Genitourinary Syndrome of Menopause (GSM): What is it & What are my Options?

Your feminine area feels dry, irritated, and even itchy sometimes. You need to urinate more often and it can even burn when you go. Sex is not as pleasurable as it used to be. If you’re experiencing one or more of these symptoms and wondering what’s going on, it could be GSM.

Welcome to Menopause

Menopause is defined as 12 months without a period, and is associated with dropping estrogen levels.  The average age when a woman experiences menopause is 51 and each woman’s menopause is unique.  Some may sail through the change with minimal issues while others may experience moderate to severe symptoms.

Through our mothers, sisters and friends, most women are familiar with the more common symptoms of menopause like hot flashes and night sweats.  About 75% of women experience hot flashes. While they may only last a few years, for some women they may persist into their 70’s. 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.

Genitourinary syndrome of menopause (GSM), however, if untreated, tends to worsen with time.  Decreased levels of estrogen contribute to vaginal atrophy—dryness, itching, discomfort and pain with sex.  GSM includes bothersome vaginal atrophy combined with urinary symptoms, such as frequency, urgency and discomfort with urination, and an increased incidence of urinary tract infections.  GSM may affect 50-70 percent of postmenopausal women.

Common Vaginal Changes

Here are the some of the changes a woman may notice with GSM.

  • 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, which in turn leads to more discomfort.
  • For some women, this can trigger involuntary tightening of vaginal and pelvic muscles (vaginismus), and 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 is sometimes difficult to discuss with your provider. But don’t be shy—there are many effective treatment options available.

Nonhormonal Treatments for GSM

  • Vaginal lubricants decrease friction and reduce discomfort with sex when the vagina is dry. Water-soluble or silicone-based products are recommended, and they’re available over the counter or online.
  • Vaginal moisturizers are intended for regular use, several times weekly at bedtime. They line the vaginal walls and maintain moisture.  Many options are available over the counter.
  • Regular sexual stimulation increases vaginal blood flow and secretions. “Use it or lose it!”
  • Expanding your views of sexual pleasure beyond traditional intercourse.
  • Pelvic floor exercises can help to strengthen weak muscles or relax tight ones.
  • Vaginal dilators are used to restore vaginalcapacity, to expand the vagina in width and depth, to provide elasticity to the tissues, and to allow for comfortable sexual activity.
  • CO2 laser treatment may increase blood flow and promote collagen growth, but they are not FDA approved for this indication, and safety and efficacy concerns remain.

Hormonal Treatments for GSM

  • Low-dose vaginal estrogen applied directly to the vagina can restore vaginal health and improve symptoms of 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 3 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 in the body. 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 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, meaning it works like estrogen in some tissues, like the vagina, and opposes estrogen in other tissues.  Unlike estrogen, Osphena may actually cause hot flashes or night sweats, but similar to systemic estrogen it may stimulate the lining of the uterus, increasing the risk for uterine cancer, blood clots and stroke.

If you are experiencing GSM symptoms, 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.

Top 5 Menopause Myths Busted

Whether you’re approaching “The Change” or are experiencing it first-hand, you might have heard rumors about hot flashes, bad sex and other lousy symptoms. Today, we’re going to clear up these misconceptions and explain how you can make the most of menopause.

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: You Gain Weight Going Through Menopause

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. 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 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.

5 benefits of exercising during menopause

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.” As difficult as it may seem, though, taking care of yourself should be a top priority when you reach menopause.

Once you go through menopause your risk for certain health conditions increases. For instance, menopause increases your risk of osteoporosis, heart disease, and urinary incontinence. Fortunately, making exercise part of your daily lifestyle can improve your health, and lower your risk for most types of health problems associated with menopause. Plus, exercise, in general, is good for not only your health, but mental health, too.

Here are five benefits of exercising during menopause.

1. Improve bone health

Women who have reached menopause are at higher risk for osteoporosis, or bone loss. Exercise helps enhance and maintain bone density and 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, and your risk for osteoporosis will become lower.

2. Improve heart health

Declining estrogen levels can affect blood vessel health, and increase your risk for heart disease. But 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 are walking, running, swimming, and dancing.

3. Enhance your mood

Menopause is associated with irritability and mood swings on behalf of estrogen deficiency, which can even interfere with sleep and make you feel crankier 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 weight gain, especially if you’re converting body fat to muscle mass thanks to your strength-training and cardio routine. Combine regular exercise with a diet high in nutrition to see better results in terms of weight loss and weight management.

5. Improve urinary incontinence

Menopause is associated with a higher risk for urinary incontinence and bladder leakage, which can be helped with exercise. Kegel exercises, also known as pelvic muscle exercises, can strengthen your bladder and urethral sphincter muscles, and prevent 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.

Want to lower your risk for early menopause? Eat your vegetables

There are many benefits to incorporating more vegetables into your diet, such as weight loss or weight maintenance, more energy and better digestion. And now, new research suggests that women who eat a high amount of vegetable protein may lower their risk for early menopause and prolong their reproductive function.

According to Science Daily, researchers at Harvard T.H. Chan School of Public Health and the School of Public Health and Health Sciences at UMass Amherst 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 approximately 6.5 percent of their daily calories as veggie protein compared to women whose intake was at 4 percent of their calories.

Not sure where you can find a good source of vegetable protein? 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.”

Here’s a list of other foods high in vegetable or plant-based protein:

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

Early menopause is when women experience menopause before the age of 40. Even though it’s rare, women who experience premature menopause often experience other health risks associated with loss of estrogen, such as 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 for menopausal women

It’s safe to say, many women dread the onset of menopause. Symptoms such as hot flashes, night sweats, irritability, loss of sexual libido, and more can bring about feelings of anxiety or discomfort. While you might not be able to avoid menopause completely, you can reduce and manage its symptoms through proper nutrition.

Eating the right foods that are high in vitamins, minerals, and other nutrients can help prevent and relieve common menopause symptoms. Here are other nutrition tips that can help you manage menopause in the healthiest way possible.

Eat calcium-rich foods

The risk for bone loss and osteoporosis increases for menopausal women. Protect your bones by increasing your intake of vitamin D and calcium-rich foods, such as low-fat yogurt, orange juice, broccoli, salmon, sardines, and tofu. Also, consider talking to your doctor about calcium supplements that can help lower your risk for 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 healthy brain and nervous cell function and 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, be aware that these substances can trigger hot flashes.

Avoid sugary and high-fat foods

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

Try the Mediterranean Diet

The Mediterranean 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.