What's Up Down THERE: Perimenopause Symptoms No One Warns You About

Perimenopause symptoms like vaginal dryness, recurrent UTIs, and bladder leaks are more common than most women realize. These changes are part of Genitourinary Syndrome of Menopause (GSM), and they are directly linked to declining estrogen.

In this video, I explain what’s really happening in your vaginal and urinary tissues during perimenopause and menopause, why these symptoms tend to persist, and the evidence-based strategies that can dramatically improve them.

If you’ve been told this is “just aging,” this conversation may shift everything.

You don’t have to quietly tolerate discomfort, infections, or incontinence. There are real solutions. And one of them might surprise you.

Download my free guide, “Why Your Body Feels Off,” to understand how perimenopause impacts your entire body: 
https://off.startwithembr.com/

If you’re looking for individualized support navigating perimenopause with clarity and confidence, you can learn more about my coaching program here
https://startwithembr.com

If this was helpful, consider subscribing or sharing it with a woman who’s been wondering if what she’s experiencing is normal.

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Kimberly Hoyt is a physician assistant with two decades of clinical experience who helps women navigate perimenopause and menopause with clarity and confidence. Her work focuses on midlife health and education, helping women understand what is happening in their bodies so they feel prepared, informed, supported and empowered. 

Medical Disclaimer: The information shared on this channel is for educational and informational purposes only and is not intended as medical advice. Kimberly Hoyt, PA-C, and associated content are not a substitute for professional medical care, diagnosis, or treatment. Viewing/Listening to this content does not establish a patient-provider relationship. Always consult your own healthcare provider before making changes to your health plan, starting supplements, or addressing medical concerns.

General Disclaimer: I am not a CPA, attorney, insurance/real estate agent, contractor, lender, or financial adv...

