Perimenopause vaginal dryness is part of a medical syndrome called GSM — Genitourinary Syndrome of Menopause — that also affects your bladder, urethra, sexual function and tissue health. Unlike hot flashes, GSM does not improve on its own. It progressively worsens without treatment. The 2025 AUA guideline — the most comprehensive ever produced — confirms safe, effective treatments exist, from local vaginal oestrogen to pelvic floor physiotherapy. Most women are never offered

Up to 70% of perimenopausal women develop bladder problems — the urgency, the leaks, the 3am trips, the UTIs that keep coming back when they never used to. It is one of the most common and least discussed symptoms of the hormonal transition. The mechanism is specific: estrogen has receptors throughout the entire urogenital system, including inside the bladder's own bacterial ecosystem — the urobiome. When estrogen drops, four systems fail simultaneously. Here's the science.