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Sexual Health and Family Planning ACT - Womens Health

About Menopause and you

Menopause is the stage in a woman’s life when she stops having periods. Menopause is a natural life event. It follows the perimenopause, or menopause transition i.e. the time from the onset of menopausal symptoms, through to 12 months after the last menstrual period. This transition can last up to 5 or 6 years.

For many women, these changes will have little impact on their lives; however, some women may experience symptoms severe enough to affect their health and well-being, and disrupt their lives. Some women might feel anxious about reaching the menopause and mourn the loss of their fertility and youth. For others the menopause can mean a new lease of life, free from concerns about periods, premenstrual syndrome or pregnancy.

Ageing well through the menopause

Ageing well Menopause

Whether you're dreading 'The Change' or looking forward to the freedom it can bring, for most women in their midlife years, menopause is on the menu.

And while this life stage may bring changes and challenges, there are positive steps that women can take to improve their health and wellbeing during this time.

February is Ovarian Cancer Awareness Month

Ovarian Cancer AwarenessIt’s time for women living with ovarian cancer to have their voices heard and their experiences known.

It’s time for funding to increase and survival rates to improve. It’s time for all Australians to ovary-act in support of our women and families. Each year over 1,600 women in Australia will be diagnosed with ovarian cancer. In the past 30 years, other cancers have been able to achieve amazing improvements in awareness, funding and survival rates and we want the same hope for our women. While some progress has been made for ovarian cancer there is still so much we need to do.

Four things you didn’t know about periods

about periods

When you first learn about periods and get your first one, there's a lot to take in, and get used to; tracking your cycle, managing the flow, and regularly changing your pads or tampons.

Often shushed by society, period talk – even into adulthood – can seem like whispered 'women's-only' business, a taboo topic rather than a crucial and celebrated part of women's health.

So in case you missed a menstrual memo, or just want to learn more, here are four things you may not know about the menstrual cycle.

To start with, sex shouldn’t hurt, and if it does, a good tip is to say “stop”, no matter what! The aftermath of sex also shouldn’t hurt – whether it’s two minutes, two hours or two days later...

Genitourinary Syndrome of Menopause

hormone levels menopause

WHAT IS GENITOURINARY SYNDROME OF MENOPAUSE?

Genitourinary Syndrome of Menopause, or GSM is a term used to describe the changes that can occur in the vulva,  vagina, urethra, and bladder when you reach menopause.

 These changes are common and occur more than 50% of the time following menopause. 

 Symptoms of GSM can occur following natural menopause or surgical menopause. Unlike other symptoms of menopause such as hot flushes and night sweats, which can improve over time, symptoms of GSM usually persist and may possibly worsen.

GSM can cause significant discomfort and distress, and it is important that it is diagnosed and managed appropriately to reduce symptoms and improve quality of life.

WHAT ARE THE SYMPTOMS OF GSM?

Symptoms vary between individuals but can include:

  • Vulval and vaginal irritation, pain, itching or burning.
  • Vaginal dryness. 
  • Discomfort and pain with penetrative sex.
  • Persistent discharge which has an offensive smell.
  • Light bleeding as the tissues of the vagina become more fragile (if you have any bleeding post menopause it is very important to see a doctor and have this investigated).
  • Weaker pelvic floor muscles that can cause urinary leakage when you cough, sneeze, jog etc.
  • Bladder symptoms such as pain when your bladder is full, urgency when you need to pass urine (needing to rush to the toilet), and pain passing urine.

WHAT CAUSES GSM?

The symptoms caused by GSM are due to decreased levels of the hormone oestrogen after menopause. Oestrogen is important in maintaining the health of your vulva, vagina, and bladder. Oestrogen keeps the tissue of these areas thick and elastic, and when the levels of oestrogen decrease the tissues become thinner, dryer, and less elastic. The pH of the vagina also changes with decreased oestrogen, and this can cause urinary tract infections, as well as a condition called bacterial vaginosis (BV), which is an imbalance in the bacteria which live in the vagina.

HOW DO YOU MANAGE IT?                                                                                                                                       

There are several ways that the symptoms of GSM can be managed and improved:

PERSONAL LUBRICANTS

The use of a lubricant during sex is very important to make sex more comfortable. Lubricants are either water based or silicone based. Personal preference is important, and you may need to try a few to find one that works well for you. Silicone lubricants can provide a higher level of lubrication however, they do not have moisturising properties. 

