Genitourinary Syndrome of Menopause (GSM) and Severe Symptoms

By: Women's Care Staff

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 provider can explain your treatment options and find one that works for you.

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