Episode 11: Breast Awareness, Vaginal Dryness & GSM

In this episode Kate Thomas, an AHPRA-registered pharmacist with 25 years of clinical experience, and Dr Sarah Farrell, GP and principal of Sydney Women's Wellness, cover:

• What breast awareness means today and how it differs from formal breast cancer screening
• Breast density, mammograms and when to seek medical review for a breast change
• Genitourinary syndrome of menopause (GSM): what it is and why it is so under-treated
• Vaginal dryness, pain with sex and recurrent UTIs after menopause
• Bladder symptoms and estrogen decline
• The full GSM treatment ladder from vaginal moisturisers to vaginal estrogen and prasterone

Breast awareness means knowing how your breasts normally look and feel so that changes are easier to notice. In Episode 11, Kate and Dr Sarah Farrell explain what breast awareness actually involves today, how it differs from the formal breast self-examination approach of previous decades, and how to interpret breast changes that happen during perimenopause and menopause. Hormonal fluctuations can cause breast tissue changes that feel alarming but are entirely normal, and this conversation helps women distinguish between those changes and the ones that warrant a prompt GP visit. Breast density and its implications for mammogram accuracy are also covered clearly and practically. 

Genitourinary syndrome of menopause, or GSM, is one of the most common and most under-treated conditions associated with menopause. Unlike hot flushes, which often improve over time, GSM tends to worsen without treatment. It encompasses vaginal dryness, pain during sex, recurrent urinary tract infections, bladder urgency and other symptoms driven by the decline of estrogen in the vaginal and urinary tissues. Kate and Dr Farrell explain why so many women suffer in silence with GSM and why it is both common and very treatable with the right approach. 

Vaginal dryness and pain with sex are among the most commonly experienced but least discussed symptoms of menopause. In Episode 11, Kate and Dr Sarah Farrell address these directly and compassionately, explaining the hormonal mechanism driving them and why they tend to worsen over time without treatment. For women experiencing these symptoms, understanding that effective treatment options exist is an important first step. A telehealth pharmacist consultation with Kate can help you understand your options and prepare the right questions before your next GP appointment. 

Recurrent urinary tract infections after menopause are strongly linked to estrogen decline and are a frequently overlooked aspect of GSM. The thinning of urinary tract tissues caused by estrogen deficiency makes women more susceptible to bacterial infection, and treating the infections alone without addressing the underlying hormonal cause leads to a frustrating and unnecessary cycle. Kate and Dr Farrell explain this connection clearly and cover the treatment options available. 

Episode 11 covers the full range of GSM treatment options in practical detail:

Vaginal moisturisers are used regularly to maintain vaginal tissue hydration and are available without prescription. Lubricants are used during sexual activity to reduce friction and discomfort. Vaginal estrogen delivers localised estrogen directly to the vaginal and urinary tissues, with minimal systemic absorption, making it appropriate for most women including many who cannot use systemic HRT. Prasterone is a vaginal insert that converts to both estrogen and testosterone locally and is another evidence-based option. Non-hormonal alternatives including hyaluronic acid vaginal preparations are also available for women who prefer or require a non-hormonal approach.

 If this episode has raised questions about GSM, vaginal dryness, breast changes or your menopause treatment options, a telehealth pharmacist consultation with Kate is a great next step. In a dedicated one-on-one session you can go through your symptoms, your current medications and your treatment options in plain language, without rushing. 

Kate Thomas offers a range of in-depth telehealth medication consultation and medication review services to help you understand your body and your medications.

You can view the transcript for this episode below