Water based lubricants can either provide lubrication only or can also act as a moisturiser. Using a lubricant which is also a vaginal moisturiser can be very helpful by reducing dryness as well as providing lubrication. There are several brands of lubricant available which offer both lubrication and moisturising. If irritation and sensitivity are a problem for you then you may want to use a lubricant for sensitive skin.

Natural oils such as sweet almond oil, coconut oil, or light olive oil can also be used as vaginal moisturisers and for lubrication. Any safe liquid substance which you find works for you is fine as well. Remember that if you are using condoms you need to avoid using oil as it can increase the risk of condoms breaking. 

VAGINAL MOISTURISERS

As discussed above there are water based vaginal lubricants and natural oils which also act as a vaginal moisturiser. There are also products designed specifically as vaginal moisturisers, such as Replens®. This is available in individual applicators which are inserted into the vagina.

Each application lasts about 3 days. Replens® is available through pharmacies as a 10 pack or 3 pack. 

VAGINAL OESTROGEN

The hormone oestrogen is available in a cream or in pessaries. These are inserted into the vagina and can be very effective at reducing or relieving the symptoms of GSM. There is almost no absorption of the oestrogen into the body, so it only acts on the local tissues, and there is also no need to take progestogen as is often the case if you are using Menopause Hormone Therapy. Both the cream and pessaries are available on prescription from your doctor. They are usually used every night for the first two weeks then two to three times a week ongoing. Vaginal oestrogen can be used alone or in combination with Menopause Hormone Therapy. 

MENOPAUSE HORMONE THERAPY (MHT)

Menopause Hormone Therapy (also known as hormone replacement therapy or HRT) is the use of hormones (usually oestrogen and progestogen) in the form of a patch, gel, or tablet. It is most often used to relieve the other symptoms of menopause such as hot flushes and night sweats but can also be effective in reducing the symptoms of GSM. Menopause Hormone Therapy is only available on prescription.

You would need to discuss the use of MHT with your GP or make anappointment with one of the doctors at the Canberra Menopause Centre to discuss your suitability for MHT. Call 6247 3077. 

VAGINAL LASER TREATMENT

Laser treatments for GSM have been available in Australia for a few years, however there is currently little evidence for the effectiveness of these treatments. There are some clinical trials underway.

almond oil

Image: Natural oils such as sweet almond oil, coconut oil or olive oil can also be used as effect vaginal moisturisers and lubrication.

SEX AFTER MENOPAUSE

Although GSM can impact on your sex life, you can continue to enjoy a pleasurable and satisfying sex life with appropriate management of symptoms, and to have and enjoy penetrative sex if you wish to. Penetrative sex has been shown to assist in keeping the vagina healthy and the vaginal tissues more elastic. It’s also important to remember that penetrative sex is only a part of sex and intimacy, and if penetration is too uncomfortable then there are many other ways to enjoy sexual pleasure and closeness with a partner. Cuddling, massage, stroking, and mutual masturbation are just some of the ways to do this. Open communication between you and your partner is very important of course and can be the key to maintaining intimacy and a pleasurable sex life for many years to come. Dr Rosie King’s books: Good Loving, Great Sex, and Where Did My Libido Go? are very useful books that discuss a lot of these issues and have very helpful suggestions. 

If you find that you are having ongoing difficulties around sex, then talking to a sex therapist may be very useful. SHFPACT doctors and nurses can give you further information about this and about sex therapists in the Canberra region. 

WHAT ABOUT THE URINARY SYMPTOMS?

Urinary symptoms may include a weaker pelvic floor, urinary leakage, urgency (needing to rush to the toilet), pain when your bladder is full, pain on urination, and getting up more frequently at night (nocturia). If you have any of these symptoms it is important to discuss them with your GP or a Canberra Menopause Centre doctor. Some of the treatments discussed above can improve urinary symptoms, and there are also medications available that can help. However, if symptoms don’t improve or are severe, then referral to a pelvic floor physiotherapist and/or a doctor who specialises in this area may be needed.

