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Most women are familiar with the hot flushes and night sweats associated with menopause. These symptoms occur during hormonal change, as estrogen levels fluctuate, and the most common treatment for these symptoms – Menopause Hormone Therapy (MHT) – is well known. Even without treatment these symptoms, although often protracted, are temporary and will cease after a time. Less well known are symptoms associated with GSM – that’s genitourinary syndrome of menopause, which covers a range of genital, sexual and urinary symptoms – and it’s not because these symptoms are any less common. In fact, about half of women will experience some form of GSM following menopause, but it’s just not talked about in the same way as hot flushes and night sweats.

Because women don’t realise how common these issues are – and that they’re happening to so many others around them – they don’t raise the subject, and this only perpetuates the sense that they’re suffering alone. Further complicating the issue, explains Dr Smart, is the fact that GSM typically appears five or six years after the more well-known signs of menopause, ‘once the estrogen has “bottomed out”,’ so the sufferer may attribute the symptoms to other things. There is also the fact, says Catherine France, General Manager at Oxford Women’s Health, that ‘women are far too good at putting up with things until they become unbearable’.

But women need to reach out sooner. The symptoms of GSM don’t go away – in fact, they usually get worse over time. Symptoms can include genital dryness, burning, and irritation (all making sex uncomfortable or painful) and urinary symptoms including the need to run to the bathroom more frequently or urinary tract infections that keep recurring. Usually mild to begin with, these symptoms are easier to treat in the early stages, although those who undergo abrupt menopause, due to the removal of the ovaries or chemotherapy, for example, can experience more severe symptoms due to the sudden drop in estrogen levels.

The good news is that there are treatments available. A GP can provide simple treatment or may seek secondary specialist advice. MHT, commonly prescribed for other symptoms of menopause, may have limitations when it comes to genital issues, but there is an effective alternative in the form of topically applied estrogen cream. It is not entirely convenient, though, requiring the use of an applicator several times per week, which users may find messy and time-consuming.

For some women, the use of a hormone-based treatment also raises fears about hormone-sensitive cancers, e.g. breast cancer, especially if they have previously experienced cancer or have a family history of the disease. ‘For those that have been through a life-threatening scare,’ says Dr Smart, ‘I can understand why they wouldn’t feel comfortable, even if we reassure them about safety.’ So, when a new treatment for GSM recently became available, it sparked a conversation amongst New Zealand gynaecologists who were looking for an alternative to offer patients. The MonaLisa Touch is widely used in Australia and, after careful consideration, Oxford Women’s Health has added it to their range of treatments.

This non-invasive treatment uses a laser to deposit minor heat spots in the skin, which stimulates natural healing to produce new collagen and elastin, and increase blood flow, resulting in healthier and more hydrated cells. Initially administered in a course of three painless 15-minute treatments, benefits can be maintained with annual ‘top-up’ treatments. The treatment can be used alone or in conjunction with an estrogen cream, for even greater benefit, and is suitable even for women who have had cancer treatment.

The result is an improvement in lubrication, less discomfort and less pain with sex – and there are sometimes additional benefits with prolapse or urinary symptoms. Menopause is a time of huge change for women, so amongst everything else, not being able to function sexually can have a major effect on self-esteem. No longer being intimate with your partner can also create a rift in personal relationships, causing a sense of loss that adds to what can be a lonely time for women suffering these symptoms in silence. These women, from late forties onwards, may be at the peak of their career and may still have children at home, says Dr Smart, so it’s a lot to experience ‘right when they really need to function at the top of their game’.

How can women navigate the changes? It starts with talking about it, realising they’re not alone and seeking professional help. In this era, women expect to have it all – family, career and an active sex life. ‘We can,’ says France, ‘but we need to have the knowledge to empower ourselves so we can manage all the demands of being a woman in the 21st century.’

WORDS Michelle Berridge