This Feels Like TMI

But someone has to talk about this stuff. So why not me?

This newsletter was originally sent out in May of 2023. But as I’ve been prepping a one-year-post-bladder-surgery update, I knew I needed to send this one out first. The information is so important and will apply to nearly ALL women at some point during peri or post menopause. And since most doctors haven’t been trained to treat menopause symptoms, you need to understand what’s happening in your body so you can advocate for appropriate medical care.

So read on if you want important info about your body, and maybe too much info about mine. I’m determined to be candid about all-things menopause related, but it definitely requires some courage on my part. Here goes nothing!

When I was growing up, my sisters (pictured above) made me go first any time we were doing anything remotely scary. Lucky for them, I found trying new things exhilarating enough that I was willing to brave my nerves (and risk humiliation) by going first.

I don’t know if I’ve just sort of resigned myself to “go first” since childhood or if I just exude “I’ll go first” energy, but after being regularly voluntold to go first in any number of circumstances, I finally accepted it as one of the roles I’ve been assigned by the universe.

So in the spirit of going first, I wanted to share my experience with genitourinary syndrome of menopause and my decision to go on vaginal estrogen therapy.

A little background:

“Genitourinary syndrome of menopause” or GSM/GUSM is the medical term for any of the changes you experience to the vulva, vagina or lower urinary tract as estrogen declines during the menopause transition.

Some of the changes are due to age (like changes in blood flow and collagen) but most of the changes are due to declining estrogen, which keeps vulva and vaginal tissues lubricated, healthy and strong. As estrogen declines, muscles lose strength and tissues become more fragile.

These changes fall under the category of, “things that don’t get better once you’re postmenopausal”. Thankfully, vaginal hormone therapy is super safe and there are many over the counter vaginal moisturizers and lubricants as well that you can lean on while you troubleshoot symptoms.

Nearly all women will have to manage some degree of GSM as estrogen declines and settles at low levels - ready or not, GSM is coming for ya!

With that out of the way, let’s get to the part where I talk openly about my vulva and vagina and pretend like it doesn’t freak me out just a little bit. My hope is that if I talk about it, you’ll feel more comfortable talking about your GSM symptoms with your partner, girlfriends and health care providers too.

Without further ado, I’ll go first. (Deep breaths.)

Last December I had my first yeast infection in 7-8 years (and the first ever that wasn’t due to antibiotics). I got through a few very uncomfortable days with the help of some Monistat and hoped it would be another 7-8 years before I had another.

Then I got another one in February. And then another in April.

I went to see my pelvic floor PT for some new pelvic floor issues (also a red flag for GSM), and after doing an exam she said that there was some descent (as in prolapse, UGH!!!) and degradation of vaginal and vulvar tissue due to GSM - both things she hadn’t seen a year prior.

None of this was a surprise given everything I know about GSM - it was what I was expecting based on my symptoms.

But I felt surprisingly upset by the diagnosis.

I didn’t realize I had an unwritten contract with my body: if I learn everything I can about menopause and take reeeeaaaaally good care of myself, then I’ll magically be exempt from experiencing miserable menopause symptoms.

Not to mention the fact that I’m only 45 years old for crying out loud! How can GSM be happening already???

It took me a few weeks to process my feelings and make the appointment to see my primary care doctor, who happily wrote me a prescription for an estrogen cream that I apply to the affected tissue every day for a month to restore/rebuild the tissue, and then 2x a week indefinitely to keep the tissue healthy, happy and strong.

Sadly, my experience isn’t uncommon. Most (if not all) of my menopause clients are also managing symptoms of GSM.

One client would routinely experience a terrible burning sensation on her vulva as well as recurring yeast infections.

Another client had a year of constant bladder infections before finally being treated for GSM. Given this client’s age and rundown of menopause symptoms, GSM should have been an easy diagnosis.

And so on and so forth.

As shocked as I am that I’m experiencing GSM symptoms already, I grateful for a foundation of knowledge that led me to get the treatment I needed quickly - which is more than most women can say.

I’ll keep you all posted as I continue to troubleshoot GSM symptoms with the hope it will help inform your own experience, including my appointment with a urogynecologist this fall to address possible prolapse. (Yes, this fall. It's a six month wait to see a urogyn that takes my insurance.)

In the meantime, I’m sending you lots of love and well wishes for a happy vulva, vag, and urinary tract - even if it requires a little help from some over-the-counter or prescription treatments. You deserve nothing less.

xo, Rebecca