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:

“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. Unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment”.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

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”.4

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”.5

Treatment

What are some GSM treatments?

In Vaginal Dryness: Treatment Options the NAMS 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…
    • Low-dose local estrogen…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA and a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.6

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)”.7

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”.8

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)”.9

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”.10

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.

On page two in Vaginal Dryness the NAMS 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”.11

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

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.

New or Updated

  1. Askearlymenopause.org [+ Video: What Is Early Menopause?]
  2. BMS Statement on Testosterone
  3. BMS TV: Testosterone Explained
  4. Bioidentical Hormones Explained – A British Menopause Society Video
  5. Bioidentical Hormones: Are They Safer?
  6. Bladder Control: Lifestyle Strategies Ease Problems
  7. CO2-Laser Therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis
  8. Caredownthere .org CareDownThere, Australia]
  9. Consumer Health: Treating Vaginal Dryness After Menopause
  10. Deciding About Hormone Therapy Use
  11. Douching Fact Sheet
  12. Dr. Stephanie Faubion – Genitourinary  Syndrome of Menopause
  13. Experiencing Vaginal Dryness? Here’s What You Need To Know
  14. Find A Menopause Practitioner [United States and Other]
  15. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  16. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  17. Foods for Menopause
  18. From Leaking Urine To Sudden Urges To Go: An Ob-Gyn Talks Bladder Control Problems
  19. Genitourinary Syndrome of Menopause (GSM)
  20. Genitourinary Syndrome of Menopause: A Systematic Review on Prevalence and Treatment [Video]
  21. HRT: Benefits and Risks
  22. Hormone Therapy: Is It Right for You?
  23. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  24. I Forgot To Ask the Doctor – E9: The Menopause: Can Every Woman That Wants It Have HRT?
  25. International Society for the Study of Women’s Sexual Health: Find A Provider
  26. 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
  27. Laser Treatment for Genitourinary Syndrome of Menopause (Scientific Impact Paper No. 72)
  28. 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]
  29. Let’s Talk About Perimenopause
  30. Low Estrogen Bladder Symptoms and Treatment
  31. Managing Menopause Symptoms With Nutrition and Diet
  32. Mayo Clinic Minute: Menopause and Sexual Health [+ Video]
  33. Mayo Clinic Q and A: 6 UTI Myths and Facts
  34. Menopause
  35. Menopause
  36. Menopause
  37. Menopause & Bladder Control
  38. Menopause Management Options
  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 Patient Information [Videos] 2. Talking To Your GP About Menopause
  42. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  43. Menopause Preparedness Toolkit Video Series: Lifestyle Tips for Menopause Wellness
  44. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  45. Menopause Ruining Your Sex Life?
  46. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  47. Menopause Treatments: What Works, What Doesn’t
  48. Menopause and Sex – Fact Sheet
  49. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  50. Menopause: Menopause – Hormone Treatments
  51. Menopause: Symptoms & Causes
  52. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  53. National Association for Continence [United States]
  54. National Center for Complementary and Integrative Health: 4 Things To Know About Menopausal Symptoms and Complementary Health Practices
  55. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  56. Natural Therapies & Supplements
  57. Navigating Menopause Together: How Partners Can Help
  58. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  59. Non-Estrogen Treatments for Menopausal Symptoms
  60. Painful Sex (Dyspareunia)
  61. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  62. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
  63. Questions To Ask Your GP About Menopause
  64. Sex and Menopause: Treatment for Symptoms
  65. Sexual Difficulties In the Menopause
  66. Sexual Dysfunction Hits Some Women Harder Than Others As They Age
  67. Supporting Women Through Menopause – Fact Sheet
  68. Symptoms of Menopause
  69. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  70. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  71. The Vaginal Laser Therapy Versus Vaginal Estrogen Therapy: The VeLVET Trial [Video]
  72. The Yin and Yang of GSM and Low Sexual Desire
  73. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) In Breast Cancer Survivors: A Systematic Review and Update
  74. Tips To Help Manage Menopause Symptoms
  75. Treating Genitourinary Syndrome of Menopause In Breast Cancer Survivors
  76. Urogenital Atrophy Explained – A British Menopause Society Video
  77. Urogenital Problems
  78. Using Natural Therapies In the Menopause Transition – Webinar
  79. Vaginal Atrophy
  80. Vaginal Atrophy
  81. Vaginal Dryness
  82. Vaginal Dryness
  83. Vaginal Dryness
  84. Vaginal Dryness
  85. 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?
  86. Vaginal Dryness: Alternative Treatments
  87. Vaginal Laser Therapy for Genitourinary Syndrome of Menopause – Systematic Review
  88. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  89. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  90. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  91. Video Series-2023
  92. Videos and Podcasts: Videos – Interviews: Vulvovaginal Atrophy
  93. Vulva & Vaginal Irritation [+ Video, Diagram and Booklet]
  94. Vulva and Vaginal Health: Getting the Right Advice
  95. Vulvovaginal Atrophy
  96. Vulvovaginal Symptoms After Menopause
  97. What Everyone Should Know About Menopause Symptoms
  98. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit
  99. Wild Yam

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: 06 May 2023
  2. Vaginal Dryness.  2022: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 06 May 2023
  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: 06 May 2023
  4. Vaginal Atrophy: Symptoms & Causes – Symptoms. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 06 May 2023
  5. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 06 May 2023
  6. Vaginal Dryness: Treatment Options. 2022: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 06 May 2023
  7. 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: 06 May 2023
  8. 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: 06 May 2023
  9. 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: 06 May 2023
  10. 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: 06 May 2023
  11. Vaginal Dryness: Note.  2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 06 May 2023
Topic Last Updated: 19 May 2023 – Topic Last Reviewed: 06 May 2023

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