Perimenopause, Hormones and Sex

Perimenopause, Hormones and Sex

Do you pee when you laugh? Sneeze? Run? 

Do you lubricate less during sex?  Does sex hurt? 

If you answer yes to any of these questions and you're in your 40s the most likely reason is perimenopause- the years before menopause, when estrogen and other hormones, start fluctuating unpredictably and declining.


Because vulvovaginal atrophy (VVA) isn’t a media-friendly term, NAMS (North American Menopause Society) has changed it to Genitourinary Syndrome of Menopause (GSM). This term is also more encompassing, as it describes not only vulvovaginal symptoms such as dryness, burning, irritation, discomfort, and painful intercourse, but also recurrent urinary tract infections, urinary urgency (a sudden compelling urge to urinate), and painful or difficult urination.

Also, the new nomenclature, GSM, doesn’t imply that the condition is a disease, like atrophy seems to, but it better describes a cluster of signs and symptoms linked to decreased estrogen and other sex hormones affecting female genitalia.


Some women in perimenopause and about half of postmenopausal women experience GSM.  Even though the incidence is so high, GSM isn’t a subject women talk about freely with their friends or even their physicians. GSM is under-reported and unfortunately for many women, under-treated. GSM affects women’s quality of life because of the negative effect on sexual function, enjoyment of sex, sexual intimacy, self-esteem, and emotional well-being.


Don’t let GSM dictate your washroom breaks, ruin your intimate relationships or decrease your enjoyment of life.  There’s an array of treatments out there and no need to suffer!


There are over-the counter (without prescription) products to alleviate vaginal dryness, burning, irritation, and painful intercourse. If these treatments aren’t effective, women can use prescription topical hormone therapy, a cream or vaginal ovule inserted directly into the vagina which does not have the same side/adverse effects as hormone therapy taken orally (in a pill form).

(I will write more about hormone therapy and side effects in another post!).


Some women may also experience structural problems, such as organ prolapse*, for which there are treatments available as well.

If your physician doesn’t ask about the health of your vagina and you are experiencing genitourinary symptoms, bring it up at your next visit.


Don’t let GSM decrease your enjoyment of life!



 Teresa is a Trailblazer in the Toronto West branch of Happy Healthy Women. She provides one-on-one consultations, in person and online, offering support and care, evidence-based, and accurate information, to enable women to make informed choices about the management of their menopause.

To learn more about Teresa Isabel and her work visit:

Contact by email

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