Going through perimenopause is difficult enough – night sweats, hot flashes, mood changes, weight gain, and sleep issues can be common among many women. However, the postmenopausal phase can have additional symptoms leading to a progressive condition that up to at least 50% of women will experience; genitourinary syndrome of menopause or GSM.
What is genitourinary syndrome of menopause?
GSM, also known as vulvovaginal atrophy or atrophic vaginitis, is when the vaginal walls can begin to atrophy. The vaginal walls become thinner, drier, less elastic, and more fragile causing burning or irritation during sexual intercourse and pain during urination due to lack of lubrication. These symptoms are caused by estrogen deficiency not only in the vagina but also in the bladder and the urethra.
Many women may not consider the symptoms of GSM to be related to menopause as they typically do with hot flashes. Since GSM affects a woman’s ability to enjoy sexual relations as she ages, talking about painful sex can make many women hesitant or embarrassed to discuss these symptoms with their doctor. And many doctors may not be asking postmenopausal women if they are having these symptoms.
Since women may not broach the topic of GSM and few healthcare providers are bringing it up, less than 10% of women who are symptomatic actually get treated for this condition.
Causes, risk factors, and symptoms of genitourinary syndrome of menopause
The primary cause of GSM is a reduction in estrogen production by the ovaries, the main source of this hormone in a woman’s body. When a woman goes through menopause, the ovaries will stop releasing an egg every month which eventually leads to the cessation of menstruation. While menopause is an expected and normal part of aging for women, there can be other reasons why some women will have a drop in estrogen:
- Surgical removal of both ovaries
- During breastfeeding
- Women taking medications that can affect estrogen levels, such as some birth control pills
- After pelvic radiation therapy or chemotherapy for cancer
- As a side effect of breast cancer hormonal treatment
There are certain risk factors that may contribute to GSM which include:
- Smoking – Cigarette smoking affects blood circulation, lessening the flow of blood and oxygen to the vagina and other nearby areas Smoking also reduces the effects of naturally occurring estrogens in the body
- Women who’ve never given birth vaginally – Women who have had vaginal deliveries are less likely to develop GSM
- Infrequent or no sexual activity – Sexual activity, with or without a partner, increases blood flow, making vaginal tissues more elastic
It’s important for women with GSM to recognize this condition in order to get a proper diagnosis and treatment. There are certain symptoms postmenopausal women should be aware of that may indicate GSM. Here are possible signs of this condition:
- Burning and urgency with urination
- Frequent urination
- Genital itching
- Recurrent urinary tract infections
- Urinary incontinence
- Vaginal dryness, burning, or discharge
- Discomfort or light bleeding after sexual intercourse
- Reduced vaginal lubrication during sexual intercourse
- Shortening or tightness of the vaginal canal
Any woman experiencing GSM symptoms should seek treatment for it. GSM is a quality of life issue that women should not have to be burdened with especially when it impacts their health and enjoyment of sexual intimacy.
Treatment for genitourinary syndrome of menopause
There is good news for women who suffer from GSM. Just recently in September 2020, the North American Menopause Society (NAMS) released a new position statement updating its recommendations for the treatment of GSM. These new guidelines include the most recent and proven safe effective therapies for treating women with GSM since the last guidelines were published in 2013.
Here are some of the main recommendations from this position statement:
- Education about and screening for GSM to be recommended for perimenopausal and postmenopausal women
- Spotting or bleeding in postmenopausal women requires a thorough evaluation
- Using nonhormonal lubricants with sexual activity
- Regular use of long-acting vaginal moisturizers for nonsurgical symptoms
- Low-dose vaginal estrogens, vaginal DHEA inserts, and oral ospemifene as a prescription therapy for more severe symptoms
- Transdermal and oral hormone therapy as possible treatments for women who have dyspareunia (pain with intercourse) due to GSM along with hot flashes and night sweats
The NAMS also recommends the need for more rigorous studies on the long-term safety and efficacy of these devices and recommendations. At this time, it is understood in order to effectively treat GSM, it takes a strong effort on educating women about GSM and continued scientific research on the safest and most effective treatments to offer women improving their quality of life.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board-certified Urologic Oncologist Expert and Robotic Surgeon in New York City.
He is regarded as one of the leading prostate surgeons in the U.S., with vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble.