Genitourinary Syndrome of Menopause (GSM)
As women approach and enter menopause, they may experience a variety of changes in their bodies due to the natural decline in estrogen. Genitourinary syndrome of menopause (GSM) affects both the genital and urinary systems, leading to discomfort and complications that can significantly impact a woman’s quality of life.
What is GSM?
GSM refers to a collection of symptoms that arise due to the reduction of estrogen and other reproductive hormones during menopause. Estrogen plays a critical role in maintaining the health of the tissues in the vagina, vulva, bladder, and urethra. When estrogen levels drop during menopause, these tissues can become thinner, drier, less elastic, and more prone to irritation and infection. GSM affects up to half of postmenopausal women, but it is often underdiagnosed and untreated.
Symptoms of GSM
GSM encompasses a variety of symptoms that affect both the genital and urinary systems. These symptoms may vary in severity and can include:
Genital Symptoms:
Vaginal dryness: Reduction in estrogen causes the vaginal walls to lose moisture, resulting in persistent dryness that can be uncomfortable or painful.
Vaginal itching or burning: The thinning of the vaginal tissues may lead to a burning or itching sensation.
Pain during intercourse (dyspareunia): Vaginal dryness and reduced elasticity can make sexual activity uncomfortable or painful.
Decreased lubrication: Natural lubrication diminishes, which can further contribute to discomfort during sexual activity.
Changes in vaginal discharge: A decrease in estrogen can alter the type and amount of vaginal discharge, often making it less noticeable or even absent.
Urinary Symptoms:
Urinary frequency: Women with GSM may experience the need to urinate more frequently.
Urinary urgency: A sudden, strong urge to urinate is common, even when the bladder is not full.
Urinary incontinence: The loss of bladder control can lead to unintentional leakage, particularly during physical activity, sneezing, or laughing.
Recurrent urinary tract infections (UTIs): The thinning of the urinary tract tissues makes it easier for bacteria to cause infections.
Burning sensation during urination: Irritation of the urethra can lead to discomfort when urinating.
How is GSM Diagnosed?
GSM can often be diagnosed based on a woman's symptoms and a physical examination of the vaginal and vulvar areas. A healthcare provider may perform a pelvic exam to assess the thinning of the vaginal tissues, and they may also recommend tests to rule out other conditions such as infections or inflammatory disorders. Since GSM can mimic symptoms of other health issues, it’s essential for women to speak openly with their healthcare providers about any discomfort they are experiencing.
Treatment Options for GSM
Several treatment options are available to help alleviate the symptoms of GSM and improve the quality of life for women going through menopause. Some treatment options include:
Non-Hormonal Treatments: For women with mild GSM symptoms who prefer not to use hormones can try vaginal moisturizers and/or vaginal lubricants.
Hormonal Treatments: Hormonal treatments provide significant relief by addressing the underlying cause of estrogen deficiency. Topical estrogen therapy is one of the most effective treatments for GSM. Local estrogen is applied directly to the vaginal area in the form of creams, vaginal rings, tablets, or inserts. Estrogen applied locally helps restore the vaginal tissues without increasing estrogen levels in the rest of the body, making it a safe option for all women.
Laser and Radiofrequency Therapy: In recent years, non-invasive treatments such as vaginal laser therapy or radiofrequency therapy have gained popularity for treating GSM. While still relatively new, some women find significant relief from these treatments.
Pelvic Floor Physical Therapy: Exercises, biofeedback, and other techniques to strengthen the muscles that support the bladder and pelvic organs, reducing incontinence and improving bladder control.
Preventing or Managing GSM
Although GSM is a natural part of the aging process for many women, there are ways to manage or even prevent some symptoms:
Stay sexually active: Regular sexual activity, whether with a partner or through self-stimulation, can help keep the vaginal tissues healthy by promoting blood flow and elasticity.
Stay hydrated: Drinking plenty of water can support overall tissue health, including the tissues of the genital and urinary systems.
Maintain good hygiene: Avoid using harsh soaps or feminine hygiene products that can disrupt the natural pH of the vagina and cause irritation.
GSM is a common yet often overlooked condition that can significantly impact a woman’s quality of life. Understanding the symptoms and available treatments can empower women to seek help and find relief. There are effective options to manage GSM and improve comfort. If you’re experiencing symptoms of GSM, don’t hesitate to talk to your healthcare provider to explore the best treatment plan for you.
