

• The vagina is self cleansing. Discontinue using soaps & douches, particularly chemical based perfumed washes. Avoid fragranced or harsh laundry detergents as they alter the pH of the vaginal microbiome & may cause irritation.

• Quit smoking. Smoking lowers oestrogen & is linked with faster onset GSM symptoms.

• Avoiding antibiotics where possible, as they may cause an imbalance not only in the gut microbiome, but also the vaginal microbiome.

• Consume nourishing, anti-inflammatory, healthy wholefoods with adequate protein, vitamin A, essential fatty acids & zinc.

• Adequate hydration can help prevent dehydration of mucous membranes along with diluting the concentration of urine reducing the risk of UTI’s.

• Movement & physiotherapy, especially strengthbuilding exercises focusing on core, back & pelvic floor may help prevent stress incontinence & prolapse, assisting with restoration of normal function.

• Lubricants & moisturisers may help relieve discomfort & improve function. There are many water, silicone & plant based oils (eg. olive, sweet almond & coconut). Check the label ensuring the product is free from irritating alcohol, mineral oils or preservatives. We stock pH balancing lubricants that contain pure organic nonirritating ingredients helping to improve moisturise content by re-hydrating vaginal tissue mimicking vaginal secretions. Use a lubricant that helps maintain a healthy vaginal microbiome!

Supplementation recommendations

• Zinc helps maintain the health of the vaginal lining & is essential for tissue repair & integrity. Zinc supplementation has been shown to significantly improve vaginal dryness within weeks.

• Sea Buckthorn Oil: The brilliant orange nutritious berries high in antioxidants from this hardy plant are renown for skin regeneration & re-hydration of mucous membranes. This enhances the integrity of vaginal tissue, relieves vaginal dryness, itching & burning & may be beneficial for dry eye syndrome. Sea Buckthorn is well tolerated with no known side effects.

• Strain specific probiotics help to normalise the health & composition of the vaginal microbiome. Lactobacillus rhamnosus GR-1 & Lactobacillus reuteri RC-14 probiotic strains have been shown to decrease pathogenic yeast & bacteria including Bacterial Vaginosis. Strain specific probiotics are also beneficial in the prevention of recurrent menopausal UTI’s. Probiotics specific for the vaginal microbiome can be taken orally &/or inserted vaginally.

• D-mannose is a naturally occurring low GI sugar found in many fruits & vegetables that can help prevent & treat urinary tract infections. It works by inhibiting E.coli & preventing the adherence of bacteria to the bladder wall.

• Magnesium may help with bladder incontinence or frequency by exerting a relaxing effect on the bladder, enabling it to empty fully.

Always seek help from a qualified healthcare practitioner who will advise an appropriate treatment plan, diet & lifestyle advice as well as guidance regarding supplementation in the best form at the safest dose.