Menopause, Pelvic Floor & Urinary Symptoms
Assess menopausal symptoms and pelvic floor problems with individualised treatment and follow-up.
Quick revision ↓ Medical Dictionary
01Recognise the transition
Menopausal symptoms may include vasomotor episodes, sleep disturbance and genitourinary discomfort, with variable impact on daily life. Age, menstrual history and clinical context guide diagnosis and the need for tests. Do not attribute every new symptom to menopause automatically. Early ovarian insufficiency, alternative endocrine disease and unexplained bleeding need their own appropriate assessment.
02Treatment discussion
Discuss hormonal and non-hormonal options according to symptoms, medical history and preferences. Hormone therapy benefits and risks depend on the preparation, route and individual circumstances. People with a uterus generally need endometrial protection when using systemic oestrogen. Review response and adverse effects, and explain that hormone replacement therapy is not a contraceptive method.
03Genitourinary symptoms
Dryness, painful sex and urinary discomfort may relate to menopausal tissue changes, but infection or other pathology can coexist. Local treatments, including moisturisers and appropriate vaginal oestrogen, may help. A personal history of hormone-sensitive cancer requires individual discussion and relevant specialist advice. Persistent pain, lesions or bleeding should not be managed indefinitely as simple dryness without reassessment.
04Incontinence assessment
Distinguish stress leakage with effort or coughing from urgency-associated leakage, while recognising mixed symptoms. Ask about fluid intake, medicines, infection symptoms and impact; examine and investigate appropriately. Bladder diaries can clarify patterns. Haematuria, retention or neurological findings change the pathway and should not be treated as uncomplicated incontinence without further assessment.
05Prolapse and conservative care
A vaginal bulge, pelvic pressure and bladder or bowel symptoms can suggest prolapse. Discuss pelvic floor training, lifestyle measures, pessaries or surgery according to severity and preferences. Pessary use needs fitting advice and follow-up rather than indefinite unattended placement. Set realistic goals and reassess function, comfort and complications over time.
High-Yield Revision
- HRT does not provide contraception.
- Stress and urgency incontinence may coexist.
- Pessaries require ongoing care and review.
Common Pitfalls
- Attributing all new bleeding to menopause or HRT.
- Prescribing a single treatment without assessing the symptom pattern.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.