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Last updated March 2021. Australian Menopause Society. Jean Hailes for women’s health. RACGP. 2017 AFP: Genitourinary Syndrome of Menopause

How to bring your A-game to your frame

bone health

We tend to think of our skeletons as a never-changing frame. However, just like other parts of our bodies, our bones are constantly being broken down and renewed.

Bones, just like muscles, are living tissue and need to be looked after. And an important part of bone care is physical activity, to enable them to gain strength and remain strong throughout life.

But what exercise or physical activity is best for bone health? You may have heard of the term 'weight-bearing exercise', but what does the term actually mean? And how do you get the most bang for your 'exercise buck' when it comes to bone health? Here, we'll answer these questions and more.

Menopause Centre

Find out how menopause may affect your life and what the Canberra Menopause Centre can do for you.

Based at SHFPACT, the Canberra Menopause Centre is a dedicated service for those seeking information, support and medical management of menopause symptoms. Menopause is the stage of life when periods cease. This occurs when the ovaries are no longer producing eggs, and is a natural life event. Menopause has three stages: perimenopause, menopause and post-menopause.

Vulva Care

The vulva is the term used to describe the external female genitals and includes the inner and outer labia (lips), the opening to the vagina, the opening of tube leading to the bladder (the urethra), and the clitoris.

THE SKIN OF THE VULVA

Taking care of the skin of your vulva is an important part of your health care. There are a few key factors to consider with vulva skincare:

  1.  Correct washing and care.
  2.  Avoiding irritants.
  3.  Reducing excess moisture.
  4.  Avoiding scratching and/or rubbing.

WASHING THE VULVA

  • The skin of the vulva is sensitive and only requires gentle washing with warm water.
  • Avoid the use of any soaps, body wash, wipe, sprays etc. even hypoallergenic, sensitive, and so-called ‘natural’ products can cause irritation.
  • If your skin is particularly dry you can try using an unscented unperfumed wash such as aqueous cream, QV ® or Dermeze®.
  • Washing once a day is plenty. More frequent washing may cause dryness and irritation.
  • If you enjoy baths, avoid having your bath too hot and avoid bubble baths, perfumed oils, medicated oils, or antiseptics. If you do use these make sure you rinse the vulva with warm water afterwards. 
  • Gently pat your vulva dry, don’t rub the skin. If your skin is irritated, you may like to try using a hairdryer on ‘cool’ setting to dry the vulva instead of a towel.

VULVAL SKIN IRRITANTS

Some of the most common substances that can irritate the vulva include the following: 

  • Soaps or anything that will lather and remove healthy oils from the skin.
  • Tea tree oil and scented oils.
  • Medicated creams, antiseptics, and peroxide.
  • Bubble bath, bath salts, and other perfumed products.
  • ‘Feminine hygiene’ products such as washes, sprays, and wipes.
  • Some brands of toilet paper, particularly highly scented or coloured ones.
  • Some pads and panty liners (especially if scented).
  • Some laundry detergents.
  • Deodorants.
  • Douches.
  • Waxing, shaving, or depilatory creams.
  • Tight synthetic clothing and dyes in some underwear.

TO PREVENT VULVAL SKIN IRRITATION

  • Wash the vulva as outlined above.
  • Avoid ‘feminine hygiene’ products e.g: sprays, wipes, powders etc.
  • Try unscented, undyed, unbleached toilet paper.
  • Try a different type of laundry detergent, preferably hypoallergenic. 
  • Consider giving underwear an extra rinse after washing to remove laundry detergent residue.
  • Use tampons or a menstrual cup rather than pads if pads are irritant.
  • Avoid using panty liners. If discharge is heavy, try changing your underpants during the day or using ‘period undies’ instead. If you need panty liners try to use unscented and unbleached products. 
  • Wear loose clothing including 100% cotton underwear. 
  • Avoid wearing any underwear at night.
  • Avoid removing pubic hair, particularly shaving, as it can cause significant irritation to the skin.

If vulval skin irritation occurs and persists despite trying the preventative suggestions, see a medical professional. Avoid trying to self-treat with over-the-counter products and creams. Only use products prescribed or advised by a health professional.

