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Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause is a chronic, progressive condition of the vulva, vagina, and lower urinary tract which is characterized by the following signs/symptoms:

Vaginal Symptoms

  • Vaginal dryness
  • Vaginal irritation/burning/itching
  • Thinning/graying pubic hair
  • Vaginal pelvic pain/pressure

Sexual Symptoms

  • Painful sexual intercourse
  • Decreased lubrication during sexual activity
  • Bleeding after sexual activity
  • Decreased arousal/loss of libido
  • Inability to orgasm

Urinary Symptoms

  • Painful urination
  • Urinary urgency
  • Urinary incontinence (stress and urge)
  • Recurrent urinary infections
  • Urethral caruncle (red vascular growth on urethra)

How is Genitourinary syndrome of menopause (GSM) different than Overactive Bladder (OAB)?

Symptoms can overlap in both conditions, but women with OAB tend to experience more urinary incontinence symptoms. Women with GSM tend to experience both vaginal and urinary symptoms together.

What is the difference between Genitourinary syndrome of menopause (GSM) and urinary tract infection (UTI)?

Both GSM and UTI’s can cause painful urination (dysuria). A UTI is diagnosed via urinary testing that shows inflammation and infection due to abnormal bacterial growth in the urinary tract. GSM tends to cause painful urination when the urine touches the thin vaginal tissue resulting in a burning sensation.

How can we treat GSM?

Non-hormonal therapy

  • Lifestyle changes (maintenance of sexual activity, smoking cessation, avoidance of vulvovaginal irritants including personal hygiene products in the vulvovaginal area)
  • Nonhormonal vaginal lubricants or moisturizers
  • Mucosal lidocaine

(Examples of over-the-counter nonhormonal vaginal moisturizers include Replens, Refresh, Good Clean Love, and Luvena)

Hormonal therapy (considered the gold-standard of treatment)

  • Vaginal estrogen therapy (cream, tablet or ring)

Estrogen: A type of hormone that promotes and maintains female traits in the body. Also referred to as a female sex hormone.

How does vaginal estrogen therapy work?

Vaginal estrogen is the most effective treatment for GSM. It improves the quality of the vaginal skin and tissues in and around the vagina. It thickens the skin of the vaginal canal and increases natural lubrication. It also restores the normal pH of the vagina. It has been shown to reduce the risk of UTI in many studies.

Is vaginal estrogen therapy safe?

Overall, the answer is yes! Local vaginal hormonal therapy is associated with minimal to no side effects/risks when used as prescribed as very little is absorbed into the blood stream.

Before prescribing, we will ask you if you have a history of breast cancer or a history of blood clots in the legs or lungs. If you have a history of either of these problems, we may consult with your Oncologist or Vascular specialist before we prescribe vaginal estrogen. In most cases, these specialists are ok with vaginal estrogen use because the systemic absorption (absorption into the blood stream) is so low.

Studies have shown that vaginal estrogen use does NOT increase the risk of cardiovascular disease or cancer.

Does vaginal estrogen interfere with sexual activity?

It is advised to wait 12 hours after inserting vaginal estrogen tablet or cream to have sex, although the risk to your partner is not thought to be of concern.

Alternative Treatment: Energy-Based Devices

Laser treatment has yet to show promise in the treatment of genitourinary syndrome of menopause. For patients experiencing vaginal atrophy, sexual dysfunction and pain with intercourse, laser therapy may offer short-term improvement. However, the benefits of this treatment may not last for more than a few months. In a recent study published in the Journal of the American Medical Association (JAMA), there was no significant improvement in vaginal symptoms 1 year after laser treatment when compared with placebo. Potential adverse events associated with laser use include vaginal pain, vaginal bleeding, and urinary tract infection.

References

  1. Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. Published 2020 Apr 8. doi:10.7759/cureus.7586
  2. Bhupathiraju SN, Grodstein F, Stampfer MJ, et al. Vaginal estrogen use and chronic disease risk in the Nurses' Health Study. Menopause. 2018;26(6):603-610. doi:10.1097/GME.0000000000001284
  3. AUGS - Vaginal Estrogen Therapy (PDF)
  4. Chen R, Wang JY, Lv K. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA. 2022;327(3):283. doi:10.1001/jama.2021.22305

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