Genitourinary Syndrome of Menopause (GSM) and Severe Symptoms

Your feminine area feels dry, irritated, and even itchy sometimes. You need to urinate more often, and it can also burn when you go. Sex does not feel as pleasurable anymore. If you experience one or more of these symptoms, it could be genitourinary syndrome of menopause or GSM.

Menopause definition and symptoms

Menopause is defined as 12 or more months without a period due to dropping levels of estrogen. The average woman reaches menopause at 51 years old. Furthermore, every woman has a unique experience with menopause. Some may sail through the change with minimal issues, while others may experience moderate or even severe menopause symptoms.

Most women familiarize themselves with menopause through education, friends, and family. Common symptoms many know include hot flashes and night sweats. Also, about 75 percent of women experience hot flashes. While they typically last a few years, for some women, they may persist into their seventies. Night sweats may interrupt sleep, which can lead to mood changes, irritability, and trouble concentrating. Fortunately, many of these symptoms will improve with time, with or without treatment.

What is genitourinary syndrome of menopause (GSM)?

Untreated genitourinary syndrome of menopause leads to severe menopause symptoms. It also tends to worsen with time. Decreased levels of estrogen contribute to vaginal atrophy. This includes dryness, itching, discomfort, and pain with sex. GSM combines bothersome vaginal atrophy with urinary symptoms, such as frequency, urgency, and discomfort with urination. In addition, the risk of developing urinary tract infections increases. GSM may affect 50 to 70 percent of postmenopausal women.

Common Vaginal Changes

Women may notice some of these changes with genitourinary syndrome of menopause:

  • Tissues become thin, dry, and less elastic with decreased secretions and lubrication.
  • Fragile tissues may tear or bleed, leading to pain with sex or pelvic exams.
  • Vaginal infections may increase, as healthy acidic pH of the vagina becomes more alkaline.
  • Pain with sex can lead to less frequent intercourse, which can cause the vagina to become shorter and narrower. This can lead to more discomfort.
  • Decreased intercourse due to pain can trigger the involuntary tightening of vaginal and pelvic muscles (vaginismus). As a result, sex may no longer even be possible.

These symptoms may significantly affect a woman’s sexual satisfaction, her intimate relationships, and her overall quality of life.  Because of the sensitive nature of this condition, it may feel difficult to discuss with your provider. However, don’t be shy. Many effective treatment options exist.

Nonhormonal Treatments for GSM

  • Vaginal lubricants decrease friction and reduce discomfort during sex with vaginal dryness. We recommend water-soluble or silicone-based products. Also, you can find them over the counter or online.
  • Vaginal moisturizers line the vaginal wall and help maintain moisture. Women can use them regularly, such as several times weekly at bedtime. Furthermore, you can find them over the counter.
  • Regular sexual stimulation increases vaginal blood flow and secretions.
  • Expand your views of sexual pleasure beyond traditional intercourse.
  • Pelvic floor exercises can help strengthen weak muscles or relax tight ones.
  • Vaginal dilators restore vaginal capacity. They expand the vagina in width and depth to provide elasticity to the tissues. This allows for comfortable sexual activity.
  • CO2 laser treatment may increase blood flow and promote collagen growth. However, they are not FDA-approved for this indication. Plus, safety and efficacy concerns remain.

Types of Hormonal Treatments for GSM

  • Low-dose vaginal estrogen applied directly to the vagina can restore vaginal health. Also, this improves GSM within a few weeks. A prescription is required in one of these forms:
    • Cream
      • 2-3 times per week
      • Estrace or Premarin
    • Insert
      • Twice a week
      • Imvexxy
      • Vagifem/Yuvafem
    • Vaginal ring
      • Changed every three months
      • Estring vaginal ring
  • Dehydroepiandrosterone (DHEA) is a steroid hormone produced by the adrenal gland that acts as a precursor to both estrogen and testosterone. Intrarosa is a prescription FDA-approved synthetic DHEA vaginal insert, used nightly, for vaginal atrophy symptoms. Blood levels of estrogen do not appear to increase with the use of low-dose vaginal DHEA.
  • Ospemifene is an oral tablet taken daily to treat painful intercourse due to vaginal atrophy. It is an estrogen agonist/antagonist. This means it works like estrogen in some tissues, like the vagina, and opposes estrogen in other tissues.  Unlike estrogen, Osphena may cause hot flashes or night sweats. However, similar to systemic estrogen, it may stimulate the lining of the uterus, increasing the risk for uterine cancer, blood clots, and stroke.

If you experience GSM, getting the best possible care means talking openly with your provider about it. Your Women’s Care Florida provider can explain your treatment options and find one that works for you.

