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 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

Health Topics A-Z

Where may I find Health Topics 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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  1. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT)
  2. Bioidentical Hormones Explained – A British Menopause Society Video
  3. Bioidentical Hormones: Are They Safer?
  4. Caredownthere.com.au
  5. Clitoral Atrophy – Ask Dr Jean
  6. Complementary Medicine Options for Menopausal Symptoms
  7. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  8. Current Treatment Options for Postmenopausal Vaginal Atrophy
  9. Deciding About Hormone Therapy Use
  10. Deconstruction of the Genitourinary Syndrome of Menopause [30 March 2021]
  11. Douching Fact Sheet
  12. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  13. Essential Information: See Your Doctor If
  14. Experiencing Vaginal Dryness? Here’s What You Need To Know
  15. Five Things You Didn’t Know About Vaginas & Vulvas — Free Health Article
  16. HRT Benefits and Risks
  17. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  18. Hormone Therapy: Is It Right for You?
  19. How To Get Help With Your Sexual Health
  20. How To Increase Your Sexual Desire During Menopause
  21. How do I deal with vaginal atrophy? — Ask Dr Jean
  22. Intercourse Was Becoming Painful – Ask Dr Jean
  23. International Society for the Study of Vulvovaginal Disease: Resource Library – Patients
  24. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  25. Mayo Clinic Q and A: Managing the Symptoms of Vaginal Atrophy
  26. Menopause
  27. Menopause
  28. Menopause & Bladder Control
  29. Menopause Explained – A British Menopause Society Video
  30. Menopause FAQs: Menopause Symptoms – Q. How Can I Counteract Vaginal Dryness During Menopause?
  31. Menopause Hormone Therapy: Who Shouldn’t Take It?
  32. Menopause Management: Managing Vaginal Problems
  33. Menopause Symptoms and Relief – Vaginal Problems and Infections
  34. Menopause What Are the Symptoms?
  35. Menopause – What Are the Symptoms? [Multiply Languages] [Video]
  36. Menopause – Will It Affect My Sex Life? [Multiply Languages] [Video]
  37. Menopause: Diagnosis & Treatment – Lifestyle and Home Remedies
  38. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  39. Menopause: Hormone Replacement Therapy (HRT) [Video Interview Stories]
  40. Menopause: Libido, Vaginal Dryness and Urinary Problems and the Menopause [Video Interview Stories]
  41. Menopause: Menopause – Hormone Treatments
  42. Menopause: Relationships, Sex and Contraception and the Menopause [Video Interview Stories]
  43. Menopause: Symptoms & Causes
  44. Mona Lisa Touch – Ask Dr Jean
  45. National Association for Continence [United States]
  46. National Center for Complementary and Integrative Health: 4 Things To Know About Menopausal Symptoms and Complementary Health Practices
  47. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  48. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  49. Natural Therapies & Supplements
  50. New Guidelines To Help Clinicians Manage GSM In Women With Breast Cancer [Genitourinary Syndrome of Menopause]
  51. New Study Reassures Women About the Safety of Vaginal Estrogen
  52. NonHormonal Treatments for Menopausal Symptoms
  53. Painful Sex (Dyspareunia)
  54. Recent Review Confirms Safety of Low Dose Vaginal Estrogen: July 2019
  55. Resequedad Vaginal
  56. Sex & Relationships: 5 Things To Know About Sex In Later Life [Video]
  57. Sex and Menopause: Treatment for Symptoms
  58. Sexual Difficulties In the Menopause
  59. Statement From FDA Commissioner Scott Gottlieb, M.D., on Efforts To Safeguard Women’s Health From Deceptive Health Claims and Significant Risks Related To Devices Marketed for Use In Medical Procedures for “Vaginal Rejuvenation” [Food and Drug Administration, United States]
  60. Supporting Women Through Menopause
  61. Symptoms of Menopause
  62. Testosterone Explained – A British Menopause Society Video
  63. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  64. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  65. The Use of Vaginal Estrogen In Women With A History of Estrogen-Dependent Breast Cancer
  66. The Vaginal Laser Therapy Versus Vaginal Estrogen Therapy: The VeLVET Trial [Video]
  67. Update on Vaginal Laser Therapy
  68. Urinary Incontinence
  69. Urogenital Atrophy Explained – A British Menopause Society Video
  70. Urogenital Problems
  71. Vaginal Atrophy
  72. Vaginal Atrophy
  73. Vaginal Atrophy: Diagnosis & Treatment
  74. Vaginal Atrophy: Symptoms & Causes
  75. Vaginal Dryness
  76. Vaginal Dryness
  77. Vaginal Dryness
  78. Vaginal Dryness
  79. Vaginal Laser Therapy 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?
  80. Vaginal Dryness and the Menopause
  81. Vaginal Dryness: Alternative Treatments
  82. Vaginal Health After Breast Cancer: A Guide for Patients
  83. Vaginal Laser Therapy
  84. Vaginal Laser Treatment of Genitourinary Syndrome of Menopause: Does the Evidence Support the FDA Safety Communication?
  85. Video Series-2019 – Talking To Your Clinician About Sexual Health Concerns
  86. Video Series-2019 – Treatment Options for Vaginal Dryness In Survivors of Breast Cancer and In Those With A High Risk of Breast Cancer
  87. Video Series-2021 – What Women Need To Know About Hormone Therapies
  88. Video Series-2021 – Treatment Options for Vaginal Dryness and Urinary Issues
  89. Vulva & Vaginal Irritation [+ Video, Diagram and Booklet]
  90. Vulva and Vaginal Health: Getting the Right Advice
  91. Vulvovaginal Symptoms After Menopause
  92. What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  93. When Sex Is Painful
  94. Wild Yam
  95. Will Menopause Affect My Sex Life? [+ Video]
  96. Women Can Breathe Sigh of Relief When Using Vaginal Estrogen To Treat Menopause Symptoms
  97. Women’s Wellness: Bladder Control Problems
  98. Women’s Wellness: Lifestyle Strategies Ease Some Bladder Control Problems
  99. Women’s Wellness: Painful Sex After Menopause
  100. Women’s Wellness: Signs and Symptoms of Vaginal Health Problems
  101. Your Sexual Health

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

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: 06 January 2021
  2. Vaginal Dryness.  2018: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 06 January 2021
  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: 06 January 2021
  4. Vaginal Atrophy: Symptoms & Causes – Overview. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 06 January 2021
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 06 January 2021
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 06 January 2021
  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: 06 January 2021
  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: 06 January 2021
  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: 06 January 2021
  10. Vaginal Dryness: When To Contact A Medical Professional. Review Date: 30 June 2019. Page Last Updated: 22 December 2020 MedlinePlus https://www.nlm.nih.gov/medlineplus/ency/article/000892.htm Accessed: 06 January 2021
  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/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 06 January 2021
  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: 06 January 2021
  13. Vaginal Dryness: Note.  2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 06 January 2021
  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: 06 January 2021

Topic Last Updated: 04 April 2021 – Topic Last Reviewed: 06 January 2021
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