Menopause is a natural stage of life, but for many women, the changes that come with it can be confusing, uncomfortable and sometimes difficult to talk about.
Hot flushes, night sweats and changes to sleep are often the symptoms we associate with menopause. But what about vaginal dryness, urinary urgency, recurrent UTIs or discomfort during intercourse?
These symptoms can also be associated with menopause, yet they're not always recognised or discussed.
In October 2026, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) released its first evidence-based menopause guideline, marking an important step forward in women's healthcare.
So, what does this mean, and why is it important?
What are the new menopause guidelines?
The guidelines, titled Management of Vasomotor and Genitourinary Symptoms of Menopause, were developed to help healthcare professionals provide consistent, evidence-based advice and treatment.
They focus on two main areas:
1. Vasomotor symptoms
These are symptoms associated with changes in the body's temperature regulation, including:
Hot flushes
Night sweats
Sleep disruption associated with these symptoms
2. Genitourinary symptoms
These involve changes to the vulva, vagina and urinary tract, including:
Vaginal dryness, burning or irritation
Discomfort or pain during intercourse
Urinary urgency or frequency
Urinary discomfort
Recurrent urinary tract infections
The guidelines provide recommendations for assessing these symptoms and discussing appropriate management options.
Menopause affects more than your periods
One of the important conversations surrounding menopause is the impact hormonal changes can have on bladder and pelvic health.
As oestrogen levels decline, changes can occur in the tissues of the vulva, vagina and lower urinary tract.
These changes are commonly referred to as genitourinary syndrome of menopause (GSM).
For some women, this may mean experiencing urinary urgency for the first time, developing recurrent UTIs or noticing vaginal dryness and discomfort.
Unlike some other menopausal symptoms, genitourinary symptoms may persist or worsen without appropriate management.
Importantly, not every bladder symptom during menopause is caused by hormonal changes. Pelvic floor dysfunction, infection and other conditions may also contribute, which is why individual assessment matters.
What do the guidelines say about treatment?
Menopausal hormone therapy
The guidelines recommend menopausal hormone therapy (MHT) as a first-line medication option for troublesome hot flushes and night sweats when it is medically appropriate.
Treatment decisions should consider individual medical history, symptoms, preferences and potential benefits and risks.
Vaginal oestrogen
Local vaginal oestrogen is an important treatment option for genitourinary symptoms associated with menopause.
It works directly on local tissues and has minimal systemic absorption.
Vaginal oestrogen may help improve dryness, irritation and discomfort, and can be beneficial for certain urinary symptoms, including recurrent UTIs in postmenopausal women.
It can also be used alongside systemic MHT when appropriate.
Non-hormonal options
Hormone therapy isn't the only option.
The guidelines also consider non-hormonal medications and treatments, recognising that not everyone can or wishes to use hormonal therapy.
Treatment should be guided by the individual's symptoms, circumstances and preferences.
Where does pelvic health fit into menopause care?
Pelvic health is an important part of supporting women throughout perimenopause and menopause.
Hormonal changes can occur alongside changes in pelvic floor function, bladder habits and pelvic comfort.
Pelvic health assessment may help identify contributing factors such as pelvic floor muscle dysfunction, altered bladder habits or musculoskeletal pain.
Management may involve bladder retraining, pelvic floor rehabilitation, education and working alongside a GP or gynaecologist when medical treatment is indicated.
For example, someone experiencing urinary urgency may benefit from bladder retraining, but if vaginal or urethral tissue changes are also contributing, local vaginal oestrogen may be an important part of their overall management.
It's not always about one treatment. It's about understanding the different factors contributing to someone's symptoms.
Why are these guidelines important?
For too long, many women have felt that symptoms associated with menopause were simply something they needed to accept.
These guidelines provide healthcare professionals with a clearer evidence-based framework for discussing symptoms and treatment options.
They also reinforce the importance of recognising symptoms that aren't always openly discussed, particularly those affecting vaginal, vulval and urinary health.
Although these guidelines don't cover every aspect of menopause, they represent an important development in supporting more consistent, informed and individualised care.
Menopause is natural. Suffering through symptoms doesn't have to be.
Experiencing menopause doesn't mean you should have to accept symptoms that interfere with your sleep, relationships, exercise, work or everyday life.
Whether you're experiencing hot flushes, urinary urgency, vaginal discomfort or recurrent UTIs, understanding what is happening in your body is an important first step.
At Yarra Valley Women's Health, we believe women deserve to feel heard, informed and supported throughout every stage of life.
Menopause shouldn't be something you have to navigate without answers or support.