Genitourinary Syndrome of Menopause

“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 (United States) Menopause Society elaborate on:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner”.2

In Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women the (United States) Mayo Clinic elaborate on:

“Vaginal dryness is common in women who are approaching menopause and those who have gone through menopause. Other related symptoms include vaginal and vulvar irritation; burning or itching; discomfort or pain with sexual activity; and urinary symptoms, such as more frequent or urgent urination, urge leak, and urinary tract infections. Together, these symptoms are referred to as “genitourinary syndrome of menopause,” or GSM. These symptoms occur in roughly half of menopausal women and are even more common in women with breast cancer”.3

Common or Not

How common is GSM in postmenopausal women?

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems the (Australian) Jean Hailes for Women’s Health (JH) explain:

“As you move into perimenopause and menopause, low oestrogen levels can change your vulval, vaginal and bladder tissues. These changes may affect up to half of postmenopausal women”.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?

On page one and two in Vaginal Dryness: Treatment Options the Menopause Society elaborate on:

Menopause“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. First-line therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be combined for optimal symptom relief and can be used in combination with prescription therapies for more severe symptoms.

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • An effective and safe treatment, low-dose local estrogen applied directly to the vagina…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA may be options for women with a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.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 The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract published July 2022, the Menopause Society note:

“For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended”.9

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use, published July 2022, the NAMS explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.10

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.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 The 2023 Practitioner’s Toolkit for Managing Menopause – Effectiveness: Local Treatment of Urogenital Atrophy, published online 01 December 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.12

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms the JH explain:

“While symptoms such as hot flushes usually disappear over time, bladder, vaginal and vulval problems can persist and may even get worse. But many effective treatments are available.”.13

On page two in Vaginal Dryness the Menopause Society also note:

