“Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic…”.1

Umbrella
What may the Genitourinary Syndrome of Menopause Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary/Genito-Urinary Syndrome of Menopause (GSM)
  • Menopause Vaginal Dryness
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy (VVA)

Definition

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Vaginal Dryness the North American Menopause Society (NAMS) elaborate on:

“Bothersome symptoms of the vagina and vulva (outer lips of the vagina) increase during and after the menopause transition or may start several years after menopause. The decrease in estrogen with menopause is a major contributor to vaginal dryness, itching, burning, discomfort, and pain during intercourse or other sexual activity. Vaginal atrophy is the medical term that describes these changes. The genitourinary syndrome of menopause includes bothersome vaginal atrophy often combined with urinary symptoms”.2

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society (AMS) elaborate on:

  • “As women age they will experience changes to their vagina and urinary system largely due to decreasing levels of the hormone oestrogen
  • The changes, which may cause dryness, irritation, itching and pain with intercourse are known as the genito-urinary syndrome of menopause (GSM) and can affect up to 50% of postmenopausal women. GSM was previously known as atrophic vaginitis or vulvovaginal atrophy (VVA)”.3

In Vaginal Atrophy: Symptoms & Causes – Overview the (United States) Mayo Clinic elaborate on:

“For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms. Because the condition causes both vaginal and urinary symptoms, doctors use the term “genitourinary syndrome of menopause (GSM)” to describe vaginal atrophy and its accompanying symptoms”.4

Symptoms

What may be symptoms of GSM?

In Vaginal Atrophy: Symptoms & Causes – Symptoms the Mayo Clinic explain:

“Genitourinary syndrome of menopause (GSM) signs and symptoms may include:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal”.5

Cause

What causes GSM?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile”.6

Treatment

What are some GSM treatments?

In Vaginal Dryness: Treatment Options the NAMS elaborate on:

Genitourinary Syndrome of Menopause

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied to the vagina are available. These can be combined for optimal symptom relief.

  • “Nonhormone Remedies…
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Estrogen Therapy…
    • An Effective and Safe Treatment…
    • Government-Approved Low-Dose Vaginal Estrogen Products…
    • Standard Doses of Estrogen Therapy…
  • Other Prescription Therapies
    • Ospemifene
    • Dehydroepiandrosterone (DHEA)…”.7

Painful Intercourse

How may painful intercourse be resolved?

The Mayo Clinic explain:

“… make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.8

Vaginal Estrogen

How may vaginal estrogen be used?

In Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? the NAMS note:

“A. …Vaginal estrogen therapy for GSM after menopause is administered into the vagina and is effective for moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower”.9

In Vaginal Dryness: Treatments the (United States) MedlinePlus explain:

“Prescription estrogen can work well to treat atrophic vaginitis. It is available as a cream, tablet, suppository, or ring. All of these are placed directly into the vagina. These medicines deliver estrogen directly to the vaginal area. Only a little estrogen is absorbed into the bloodstream”.10

Menopausal Hormone Therapy

What is one of the points of consensus about menopausal hormone therapy (MHT) and GSM?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “MHT, including tibolone, is effective in the treatment of vulvovaginal atrophy (VVA), now also considered as a component of the genitourinary syndrome of menopause (GSM). Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections. Ospemifene, an oral selective estrogen receptor modulator, is also licensed in some countries for the treatment of dyspareunia attributed to VVA”.11

Health Care Provider

What if I think I have GSM?

If you think you have GSM, it may be in your best interest to choose to talk to your health care provider about this.

In Vaginal Discomfort: Discomfort Not Directly Related To Menopause the NAMS explain:

“Because vaginal discomfort can arise from so many different sources, persistent symptoms of dryness, irritation, burning, itchiness, or pain should be evaluated by a healthcare provider to determine their cause”.12

On page two in Vaginal Dryness the NAMS also note:

“Note: Vaginal symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare provider if symptoms do not improve with treatment”.13

The AMS note:

  • “Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with ageing”.14

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Sources

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Sources

  1. Vaginal Atrophy: Symptoms & Causes – Causes. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 24 October 2020
  2. Vaginal Dryness.  2018: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 24 October 2020
  3. Vulvovaginal Symptoms After Menopause. Content Created September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/376-vulvovaginal-symptoms-after-menopause Accessed: 24 October 2020
  4. Vaginal Atrophy: Symptoms & Causes – Overview. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 24 October 2020
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 24 October 2020
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 24 October 2020
  7. Vaginal Dryness: Treatment Options. 2018: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 24 October 2020
  8. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 24 October 2020
  9. Menopause FAQs: Hormone Therapy & Menopause Symptoms – Q. What is hormone therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 24 October 2020
  10. Vaginal Dryness: When To Contact A Medical Professional. Review Date: 08 October 2020. Page Last Updated: 02 July 2020. MedlinePlus https://www.nlm.nih.gov/medlineplus/ency/article/000892.htm Accessed: 24 October 2020
  11. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 24 October 2020
  12. Vaginal Discomfort: Discomfort Not Directly Related To Menopause. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort Accessed: 24 October 2020
  13. Vaginal Dryness: Note.  2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 24 October 2020
  14. Vulvovaginal Symptoms After Menopause. Content Created September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/376-vulvovaginal-symptoms-after-menopause Accessed: 24 October 2020

Topic Last Updated: 24 October 2020 – Topic Last Reviewed: 24 October 2020
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