What is the Genitourinary Syndrome of Menopause (GSM)?
The genital system and the urinary system are combined in this symptom because they both contain estrogen receptors in the tissues of the vagina, the vulva, the bladder and the urethra. When estrogen begins to decline during perimenopause, the receptors do not receive the regular amount of estrogen delivering hormonal signals to these tissues, and both begin to change, becoming thinner, less muscular and receiving lower levels of blood flow.
Signs and Symptoms of GSM
Vagina
▢ vaginal dryness
▢ irritation / burning / itching
▢ changes to vaginal discharge
▢ thinning / graying pubic hair
▢ vaginal / pelvic pain and pressure
▢ vaginal prolapse (top of the vagina falling into the vaginal canal)
Urinary System
▢ painful urination
▢ urgency incontinence
▢ stress incontinence
▢ frequent / recurring urinary tract infections
▢ urethral prolapse
Sexual
▢ painful sex
▢ bleeding after sex
▢ decreased orgasm
▢ loss or reduction in libido
▢ pain after orgasm (dysorgasmia)
Urinary Tract and Urinary Tract Infections (UTIs)
A urinary tract infection is an infection in any part of the urinary tract. Your urinary system (or urinary tract) exits your body through the urethra, which is located in the vulva. The urethra and the bladder are referred to as the ‘lower urinary tract’ while the ureters and the kidneys are the ‘upper urinary tract’.
Symptoms of an infection in the urethra include:
▢ Burning or pain during urination
▢ Needing to pee more often than usual, including at night
▢ Needing to pee more urgently or suddenly than usual
▢ Unusual discharge (note that it can be hard to tell if discharge is coming from the urethra or the vagina. If you have the other symptoms, do not assume that new or unusual discharge is vaginal.)
Symptoms of an infection in the bladder include:
▢ Cloudy pee
▢ Blood in your pee
▢ Pain in the lower tummy or lower back (just below the ribs)
▢ Pelvic pressure
Types of Urinary Tract Infections
Recurrent UTIs
Recurrent UTIs
Recurrent UTIs are UTIs that continue to come back after treatment. If you have 2 or more UTIs within a six month period, these are also considered to be recurrent. Your healthcare provider will likely prescribe a longer-term antibiotic, a vaginal Hormone Therapy (HT), or refer you to a specialist for more specific treatments. [4]
Chronic UTIs
Chronic UTIs
Chronic UTIs are UTIs that don’t go away – urine tests usually won’t show an infection, antibiotics don’t make an impact, but the symptoms remain. This often occurs when the infection enters the lining of the bladder. [4]
Kidney Infections
Kidney Infections
UTIs are frustrating and can be painful. However if the infection continues and moves into your upper urinary tract where it affects your kidneys, it can become life-threatening. The key signs to watch for are a high fever with chills, a drop in body temperature (below 36C), being confused, disoriented or drowsy, abdominal pain – possibly with swelling, have severe pain in the lower back or sides, and/or see blood in your pee. If you have any of these symptoms, seek medical care urgently. [5]
Symptoms of an infection in the kidney:
- Back or side pain
- A high fever
- A sudden drop in temperature (below 36C)
- Shaking and chills
- Nausea
- Vomiting
- Being confused, disoriented or drowsy
** Kidney infections can be life threatening. If you experience any of these symptoms seek medical attention immediately**
To prevent UTIs at home, you can:
- Practice good hygiene, especially when wiping. Remember to always go front to back, lowering the risk of bacteria entering the urethra.
- Pee frequently, which reduces the risk of bacteria growing in your urinary tract
- Pee immediately after sexual intercourse. Sex can introduce bacteria to your urethra and peeing flushes them out.
- If you are prone to UTIs, take showers instead of baths. Avoid bath oils. [6]
- Drink cranberry juice or take cranberry tablets. The science remains inconclusive on how effective cranberry products are, however, there is no risk to drinking cranberry juice for most people (if you are taking blood thinners, avoid cranberry juice). Remember to be aware of the high sugar levels in most juices.
To ease your discomfort and speed up recovery:
- Drink plenty of water, which will dilute your urine and help flush bacteria out of your system.
- Avoid drinks that can irritate your bladder, such as caffeine, alcohol, and citrus juices.
- Use a heating pad on your abdomen – warm, not hot – to help the pain and tenderness.
- Peeing more means that the bacteria will be flushed out more quickly and not have a chance to infiltrate into the bladder or urethral tissues.
- Consuming cranberry juice has been shown to help speed up recovery, as it reduces the likelihood of bacteria infiltrating or sticking to the walls of the bladder and urethra.
However, a recent review study indicated that, while there were many papers published on how well cranberry juice works to treat UTIs, the results of the 12 papers examined all had conflicting results. [10] - D-mannose is a type of sugar found in many fruits. It also exists naturally in the body. A recent study supports consuming d-mannose to keep bacteria from sticking to the walls of the urethra and bladder. It has also been suggested to be a promising alternative to antibiotics [9] [10] [11]
Sources of d-mannose include cranberry and cranberry juice; apples; oranges; peaches; broccoli; and green beans. [10]
D-mannose is found in nutritional supplements, either on its own or with other ingredients including cranberry; dandelion extract; or probiotics. [10]
Therapy for UTIs
At age 40 find a reliable, educated primary care provider familiar with recognizing and treating the symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.
Therapy for UTIs is based on the type of UTI:
Acute UTIs
Acute UTIs
Antibiotics are the frontline therapy for UTIs.
UTIs rarely go away on their own, although it is possible. The symptoms may fade for a few days, but they will almost always return. [8] If your UTI doesn’t resolve, your healthcare provider will assess you. The most common test is a urinalysis, where your urine sample is checked to see if it contains white blood cells, red blood cells, or bacteria.
