Genitourinary syndrome of menopause, or GSM, is common, chronic and often under-recognised. In this episode, we look at how declining oestrogen affects the vulva, vagina, urethra and bladder and why symptoms can include much more than vaginal dryness.
We explore the role of low-dose vaginal oestrogen, including how it restores the vaginal epithelium, glycogen, Lactobacillus populations and an acidic vaginal environment. We also discuss intravaginal prasterone, its intracrine conversion to oestrogens and androgens within vaginal cells, and where it may fit into treatment.
Plus: recurrent UTIs, moisturisers and lubricants, using vaginal oestrogen alongside systemic MHT, whether progesterone is required, considerations after breast cancer, red flags, and the practical counselling points clinicians need to know.
Next episode: MHT risks, contraindications and complex clinical situations, including a closer look at the Women’s Health Initiative and how it changed the menopause conversation.
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