5 Menopause Myths Debunked

Whether you’re approaching “the change” or are experiencing it first-hand, you might have heard rumors about menopause. From hot flashes to bad sex to other lousy symptoms, everyone experiences it differently. Providers at Women’s Care Florida clear up some of the top misconceptions. Here are five of the top menopause myths debunked.

Myth #1: Hormone Replacements Are Dangerous

Temporary use of low-dose hormone replacement is safe for the majority of women. You can use hormone replacement therapy to help with hot flashes, lack of energy, decreased libido, and vaginal dryness. Therapy could even reduce your risk for osteoporosis or heart disease, especially if you start menopause before age 45.

However, some women, such as women with a history of breast cancer or stroke, should avoid hormone replacement. Talk to your doctor about possible risks and benefits so you can decide if hormone replacement is right for you.

Myth #2: Major Menopause Weight Gain

Although menopause changes where you may gain weight (your abdomen instead of your breasts, for instance), aging is the real culprit behind middle-aged weight gain. All people are likely to gain fat as they age due to decreased muscle mass, less physical activity, and poor sleep.

To combat weight gain, exercise more often. Include activities that help you maintain muscle mass, such as lifting weights. You should also change up your diet by eating fewer calories and more fruits and vegetables.

Myth #3: Menopause Ruins Sex

Changes in hormones can affect your libido and lead to changes in your vagina. However, not all women experience these problems. In the top menopause myths debunked, ruined sex takes the cake. Many women enjoy sex more after menopause because they don’t have to worry about becoming pregnant and, without children around, have more time to enjoy their partners.

If you are experiencing problems with sex due to menopause symptoms, don’t be shy; talk to your physician. Certain lubricants, creams or other treatments can help you experience more sexual satisfaction. With no period to worry about, you may find that menopause and sex in your fifties is the best sex you’ve ever had.

Myth #4: I Don’t Need Contraception After Menopause

While it’s true you can’t get pregnant after menopause, that doesn’t mean you don’t need contraception. Sexually-transmitted diseases, including HIV, are on the rise in people over 50. According to the Centers for Disease Control and Prevention, seniors have the same risk of getting HIV as young people—but are more likely to be diagnosed later when medicines can’t help.

Feel free to throw those birth control pills away, but always use a condom to protect yourself from syphilis, HIV, and other diseases.

Myth #5: I Got My Period Young So I’ll Start Menopause Early

Though this myth sounds like it makes sense, it’s simply untrue. There’s no set number of periods to get through before you reach menopause. Even if you started your period at age 11, you’ll likely start menopause at around age 52 like the average woman.

Want to learn more about menopause and treatments? Schedule an appointment with a doctor here.

Menopause and Exercise: 5 Ways to Reduce Risks and Symptoms

Menopause can interfere with your lifestyle. It can slow you down due to lack of sleep, hot flashes, stress, etc. Let’s face it —it’s a challenge to stay motivated when your body is going through “the change.” Although, as tricky as it may seem, taking care of yourself should be a top priority when you reach menopause. Once you go through menopause, your risk for health conditions increases. For instance, menopause increases your risk of osteoporosis, heart disease, and urinary incontinence. Fortunately, the combination of menopause and exercise can improve your health and lower your risk for most types of health problems associated with menopause. Plus, exercise can not only be used as a menopause treatment but as a mental health treatment too.

Here are five benefits of exercising during menopause.

1. Improve bone health

Women who reach menopause have a higher risk of developing osteoporosis or bone loss. Exercise helps enhance and maintain bone density. It also lowers your risk for fractures. Ask your gynecologist about fitness programs ideal for women who want to prevent osteoporosis.

Combine aerobic exercise with strength training for the best results. For example, do sets of weight training exercises such as push-ups, squats, and lunges, followed by 30 minutes of brisk walking. Over time, your muscles and bones will strengthen. Therefore, your risk for osteoporosis will become lower.

2. Improve heart health

Declining estrogen levels can affect blood vessel health and increase your risk of heart disease. However, aerobic exercise can improve blood flow and circulation as well as blood vessel health. Engage in 30 to 45 minutes of aerobic exercise at least three days per week to lower your risk for heart disease. Examples of ideal aerobic exercises that can help include walking, running, swimming, and dancing.

3. Enhance your mood

Menopause can cause irritability and mood swings due to estrogen deficiency. This can also interfere with sleep and make you feel moodier than usual. Fortunately, exercise naturally helps lift your mood and combats depression and anxiety. Maintain a regular exercise routine to benefit from increased endorphin levels and less moodiness.

4. Maintain a healthy weight

Many women tend to gain excess weight during menopause due to fluctuating hormone levels. However, exercise naturally helps combat menopause and weight gain. Combine regular exercise with a diet high in nutrition such as whole foods and protein to see better results in terms of weight management.

