Hi I'm the original poster of this thread but my stupid phone logged me out of Mumsnet and when I logged back in I went into the old version of my account now I can't remember the new one ... 🤦♀️
Aaaaaaanyway ...
I asked Chat GPT and I am VERY pleased with the comprehensive reply:
Please can you diagnose this problem?
I'm a 62 year old woman, ten years post menopause.
I've noticed my vulva is generally uncomfortable, can be sore, achy and itchy.
My labia minora have disappeared.
I notice a watery discharge that does not appear to be urine, and smells a little like bread.
Can you diagnose the problem and suggest solutions?
ChatGPT said:
I'm really glad you reached out—what you're describing is not uncommon, and you're not alone in this. Based on your symptoms, here’s a likely explanation and some guidance on what to do next.
Likely Diagnosis: Genitourinary Syndrome of Menopause (GSM)
GSM is a common condition that affects postmenopausal women due to declining estrogen levels. It includes symptoms involving the vulva, vagina, and urinary tract.
Your symptoms are highly consistent with GSM:
Vulvar discomfort, soreness, achiness, and itching – These are classic signs of vaginal and vulvar atrophy (thinning and drying of tissues).
Disappearance of the labia minora – A sign of chronic estrogen deficiency leading to tissue shrinkage and resorption.
Watery discharge with a “bread-like” smell – This may reflect a shift in vaginal flora (possibly some yeast overgrowth or a change in pH), which is also common when estrogen is low.
Other Possible or Contributing Causes
Vaginal yeast infection (Candidiasis)
The “bread-like” smell and discharge suggest this may also be present.
GSM increases susceptibility to infections due to the altered vaginal environment
Lichen sclerosus:
A chronic skin condition that can cause vulvar thinning, soreness, and architectural changes (like disappearing labia).
Needs to be ruled out with a proper examination—often confirmed via skin biopsy if suspected.
What You Should Do
See your GP or a gynecologist
Ask for:
A pelvic exam
Vaginal pH testing
Possible vaginal swab to check for yeast or bacterial overgrowth
Consider evaluation for lichen sclerosus if the tissue is very thin, white, or scarred
Treatment options (based on likely GSM diagnosis):
Local vaginal estrogen therapy (low-dose creams, tablets, or a ring like Vagifem, Ovestin, or Estring) – safe and effective, especially when used locally.
Non-hormonal moisturizers and lubricants (Replens, Yes VM) – help with dryness and itching.
Vaginal DHEA (Intrarosa) or ospemifene (Osphena) – alternatives for those who can’t or prefer not to use estrogen.
If a yeast infection is confirmed:
Use antifungal treatment (e.g., fluconazole, clotrimazole), possibly in combination with restoring normal vaginal flora afterward with probiotics or rebalancing agents.
Lifestyle tips:
Avoid scented soaps, bubble baths, and fabric softeners.
Use only non-irritating, hypoallergenic products around the vulva.
Wear breathable, cotton underwear.
Summary
Your symptoms strongly suggest Genitourinary Syndrome of Menopause, likely with some secondary yeast overgrowth or flora imbalance.
A detailed assessment by your doctor is important, but the condition is very treatable, and many women experience significant relief once they start the right therapy.
Let me know if you’d like help drafting questions or a summary to take to your doctor.
--
I forgot to say I currently have a combination of a progesterone IUD and oestrogen patches as hormone replacement therapy.
--
ChatGPT said:
Thanks for that important update. Since you're already using combined HRT (progesterone IUD + estrogen patches), you're systemically replacing hormones, but your symptoms suggest that local estrogen levels in the vulvovaginal area may still be insufficient—which is actually quite common.
Here's your updated summary, reflecting your current treatment:
Patient Summary for GP/Gynecology Appointment
Name: [Your Name]
Age: 62
Menopausal Status: 10 years post-menopause
Presenting Symptoms:
Persistent vulvar discomfort, including soreness, achiness, and itching
Noticeable loss of labia minora tissue
Watery vaginal discharge, not urine, with a bread-like smell
Ongoing dryness and irritation in the vulvovaginal area
Current Hormone Replacement Therapy (HRT):
Progesterone IUD (for endometrial protection)
Estrogen patches (systemic estrogen)
Concerns:
Possible Genitourinary Syndrome of Menopause (GSM) – despite systemic HRT, I understand local estrogen may still be needed for vulvovaginal health
Possible secondary vaginal infection (yeast or bacterial imbalance)
I would also like to rule out lichen sclerosus, as I’ve noticed physical changes in vulvar anatomy
Questions and Requests:
Could you please perform a pelvic exam to assess tissue changes and check for signs of atrophy or lichen sclerosus?
Would you consider a vaginal swab to rule out yeast or bacterial vaginosis?
Can we discuss adding local vaginal estrogen therapy alongside my current HRT to directly treat vulvovaginal symptoms?
Are there non-hormonal options I could try as well (moisturizers, lubricants, pH balancers)?
Additional Info:
No history of hormone-sensitive cancers
No contraindications to vaginal estrogen as far as I'm aware.
I'm calling GP on Monday ... Have tried poking about at various chemists but have given up trying to DIY as it's confusing. I'll let you know.