Depending on the findings, your healthcare provider may also do a urine culture, where the bacteria found in your urine are regrown in the lab. This is usually done to identify the best type of antibiotic as treatment. You may also be prescribed painkillers if you need them.
Recurrent UTIs
Recurrent UTIs
Recurrent UTIs are UTIs that continue to come back after treatment.
If you have 2 or more UTIs within a six month period, these are considered to be recurrent.
Your healthcare provider may run additional tests. An ultrasound, a CT scan, or an MRI can be used to create an image of your urinary tract. This can highlight if there is a blockage or a structural issue that is causing the UTIs. [4]
You may also have a cystoscopy done. Cytoscopy involves inserting an endoscope into the urethra and up into the bladder to assess the health of the tissues and identify if there are any abnormalities or blockages.
Your healthcare provider will likely prescribe a longer-term antibiotic, a topical vaginal hormone therapy, or refer you to a specialist for more specific treatments.
There are three common methods of applying topical hormone therapy:
- Ring: You or your doctor can insert a soft, flexible ring, also called a “pessary”, into your vagina. It releases estrogen directly to the vaginal tissues. The ring lasts about three months so it will need to be replaced regularly.
- Tablets: These tablets are inserted into your vagina with a disposable applicator.
- Cream: The cream is inserted into your vagina using an applicator.
Chronic UTIs
Chronic UTIs
Chronic UTIs are UTIs that don’t go away – urine tests usually won’t show an infection, antibiotics don’t make an impact, but the symptoms remain.
This often occurs when the infection enters the lining of the bladder. If this is the case, the basic tests may not show an infection and you will need to see a specialist to get more detailed tests done. Once diagnosed, the treatment is a long-term (up to 6 months) antibiotic.
The Science
The genital and urinary systems are combined together into the genitourinary syndrome of menopause because these two systems develop together in the embryo. The estrogen receptors in the urethra, bladder, vulva and vagina originate at this time.
As estrogen levels decline during perimenopause, there is no longer enough estrogen to activate these receptors. This results in fewer and fewer biochemical changes and reactions inside the nearby cells. It is these changes that cause, for example, weaker and less muscular tissue surrounding the urethra walls.
Hormones & Receptors
Hormone receptors (of any kind) are specialized proteins that are able to identify their specific hormone from among other similar molecules. Estrogen receptors, for example, can identify any hormones that are not estrogen and will not connect with them.
Once a hormone ‘lands’ on its receptor, it triggers biochemical reactions that keep the nearby cells and tissues healthy.
No. Sexual activity can increase the risk for a UTI but does not directly cause the UTI. Sexual intercourse can introduce bacteria close to or into the urethra, which can lead to an infection in the urinary tract. You can lower your risk by urinating before and after intercourse, and by drinking plenty of water after intercourse to increase the volume of urine and help flush bacteria out of the system.
No.
UTIs are not contagious or passed between partners by sexual or casual physical contact.
No. Antibiotics are the most common treatment, used when there are painful or bothersome symptoms, and bacteria present in the urine. However, some UTIs have no symptoms, and these infections usually go away on their own because the person is unaware they even have a UTI.
There are many non-antibiotic treatments being explored. The most promising is to take increased amounts of D-mannose is a type of sugar found in many fruits. It also exists naturally in the body. A recent study supports consuming d-mannose to keep bacteria from sticking to the walls of the urethra and bladder. It has also been suggested to be a promising alternative to antibiotics, but more research is needed. [7] [10]
No. While most UTIs cause symptoms, like pain or burning when urinating, sometimes, there can be bacteria in the urinary tract without any UTI symptoms. This is called asymptomatic bacteriuria. It is most common in older adults or people using catheters to empty their bladders.
Chronic UTIs don’t go away, often occurring when an infection enters the lining of the bladder. Properly diagnosing chronic UTIs requires detailed tests and, once diagnosed, the treatment is a long-term (up to 6 months) antibiotic.
It is very unlikely that supplements will help ease GSM symptoms. Even cranberry supplements (that many people are familiar with) have no scientific support for their effectiveness. Unfortunately, we live in a time when many celebrities and ‘health’ experts promote products that have no scientific basis for working. These supplements may cause a placebo effect (where you feel better simply because you think you feel better – there is no scientific basis for the improvement), may have no effect, or, in some cases, may be dangerous. Remember that many supplements are unregulated, so there is no guarantee that they contain the ingredients they advertise at the stated levels. Even worse, untested combinations of ingredients are common, and these could cause worse health issues than the original symptoms being treated.
Yes, it should help. The cause of GSH is reduced levels of estrogen due to perimenopause and that is irreversible. However, HRT can be used to increase your estrogen levels and that may ease your symptoms.
Yes and No.
There are natural treatments (such as drinking cranberry juice and urinating frequently) that may help either the vaginal or the urinary symptoms. However, the cause of GSM is reduced levels of estrogen, so it is unlikely that the improvements will be maintained. As estrogen levels continue to decline, the condition will continue to develop.
It may, but only if you are using Menopause Hormone Therapy (MHT) to increase your estrogen levels. The cause of GSM is reduced levels of estrogen due to perimenopause and that is irreversible.
References
[2] https://www.sciencedirect.com/topics/neuroscience/hormone-receptor
[3] https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447
[5] https://www.verywellhealth.com/kidney-infection-when-to-go-to-the-hospital-7511488
[8] https://www.healthline.com/health/signs-your-uti-is-going-away-without-antibiotics
Not AI generated.
Original content, last updated October 7, 2024.
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