5. Improve urinary incontinence

Menopause is associated with a higher risk for urinary incontinence and bladder leakage. Exercise can also help with these conditions. Kegel exercises, also known as pelvic muscle exercises, can strengthen your bladder and urethral sphincter muscles. Strengthening these muscles prevents you from experiencing future accidents. Ask your gynecologist for more information about how to perform Kegel exercises and how they can aid in preventing urinary incontinence.

The board-certified physicians at Women’s Care Florida are dedicated to providing the gold-star standard in women’s healthcare. Each of our Physician Care Groups has a distinctive style and practice that can be tailored to fit your individual needs.

For more information about how WCF can help you take care of you, contact us to schedule an appointment.

Stop Early Menopause and Eat Your Vegetables

Many benefits exist when incorporating more vegetables into your diet. Some benefits include maintaining a healthy weight, more energy, and better digestion. Furthermore, new research suggests that women who eat more vegetable protein may lower their risk for early menopause. Therefore, prolong your reproductive function by eating vegetables!

The Link Between Vegetables and Early Menopause

According to Science Daily, researchers conducted an ongoing study of 116,000 women ages 25 to 45. Throughout the study, they asked participants to report how often they ate a single serving of 131 foods. They found that women had a 16 percent lower risk of early menopause when they ate veggie protein. Moreover, the veggie protein consisted of approximately 6.5 percent of their daily calorie intake compared to other women whose intake was at 4 percent of their calories.

Where to Find Vegetable Protein

Not sure where you can find a good source of vegetable protein? Also according to Science Daily, vegetable protein can be found in foods such as whole grains, soy, and tofu. “Consuming enriched pasta, dark bread and cold cereal were especially associated with lower risk,” the article said, “while they observed no similar relation to eating animal sources of protein.”

In addition, see our list of other foods high in vegetable or plant-based protein:

  • Lentils
  • Black Beans
  • Quinoa
  • Green Peas
  • Artichokes
  • Oatmeal
  • Pumpkin Seeds
  • Chia Seeds
  • Edamame

What is Premature Menopause?

Providers define early menopause as menopause experienced before the age of 40. Although rate, women who experience premature menopause often experience other health risks. Furthermore, some of these risks include loss of estrogens that can contribute to colon and ovarian cancer and osteoporosis.

To learn more about how you can lower your risk of early menopause, schedule an appointment with one of our board-certified OB/GYNS.

Nutrition Tips and What to Eat During Menopause

Many women dread the onset of menopause. Symptoms like hot flashes, night sweats, loss of sexual libido, and more can bring feelings of anxiety or discomfort. While you might not be able to avoid menopause, you can reduce its symptoms through proper nutrition. Eating the foods high in vitamins, minerals, and other nutrients can help prevent and relieve common symptoms. Here is what to eat during menopause that can help you manage symptoms in the healthiest way possible.

Eat calcium-rich foods

The risk of bone loss and osteoporosis increases for menopausal women. Protect your bones by increasing your intake of vitamin D and calcium-rich foods. Therefore, foods for menopause include low-fat yogurt, orange juice, broccoli, salmon, sardines, and tofu. Also, consider talking to your doctor about vitamins for menopause and calcium supplements. They can help lower your risk of bone loss. Your total calcium intake, including diet and supplements, should be at least 1500 ml per day.

Consume more omega-3s and vitamin B

Omega-3 fatty acids and B vitamins are key to a healthy brain and nerve cell function. They can help manage irritability and mood swings accompanied by menopause. Eat flaxseed, walnuts, and oily fish such as tuna, mackerel, and salmon for omega-3s, and consume more lentils and lean meats to get higher amounts of B vitamins.

If you consume caffeine and alcohol, know that these substances can trigger hot flashes.

Foods to avoid during menopause

Foods high in sugar and fat often lack nutritional value. In addition, they can upset your hormonal balance to worsen menopausal symptoms. Try to limit how much desserts and sweets you consume. Furthermore, stop eating processed foods high in sugar, fat, additives, and preservatives.

Try the Mediterranean Diet

An easy way to know what to eat during menopause is by following the Mediterranean diet. This diet, which is mainly comprised of fruits, vegetables, whole grains, and olive oil can help stave off weight gain and improve heart health. Plus, these foods can reduce hot flashes and night sweats, stabilize estrogen levels, and regulate blood sugar — all of which help ease menopausal symptoms.

If you suspect you’ve entered menopause, make an appointment with Women’s Care Florida to learn more about bioidentical hormone replacement therapy and other treatments that can help ease symptoms.