The term "Menopause" is frequently associated with thoughts of flushes, sweats and the dilemma of whether or not to take HRT. In addition, fluctuations in hormone levels during the peri-menopausal phase causes changes in messaging in the brain, which can lead to mood swings, irritability, loss of confidence and depression. While these are important aspects to consider when thinking about menopause, what is still hugely under-reported and under-treated is the extremely common later consequence of the menopause, or of estrogen deficiency, which is the effect on the vagina and bladder.
The lack of estrogen which occurs when our ovaries run out of eggs and stop producing estrogen can have a significant effect on reducing vaginal blood flow, secretions, elasticity, collagen support, acidity level and hence reduced barrier to infection, not to mention bladder function. This takes some time to develop and so often is first noticed a few years after the menopause, or a few years after stopping HRT. Symptoms include vaginal dryness, discomfort during sex, discharge, irritation of the outer lips, reduced response during sex, passing urine more often and feeling of urgent need to pass urine and having to pass urine through the night, all of which can make a woman very anxious about the physical changes she is experiencing.
Despite these symptoms being incredibly common, they are often neglected due to embarrassment, difficulty in being able to talk about vaginal and bladder problems, and women being unaware that the symptoms may be due to hormonal changes of the menopause and that treatments are available. I am often saddened by tales from women who have put up with these changes for many years while they gradually worsen, being even unable to talk to their partners, often making excuses not to have sex because of the discomfort. It is clear that many relationships and lives have been affected by this common, and yet easily treatable consequence of estrogen deficiency, as confirmed by the recently published results of the CLOSER study. This study also showed that compared to their counterparts in Europe and North America, women in the UK were 50% less likely to access recommended local estrogen treatment for 'vaginal atrophy', which is the medical term for vaginal dryness and discomfort caused by estrogen deficiency. Could this once again be the result of the infamous British stiff upper lip?
These changes are not only neglected by women but also by healthcare professionals who may not be aware of the magnitude of the problem, nor have time to raise the issue during consultations. In addition, partners/husbands have a really important role in supporting a woman through all the physical and psychological symptoms she experiences, but menopause often emerges completely out of the blue for them and unfortunately can result in the break-down of relationships both at home, as well as at work. Much work is still needed to raise awareness of the condition and enable women to ask for help, for men to understand what their partners are going through, and for healthcare professionals to ask appropriate questions during any menopause consultation, and opportunistically, eg when women are attending for cervical smears.
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