Menopause is a personal and significant journey for every woman. While we often talk about hot flashes and mood changes, there are other very real, yet often unspoken, shifts that happen within our bodies, particularly concerning our urogynaecological health. These changes can feel isolating, but please know you’re not alone, and there’s so much we can do to help.

This article is here to shed a warm, comforting light on some of these common urogynaecological conditions that many women experience during menopause. 

Our aim is to help you understand what’s happening, recognise the signs, and feel empowered to seek the quality care you deserve. Rest assured, specialised urogynaecology services in Singapore are readily available, with dedicated professionals committed to supporting your well-being.

Beyond Hot Flashes: Understanding Urogynaecological Issues During Menopause

As you transition through menopause, the most significant change happening internally is the natural decline in oestrogen levels. Think of oestrogen as a vital nutrient for many parts of your body, including the delicate tissues of your vulva, vagina, urethra, and bladder. When oestrogen levels decrease, these tissues can become thinner, drier, and lose some of their natural elasticity. This process is what doctors call atrophy. Even the natural balance of beneficial bacteria in your vagina can shift, making things feel a little different.

These urogynaecological changes, though invisible to others, can genuinely impact your comfort, sexual intimacy, and overall confidence. They might make daily activities a bit less comfortable, or even make you hesitate in social situations. It’s perfectly normal to feel this way.

GSM and POP: Common Urogynaecological Conditions in Menopause. Let’s delve into two very common conditions that many women encounter during this phase of life.

1. Genitourinary Syndrome of Menopause (GSM)

Have you noticed persistent dryness, itching, or discomfort down there? 

These could be signs of Genitourinary Syndrome of Menopause (GSM). This is a common and progressive condition caused by that decline in oestrogen affecting the intimate areas, including the labia, clitoris, vagina, urethra, and bladder.

While exact numbers can vary, clinical experience shows that a significant number of postmenopausal women experience symptoms of GSM. Many women report vaginal dryness, which is just one piece of the GSM puzzle.

What GSM might feel like:

• Vaginal symptoms: Persistent vaginal dryness, burning, itching, or irritation.You might also experience discomfort or painful intercourse (dyspareunia), sometimes with a little bleeding afterwards.
• Urinary symptoms: Feeling a sudden urgency to pee, pain during urination (dysuria), or even more frequent urinary tract infections (UTIs).
  
  

GSM can certainly affect your sexual well-being and daily comfort, but thankfully, there are effective ways to manage it.

Solutions for GSM:

• Lifestyle Changes: Simple adjustments like adequate fluid intake, wearing loose clothing, and avoiding vaginal douching or the overuse of strong feminine products can significantly reduce symptoms.
• Hormonal Treatment: topical oestrogen therapy is an effective and commonly prescribed treatment by gynaecologists in Singapore. It works by gently reversing age-related changes in the vagina, bladder, and urethra, and also helps restore the healthy vaginal microbiome.
• Personalised Care: It is important to seek advice from a doctor, as symptoms can overlap with other conditions. Your doctor will take into account your specific symptoms, lifestyle, and risk factors to create an appropriate treatment plan.

2. Pelvic Organ Prolapse (POP)

Sometimes, during menopause, you might start to feel a sensation of “something coming down” or a heaviness in your vagina. This could be a sign of Pelvic Organ Prolapse (POP). This happens when pelvic organs like your bladder (cystocele), uterus (uterine prolapse), or rectum (rectocele) gently shift from their usual position and create a bulge in the vagina.

POP is actually quite common, especially among older women. Studies suggest that up to half of all women might experience some degree of prolapse, with a smaller number needing more significant intervention. 

Why POP can happen:

It often occurs due to weakened pelvic floor muscles and the connective tissues that support your organs. Factors like childbirth (especially vaginal deliveries, which are common in Singapore), chronic coughing, and crucially, the loss of oestrogen support during menopause in women, can all contribute.

