65: Why 85 Percent of Women Develop the Genitourinary Syndrome of Menopause with Dr Daiana Castleman

In this episode, I sit down with Dr. Daiana Castleman, naturopath and menopause specialist, to talk about something that affects most of us but rarely gets the attention it deserves: genitourinary syndrome of menopause (GSM). What you'll learn: GSM includes symptoms like vaginal dryness, painful intercourse, recurrent UTIs, urinary urgency, and frequency—all stemming from declining estrogen levels. It's chronic and progressive, meaning it gets worse over time if untreated. And here's the stat that should wake us all up: by 20 years post-menopause, 85% of women will experience GSM, yet it remains underdiagnosed and undertreated. We dig into why vaginal estrogen is such a game-changer—not just for sexual function, but for preventing UTIs by supporting healthy vaginal and urinary microbiota. Daiana explains how estrogen decline alters our protective lactobacilli, making us more susceptible to infection. We also talk about sleep, because when you're waking up four times a night to pee, your sleep quality tanks. Daiana shares why multiple nighttime bathroom trips aren't normal (despite what we've been told) and what to assess before reaching for supplements. Spoiler: sometimes it's sleep apnea, and it doesn't always include snoring. Finally, we touch on cardiovascular health—because over 90% of cardiovascular disease is preventable, and menopause is the perfect time to take action. (We're absolutely doing a part two on this.) About Dr. Daiana Castleman: Daiana is a naturopathic doctor specializing in menopause, hormone therapy, and women's sexual health. She's passionate about empowering patients to understand their bodies and advocate for the care they deserve. Daiana was a keynote speaker at The Pleasure Principle 2025 conference. Theme Song: "Rise Up" by Andra Day Connect with Dr. Daiana Castleman: Website: dianacastleman.comInstagram: @dr.dianacastleman Visit blueberrytherapy.ca to learn more about pelvic health services in Hamilton, Ontario. Subscribe to The Hole Shebang Podcast and connect with us on Instagram @blueberrytherapypelvichealth. Additional Resources: Menopause Foundation Canada - Evidence-based menopause information and resources