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 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”.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 The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract published July 2022, the NAMS 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 10 June 2022, Hamoda et.al. also note:

  • “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 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

Where may I find Links related to Genitourinary Syndrome of Menopause?

Your Country may have Links similar to:

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.

  1. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  2. Bioidentical Hormones Explained – A British Menopause Society Video
  3. Bioidentical Hormones: Are They Safer?
  4. Bladder Control: Lifestyle Strategies Ease Problems
  5. CO2-Laser Therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis
  6. Caredownthere.com.au
  7. Clitoral Atrophy – Ask Dr Jean
  8. Complementary Medicine Options for Menopausal Symptoms
  9. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  10. Consumer Health: Treating Vaginal Dryness After Menopause
  11. Deciding About Hormone Therapy Use
  12. Douching Fact Sheet
  13. Dr. Stephanie Faubion – Genitourinary  Syndrome of Menopause
  14. EMAS Replay: Genitourinary System Laser Treatment In Menopause
  15. EMAS Replay: Risk Assessment for MHT – When, To Whom, Which, and How Long?
  16. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  17. Experiencing Vaginal Dryness? Here’s What You Need To Know
  18. Find A Menopause Practitioner [United States and Other]
  19. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  20. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  21. Five Things You Didn’t Know About Vaginas & Vulvas — Free Health Article
  22. From Leaking Urine To Sudden Urges To Go: An Ob-Gyn Talks Bladder Control Problems
  23. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  24. HRT: Benefits and Risks
  25. Hormone Therapy: Is It Right for You?
  26. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  27. Intercourse Was Becoming Painful – Ask Dr Jean
  28. International Society for the Study of Women’s Sexual Health: Find A Provider
  29. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing and Intimacy During and After Menopause [+ Video: Menopause Is the End of Your Sex Life]
  30. Low Estrogen Bladder Symptoms and Treatment
  31. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  32. Menopause
  33. Menopause
  34. Menopause & Bladder Control
  35. Menopause Explained – A British Menopause Society Video
  36. Menopause FAQs: Menopause Symptoms – Q. How Can I Counteract Vaginal Dryness During Menopause?
  37. Menopause Hormone Therapy: Who Shouldn’t Take It?
  38. Menopause Management: Managing Vaginal Problems
  39. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Genitourinary Syndrome of Menopause
  40. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
    Genitourinary Syndrome of Menopause
  41. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  42. Menopause Symptoms and Relief – Vaginal Problems and Infections
  43. Menopause What Are the Symptoms?
  44. Menopause: Diagnosis & Treatment – Lifestyle and Home Remedies
  45. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  46. Menopause: Menopause – Hormone Treatments
  47. Menopause: Symptoms & Causes
  48. Menopause: What Are the Symptoms? [Multiply Languages] [Video]
  49. Menopause: Will It Affect My Sex Life? [Multiply Languages] [Video]
  50. Mona Lisa Touch – Ask Dr Jean
  51. National Association for Continence [United States]
  52. National Center for Complementary and Integrative Health: 4 Things To Know About Menopausal Symptoms and Complementary Health Practices
  53. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  54. Natural Therapies & Supplements
  55. NonHormonal Treatments for Menopausal Symptoms
  56. Painful Sex (Dyspareunia)
  57. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  58. Sex & Relationships: 5 Things To Know About Sex In Later Life [Video]
  59. Sex and Menopause: Treatment for Symptoms
  60. Sexual Difficulties In the Menopause
  61. Sexual Dysfunction Hits Some Women Harder Than Others As They Age
  62. Supporting Women Through Menopause – Fact Sheet
  63. Symptoms of Menopause
  64. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  65. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  66. The Vaginal Laser Therapy Versus Vaginal Estrogen Therapy: The VeLVET Trial [Video]
  67. Treatment of Urogenital Symptoms In Women With A History of Estrogen-Dependent Breast Cancer
  68. Update on Vaginal Laser Therapy
  69. Urinary Incontinence
  70. Urogenital Atrophy Explained – A British Menopause Society Video
  71. Urogenital Problems
  72. Vaginal Atrophy
  73. Vaginal Atrophy
  74. Vaginal Atrophy: Diagnosis & Treatment
  75. Vaginal Atrophy: Symptoms & Causes
  76. Vaginal Dryness
  77. Vaginal Dryness
  78. Vaginal Dryness
  79. Vaginal Dryness
  80. 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?
  81. Vaginal Dryness: Alternative Treatments
  82. Vaginal Laser Therapy
  83. Vaginal Laser Therapy for Genitourinary Syndrome of Menopause – Systematic Review
  84. Video Series-2021: Common Issues Surrounding Sexuality and Menopause
  85. Video Series-2021: Female Urinary and Bladder Issues At Midlife
  86. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  87. Video Series-2021: What Women Need To Know About Hormone Therapies
  88. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  89. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  90. Videos and Podcasts: Interviews and Podcasts – Interviews: Vulvovaginal Atrophy
  91. Vulva & Vaginal Irritation [+ Video, Diagram and Booklet]
  92. Vulva and Vaginal Health: Getting the Right Advice
  93. Vulvovaginal Symptoms After Menopause
  94. Webinars: Previous – Sexual Health Issues In Menopause
  95. Webinars: Previous – VVA – The Silent Epidemic [Vulvovaginal Atrophy]
  96. When Sex Hurts – Podcast [Vaginismus and Vulvodynia]
  97. When Sex Is Painful
  98. Wild Yam
  99. Will Menopause Affect My Sex Life? [+ Video]
  100. Women’s Wellness: Signs and Symptoms of Vaginal Health Problems

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: 09 July 2022
  2. Vaginal Dryness.  2018: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 09 July 2022
  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: 09 July 2022
  4. 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: 09 July 2022
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 09 July 2022
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 09 July 2022
  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: 09 July 2022
  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: 09 July 2022
  9. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. Published July 2022. The North American Menopause Society https://journals.lww.com/menopausejournal/Abstract/2022/07000/The_2022_hormone_therapy_position_statement_of_The.4.aspx Accessed: 09 July 2022
  10. Deciding About Hormone Therapy Use. Published July 2022. The North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 09 July 2022
  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 10 June 2022 https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 09 July 2022
  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: 09 July 2022
  13. Vaginal Dryness: Note.  2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 09 July 2022
  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: 09 July 2022

Topic Last Updated: 09 July 2022 – Topic Last Reviewed: 09 July 2022
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