Transcript

Kimberly Hoyt 0:00

If you are experiencing vaginal dryness, recurrent UTIs, or suddenly dealing with bladder leaks, your body isn't broken. It's responding to very specific hormonal changes that we can actually address. I'm going to explain exactly what's happening in your vaginal and urinary tissues during perimenopause and menopause. Why these changes make you more susceptible to infections and incontinence. And most importantly, I'm going to give you five evidence-based solutions that can dramatically improve your symptoms. So stick around into the end because solution number five might actually surprise you, but it's something you can start doing today. That costs nothing and can genuinely help restore your vaginal health. What we're talking about today is called the Genitourinary Syndrome of Menopause, or GSM for short cause that's much easier to say and it can affect up to 50% of women. Now I've seen actually up to 87% of women can experience some of these symptoms. But here's the thing. Unlike hot flashes that often improve over time, GSM symptoms tend to persist, and they can actually get worse without treatment. GSM includes vaginal dryness, discomfort, or pain during intercourse. Increased urinary tract infections or STDs and urinary incontinence, both urge incontinence where you have that sudden strong urge to urinate, as well as stress incontinence where you leak during coughing, sneezing, or exercise. These aren't just minor inconveniences. They impact intimacy, daily comfort, confidence, and quality of life. But here's what you need to know. These changes are completely understandable from a physiological standpoint, and they are treatable. So let's dive into what's actually happening in your body, because when you understand the why, the solutions make much more sense. The primary driver of all these changes is declining estrogen. Estrogen is like the maintenance crew for your vaginal and urinary tissues. And when levels drop during perimenopause and menopause, several domino effects occur loss of elasticity, lubrication, and suppleness. First, estrogen maintains vaginal tissue thickness, elasticity, and natural lubrication. When estrogen decreases, the vaginal walls become thinner, sometimes called vaginal atrophy. They lose their elasticity becoming less stretchy and more fragile. Natural lubrication decreases significantly leading to that persistent dryness that many women experience. Estrogen also supports collagen production, which is the structural scaffolding that gives your tissues support and resilience. As estrogen declines, collagen decreases and the vaginal tissues lose their underlying support structure. This can actually change the shape and structure of the vaginal canal itself. It can become shorter, narrower, and less flexible. Here's where it gets really interesting. Your vaginal microbiome, the ecosystem of beneficial bacteria is also estrogen dependent. In a healthy, estrogen rich environment, vaginal cells produce glycogen, which feeds lactobacilli bacteria, and these beneficial bacteria. Lactic acid and hydrogen peroxide, and this keeps the vaginal pH acidic around 3.8 to 4.5. This acidic environment protects against harmful bacteria and yeast. When estrogen drops glycogen production decreases and lactobacilli populations decline as well. the vaginal pH becomes less acidic, sometimes rising above five. This creates an environment where harmful bacteria can more easily colonize, which is why you become more susceptible to urinary tract infections, bacterial vaginosis, and other infections in the vaginal canal, the urethra, the bladder and the pelvic floor tissues also have estrogen receptors. So as that estrogen declines, the urethral lining thins, pelvic floor support weakens and bladder control can be affected. This contributes to both urge incontinence and stress incontinence, and makes the urinary tract more vulnerable to infection. Now before we get into the solutions, and trust me, there are real effective solutions. If you're finding this information helpful, do me a favor and hit that subscribe button click that little bell so you don't miss future videos. And if you know someone going through perimenopause or menopause who's been struggling with these symptoms, please share this video with them. Knowledge is power, and no one should suffer in silence thinking that this is just something that they have to live with. Now let's talk solutions. Here are five evidence-based approaches to managing GSM. Solution number one, vaginal estrogen. This is often the gold standard treatment for GSM. Vaginal estrogen comes as a cream, a tablet, or a ring that you insert into the vagina. Unlike systemic hormone therapy, vaginal estrogen works locally, very little is absorbed into your bloodstream, so it primarily acts right where it's needed. Vaginal estrogen can restore vaginal tissue thickness, improve elasticity and lubrication, restore a healthy pH, support that beneficial lactobacilli bacteria, And can significantly reduce UTI frequency. Many women see improvement within several weeks, and this is a prescription only, so you'll need to discuss it with your healthcare provider. But it is one of the most effective interventions that we have. I was watching a recent podcast episode and the physician was saying that vaginal estrogen is something that all women should be using until death do us part. When we look at women who are in nursing homes, one of the things that we see is these recurrent urinary tract infections, and if we can reduce the amount of infections and burden that we have, especially as we get older, it's only going to improve our health outcomes long term. Okay. I'm hopping off my soapbox. And let's move on to solution number two. Pelvic floor physical therapy and exercises. Your pelvic floor muscles support your bladder, your urethra, the vagina, and the rectum. Strengthening these muscles through pelvic floor exercises can significantly improve urinary incontinence, provide better support to the pelvic organs, improve sexual function, and even enhance sensation. But here's the thing, many women don't do these or do them correctly. So I would recommend considering working with a pelvic floor physical therapist who can assess your specific needs, teach you proper technique, and create a personalized program just for you. This is especially important if you have pelvic organ prolapse or severe incontinence. Solution number three, lubricants and vaginal moisturizers. These work differently, but both are important. Lubricants are used during sexual activity to reduce friction and discomfort. Look for water-based or silicone-based options without glycerin, parabens, or fragrances, which can be irritating. Vaginal moisturizers are different. These are used regularly, typically two to three times a week to help maintain vaginal moisture levels over time. Think of moisturizers like lotion for your face. You use them consistently for ongoing hydration, not just in the moment. Solution number four, diet, lifestyle, and exercise. Your overall health absolutely impacts your vaginal and urinary health. Regular physical exercise improves circulation to pelvic tissues, helps maintain a healthy weight, which reduces stress on pelvic floor and supports overall hormonal balance. A nutrient dense diet can help too. Foods rich in phytoestrogens like flax seeded, soy, and legumes may provide mild estrogenic effects. Omega-3 fatty acids support tissue health and reduce inflammation and adequate hydration is crucial for urinary health, though some women mistakenly restrict fluids. Thinking it will help with incontinence that actually makes things worse. Stay hydrated. Ladies. Managing chronic conditions like diabetes is also super important as high blood sugar can increase that urinary tract infection risk and affect nerve function related to bladder control. Solution number five. Here's that surprising solution I mentioned in the beginning. Regular sexual activity, whether with a partner or solo, actually helps maintain vaginal health. Sexual arousal increases blood flow to the vaginal tissues, which brings oxygen and nutrients. Regular penetration helps maintain vaginal elasticity and can prevent the vaginal canal from narrowing or shortening. Some research suggests that women who remain sexually active during and after menopause experience fewer GSM symptoms. Now, I know this can feel like a catch 22 when sex is painful or very uncomfortable, which is why combining this with lubricants and moisturizers or that vaginal estrogen can make it feasible and enjoyable again. So let's circle back to where we started. If you're experiencing vaginal dryness, recurring UTIs, or bladder leaks, your body isn't broken. These symptoms are the direct result of estrogen declining, affecting your vaginal tissue thickness, elasticity, collagen support, and microbiome balance. And as we've covered today, there are five effective solutions: vaginal estrogen, pelvic floor exercises, lubricants and moisturizers, lifestyle, and number five, regular sexual activity. You don't have to just accept these symptoms as an inevitable part of aging. They are treatable. Now, here's the thing. The genitourinary symptoms we talked about today are often just one piece of the larger puzzle. Many women don't realize that their vaginal dryness, the UTIs, the sleep disruption, the brain fog, the joint pain, The anxiety, all of these seemingly random symptoms can actually be connected to the same hormonal transition. That's why I created a free guide called Why Your Body feels Off. This guide walks you through how perimenopause can show up across your entire body, not just your reproductive system, but your cardiovascular system, your nervous system, your musculoskeletal system. And even your skin and hair. It helps you see the pattern in what you've been experiencing so that you can stop wondering if it's all in your head and start having more informed conversations with your healthcare provider. You can download that guide. It's completely free. See the link down below and if you're ready for more personalized support as you navigate this transition, I do work with women through coaching, you can learn more about the current offerings and see if we might be a good fit by visiting my website. The link is right there in the description below. Remember, your health matters. These symptoms matter and you deserve to feel comfortable and confident in your body. You are not imagining what you've been experiencing, and you are absolutely not alone. Thanks for watching and I'll see you in the next video.