EXCESS MOISTURE

Excess moisture can worsen the effects of irritation, to reduce this:

  • Take off wet swimwear as soon as possible (especially if swimming in a chlorinated pool). 
  • Wear underwear that will absorb moisture – some synthetic underwear will hold moisture at the surface whereas cotton will absorb it. 
  • Carry clean underwear to change into if needed.

SCRATCHING AND/OR RUBBING

Vulvar Skin Conditions Itchy

Skin damaged or irritated by friction and rubbing is more easily infected. Scratching can also create what is known as an ‘itch-scratch cycle’ where skin and nerve fibres thicken, which in turn increases itching.

  • To avoid damage and irritation from scratching and rubbing:
  • Avoid rubbing the vulva with a washcloth, just gently wash with your hands or a handheld shower.
  • Gently pat dry with a towel or use a hairdryer on cool.
  • Avoid hair removal in the area.
  • Avoid tight clothing.
  • Use plenty of water-based non-perfumed, hypoallergenic lubricant during sexual activity.  

IF SKIN IS ITCHY

  • Keep nails short if scratching is happening at night when asleep.
  • Wear loose cotton underwear and avoid underwear at night.
  • Avoid overheating the skin – avoid electric blankets, showers/ baths that are too hot, or synthetic clothing pressed up again skin.
  • Keep skin cool – use a covered ice pack or a damp cloth to soothe, if using any creams on your vulva store them in the fridge.
  • Try distraction, mindfulness, or relaxation techniques when the urge to scratch strikes.
  • Consult with a health professional if this is the first occurrence or if an existing condition is persistent.

 VULVAL SELF-EXAMINATION

One way to pick up on changes in the vulva before they become an issue is to perform vulval self- examinations. The sooner you detect any changes the less likely symptoms will persist and potentially the need for extended treatment may be reduced. It’s also just great to get to know your own body. You can do this on a regular basis, once a month, or whenever you think of it.

HOW TO DO A VULVAL SELF-EXAMINATION

  • Find a private place and time when you can relax. 
  • Use a hand mirror so you can see what you are looking at.
  • Starting at the top (known as the mons pubs — the place where public hair grows) gently touch and feel as well as look at the skin. Work yourway down by checking the clitoris, the outer lips, the inner lips, and the perineum (area between the vaginal opening and the anus).
  • Look out for any changes in the colour of the skin, any thickening of the skin, any new lumps or bumps (such as warts or skin tags), any ulcers or sores, any symptoms of persistent itching or soreness.

If anything is different or you are concerned, consult a health professional who you are comfortable with or see one of the doctors at SHFPACT. 

DISCHARGE

Discharge is the fluid like substance that is secreted from the vagina. It is produced by the cervix, the uterus, and the vagina itself. It generally appears on underwear but may also be seen during a vulval examination. Discharge is a normal and healthy ‘housekeeping’ function of the vagina. 

A change in your discharge can also be an indication that something is wrong so it’s important to know what your normal discharge looks like (usually clear or creamy white which can look pale yellow when it dries on your undies). If there are unusual changes to the colour, smell, or amount of your vaginal discharge then a visit to a health professional is recommended.

A NOTE ABOUT THE APPEARANCE OF VULVAS

As with many parts of our bodies, vulvas look different from person to person, as well as at different stages on our lives. Vulvas are as individual as our faces! Many things can influence the way we feel about our bodies (e.g., what media we watch, what social media engage in, what we read or listen to, attitudes from our family of origin, messages from the society we live in, and our own attitudes and feelings). 

It’s good to take a moment to consider the reality versus the fantasy of what we see and hear. It can also help to understand more about the vulva and see the different types of real vulvas out there.

It should be noted that pornography and other sexual imagery are not good places to learn more about our bodies — the vulva included. Reputable, evidence-based sites like the Labia Library: labialibrary.org.au aim to help women understand more about their vulva and become more comfortable with the way it looks. Anyone with concerns with the way their vulva looks should talk with a health professional or make an appointment at the SHFPACT clinic to talk with a doctor or nurse.

VOLVA CARE BROCHURE PDF

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References: Melbourne sexual health Centre: Genital Skin Care. Dept of Obstetrics and gynaecology Uni of Washington: Guidelines for vulvar skin care. UK Vulval Pain Society: How to perform a vulval self-examination. ANZ Vulvovaginal Society. Last updated December 2020.