What POP might feel like:

• A noticeable bulging tissue at the vaginal opening
• Constant pressure or discomfort in your pelvis
• Difficulties with urination or bowel movements
• Pain during sexual intercourse or the inability to have sex itself

Seeking Support and Solutions for POP :

Non-Surgical Management:

• Pelvic floor exercises are important for strengthening the supporting muscles. 
• Lifestyle Adjustments: Simple changes like maintaining a healthy weight, or avoiding  constipation can make a big difference.
• Pessaries are another non-surgical option, fitted and managed by your urogynaecologist. These are removable devices inserted into the vagina to support pelvic organs and relieve symptoms.
  
  

Surgical Management:

If non-surgical methods aren’t enough, various surgical repairs are available in Singapore, performed by experienced urogynaecologists. The type of surgery can be discussed with your urogynaecologist. 

UTIs, Incontinence, and Prolapse: Urogynae Challenges of Menopause

Let’s explore further common urogynaecological challenges that can arise during menopause.

1. Recurrent Urinary Tract Infections (UTIs) during Menopause

Have you found yourself battling recurrent UTIs more often after menopause? 

You’re not alone. The decline in oestrogen can make the lining of your urethra and bladder tissue more delicate. It also changes the natural balance of bacteria in your vagina, leading to a less acidic environment and reduced protective lactobacilli, making the urinary tract more susceptible to bacterial infections. Sometimes, incomplete bladder emptying, which can be linked to prolapse, also plays a role. You can find more detailed information about Urinary Tract Infections (UTIs).

UTIs are common, and their frequency does tend to increase with age, especially after 50. Postmenopausal and elderly women are at a higher risk, and experiencing repeated UTIs can be truly frustrating.

What UTIs feel like:

It usually presents with a burning sensation when you pee, frequent urges to go, and discomfort in your lower abdomen.

Finding Relief and Preventing UTIs :

• Treatment of UTIs: If you suspect a UTI, prompt medical attention is essential. Antibiotics are commonly prescribed, usually for a course of 3-7 days. It’s crucial to complete the entire prescribed course.
• Prevention of Recurrent UTIs:
  • Lifestyle Measures: These include adequate hydration, urinating soon after intercourse, avoiding vaginal douching and irritating feminine products, and choosing breathable cotton underwear.

2. Urinary Incontinence during Menopause

Urinary incontinence menopause – the involuntary leakage of urine – is a very common yet often unspoken concern. It can feel embarrassing, but it’s important to remember that many women experience it. 

Understanding the Types of Incontinence:

• Stress Urinary Incontinence (SUI): This happens when you leak urine with activities that put pressure on your bladder, like coughing, sneezing, laughing, or exercising. It’s usually due to weakened pelvic floor support. 
• Urge Urinary Incontinence (UUI) / Overactive Bladder (OAB): This is characterized by a sudden, strong urge to urinate that’s hard to control, and may lead to leakage before you can reach the toilet. This can be related to changes in bladder muscle function. 
• Mixed Incontinence: Sometimes, women experience a combination of both SUI and UUI.
  
  

Factors contributing to incontinence include oestrogen deficiency, weakened pelvic floor muscles (especially after childbirth), malfunctioning bladder muscle, and some medication effects (including diuretics and certain sedatives) can all contribute to incontinence.

Steps to Take for Urinary Incontinence:

• Non-Surgical Management:
  • Pelvic floor exercises
  • Bladder Training
• Surgical Management:

For more persistent cases of stress urinary incontinence, various minimally invasive procedures are available, performed by urogynaecologists in Singapore. These primarily include:

• Synthetic Mid-Urethral Tape (e.g., TVT or TOT procedures): This procedure involves positioning a thin strip of synthetic mesh beneath the mid-urethra. Functioning as a sling, it supports the urethra and helps keep it closed during activities that increase abdominal pressure, like coughing or exercising. This surgery is minimally invasive, often performed through small incisions, and is effective for women with stress urinary incontinence. 
• Open Colposuspension (Known as Burch colposuspension): This surgical option involves making an incision in the lower abdomen to access the bladder neck and urethra. Sutures are placed to lift and secure these structures to the pelvic ligaments, providing support and preventing urine leakage. This procedure is particularly beneficial for stress incontinence and is often recommended for women who have not found relief from less invasive treatments. While more invasive than sling procedures, it offers long-term efficacy in managing incontinence.

Prolapse and its Deeper Connection to Menopause

While your body will do a lot of healing on its own, you should talk to a professional if: