Genitourinary syndrome of menopause (GSM) is a term used to describe symptoms of the vulvo-vaginal and urethral areas that occur due to low estrogen levels. When women go through menopause, there is a decrease in estrogen levels in the body. GSM is a broader term for what was previously called “atrophic vaginitis.” Because symptoms can also affect the vulva and urinary system, GSM is now the preferred terminology.
The average age of menopause is 51 and is defined as going one full calendar year without a period. The number of women who experience symptoms of GSM is not well established, but some studies estimate that it is over 50 percent of postmenopausal women. Many women feel uncomfortable discussing symptoms of GSM, but there is treatment for the condition that can improve quality of life by minimizing symptoms.
Vaginal atrophy and urinary symptoms due to low estrogen can also occur outside of menopause. Some premenopausal women may experience low estrogen due to medications they are taking, such as Provera, Depo-Provera, or Lupron. Estrogen levels can also decrease during breastfeeding. Some women may enter a menopausal state earlier in life if they have their ovaries removed or go through therapy for treatment of cancer.
Symptoms of GSM include vaginal dryness, pain with intercourse, bleeding after intercourse, vaginal itching or pain, or change in vaginal discharge consistency or odor. Some women describe symptoms of burning or pressure in the vagina that can be associated with GSM. Urinary symptoms include pain with urination, urinary frequency, and leaking urine. Women with GSM may also be prone to more frequent urinary tract infections.
The first step in treatment of GSM is usually over-the-counter products that can improve symptoms. Vaginal moisturizers can help with dryness symptoms. They may be inserted into the vagina using an applicator or can be applied around the outside of the vagina on the vulva. If a woman is having pain with sex, vaginal lubricants can be used at the time of intercourse. Lubricants reduce friction and help minimize vaginal discomfort during sex.
If over-the-counter products are not effective, a prescription medication is usually the next step. Because GSM is caused by low estrogen, use of a topical estrogen is a very effective treatment option. Low-dose vaginal estrogen products include tablets, creams, capsules, and an estrogen-containing vaginal ring.
These medications are considered topical because they are placed inside the vagina, delivering estrogen directly to the tissue that is low in estrogen. Because the medication is topical, a low dose can be used effectively. Low-dose estrogen therapy has minimal side effects and adverse outcomes and can be safely used for many years. If estrogen is effective, it will need to be continued long-term to continue to have benefits.
There are other non-estrogen medication options, including the brand-name medications Intrarosa and Osphena. Intrarosa is a daily vaginal suppository that uses a formulation of the hormone DHEA. Osphena is a pill that is taken by mouth daily that contains a prescription medication that is similar to estrogen but does not contain any estrogen.
Not all women are candidates for the prescription medication therapies, such as women who have had breast cancer. If you are experiencing symptoms, it is important to bring it up to your healthcare provider. You can work with your provider to see if your symptoms could be due to GSM and what treatments would be recommended.