“Note: Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.14

Health Topics A-Z

Where may I find Health Topics A-Z related to Genitourinary Syndrome of Menopause?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. ACOG Explains: Managing Menopause Symptoms [American College of Obstetricians and Gynecologists]
  2. Askearlymenopause.org [+ Video: What Is Early Menopause?]
  3. BMS TV: Urogenital Atrophy
  4. Bioidentical Hormones: Are They Safer?
  5. Bladder Control: Lifestyle Strategies Ease Problems
  6. CAMS Menopause Hour: Genitourinary Health [Council of Affiliated Menopause Societies]
  7. CO2-Laser Therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis
  8. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause: An Evidence Map
  9. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  10. Deciding About Hormone Therapy Use
  11. Douching Fact Sheet
  12. Dr. Stephanie Faubion – Genitourinary  Syndrome of Menopause
  13. Endometrial Safety of Low-Dose Vaginal Estrogens
  14. Endometrial Safety of Low-Dose Vaginal Estrogens [Video]
  15. Experiencing Vaginal Dryness? Here’s What You Need To Know
  16. Find A Menopause Practitioner [United States and Other]
  17. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  18. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  19. Gaslighting of Genitourinary Symptoms of the Menopause
  20. Genitourinary Syndrome of Menopause (GSM)
  21. Genitourinary Syndrome of Menopause (Vaginal Atrophy)
  22. Genitourinary Syndrome of Menopause [Video]
  23. Genitourinary Syndrome of Menopause [Podcast]
  24. Genitourinary Syndrome of Menopause and the False Promise of Vaginal Laser Therapy
  25. Genitourinary Syndrome of Menopause: A Systematic Review on Prevalence and Treatment [Video]
  26. Genitourinary Syndrome of Menopause: New Name, Old Problem
  27. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
  28. Hormone Therapy: Is It Right for You?
  29. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  30. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  31. International Society for the Study of Women’s Sexual Health: Find A Provider
  32. Is It Too Late To Start HRT?
  33. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  34. Laser Treatment for Genitourinary Syndrome of Menopause (Scientific Impact Paper No. 72)
  35. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life]
  36. Low Estrogen Bladder Symptoms and Treatment
  37. Lubricant Alternatives: What To Use and What To Avoid
  38. Mayo Clinic Minute: Menopause and Sexual Health [+ Video Courtesy: Mayo Clinic News Network]
  39. Genitourinary Syndrome of MenopauseMayo Clinic Q and A: 6 UTI Myths and Facts
  40. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
  41. Menopause
  42. Menopause
  43. Menopause Checklist Podcast: Episode 1: A Wee Problem
  44. Menopause Management Options
  45. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Genitourinary Syndrome of Menopause
  46. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
    Genitourinary Syndrome of Menopause
  47. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  48. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  49. Menopause Preparedness Toolkit Video Series: Lifestyle Tips for Menopause Wellness
  50. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  51. Menopause Ruining Your Sex Life?
  52. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  53. Menopause Treatments: What Works, What Doesn’t
  54. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
  55. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  56. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  57. Mymenoplan.org [My Menoplan, United States]
  58. Navigating Menopause Together: How Partners Can Help
  59. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  60. Navigating Menopause: Honest Answers To All Your Questions [+ Video: What To Expect in Menopause]
  61. Painful Vaginal Sex (Dyspareunia)
  62. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  63. Perimenopause and Menopause Symptom Checklist
  64. Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)
  65. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
  66. Questions To Ask Your GP About Menopause
  67. Sexual Difficulties In the Menopause
  68. Surprising Menopause Symptoms Revisited | Dr Louise Newson [Video]
  69. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems
  70. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  71. The 2023 Practitioner’s Toolkit for Managing Menopause
  72. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  73. The Vaginal Laser Therapy Versus Vaginal Estrogen Therapy: The VeLVET Trial [Video]
  74. Tips To Help Manage Menopause Symptoms
  75. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) In Breast Cancer Survivors: A Systematic Review and Update
  76. The Truth About Menopause Supplements | Dr Sarah Berry
  77. Therapy for the Effects of Menopause
  78. Tips To Help Manage Menopause Symptoms
  79. Treating Genitourinary Syndrome of Menopause In Breast Cancer Survivors
  80. Treating Incontinence During Your Perimenopause and Menopause Years
  81. UTI: This Common Infection Can Be Serious
  82. Urogenital Problems
  83. Urologic View In the Management of Genitourinary Syndrome of Menopause
  84. Using Natural Therapies In the Menopause Transition – Webinar
  85. Vaginal Atrophy
  86. Vaginal Atrophy
  87. Vaginal Dryness
  88. Vaginal Dryness
  89. Vaginal Dryness
  90. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  91. Vaginal Dryness: Alternative Treatments
  92. Vaginal Dryness: What To Do About It
  93. Vaginal Laser Therapy for GSM/VVA: Where We Stand Now – A Review By the EUGA Working Group on Laser
  94. Vaginal Laser Therapy for Genitourinary Syndrome of Menopause – Systematic Review
  95. Videos & Podcasts: Videos – Interviews: Genitourinary Syndrome of Menopause
  96. Videos & Podcasts: Videos – Interviews: Vulvar Diseases, Overview for Aging Women [June 2024]
  97. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  98. Webinars: Previous – Skin and Connective Tissue Ageing At the Time of the Menopause
  99. Vulval Irritation
  100. Vulvovaginal Atrophy

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 12 September 2024
  2. Vaginal Dryness. 2022: 1. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 12 September 2024
  3. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women. 14 July 2021. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-treatment-for-vaginal-dryness-for-menopausal-women/ Accessed: 12 September 2024
  4. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems. Last Updated: 21 April 2024. Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 12 September 2024
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 12 September 2024
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 12 September 2024
  7. Vaginal Dryness: Treatment Options. 2022: 1-2. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 12 September 2024
  8. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 12 September 2024
  9. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. Published July 2022. Menopause Society https://journals.lww.com/menopausejournal/Abstract/2022/07000/The_2022_hormone_therapy_position_statement_of_The.4.aspx Accessed: 12 September 2024
  10. Deciding About Hormone Therapy Use. Published July 2022. Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 12 September 2024
  11. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayesena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022 https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 12 September 2024
  12. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam12 September 2024, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: The 2023 Practitioner’s Toolkit for Managing the Menopause Supporting Notes – Effectiveness: Local Treatment of Urogenital Atrophy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 12 September 2024
  13. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms. Last Updated: 21 April 2024. Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 12 September 2024
  14. Vaginal Dryness: Note. 2022: 2. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 12 September 2024
Topic Last Updated: 12 September 2024 – Topic Last Reviewed: 12 September 2024

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