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Genitourinary Syndrome of Menopause (GSM)

GSM is group of problems involving the vagina, urinary tract, and sexual difficulty due to the low estrogen state after menopause. These tend to be long term problems and progressively worsen. Over half of postmenopausal women will experience at least one of these complications. Common complaints are vaginal dryness, painful sex, vaginal itching, discharge, and pelvic pain. The lack of estrogen after menopause causes an elevated pH of vaginal fluid which promotes an overgrowth of bacteria that can lead to vaginal infections, UTI, and inflammation. Low estrogen also causes decreased blood supply to the vagina and urinary tract causing the vaginal walls to become thin and less elastic. This can cause painful sexual activity. The bladder and urethra are similarly affected, causing urinary incontinence and increased frequency of urination.

There are three types of medication treatments for these symptoms: systemic or topical hormone replacement and selective estrogen receptor modulators (SERM). Systemic hormone replacement is suggested for patients with GSM symptoms as well as additional menopause symptoms like hot flashes and a risk of low bone density. Topical treatment is recommended for patients who only have vaginal symptoms. Estrogen therapy, whether systemic or topical, will improve vaginal and urethra bacteria and help to prevent frequent vaginal infections and UTIs. There are certain individuals who should not take estrogen therapy, and this will be discussed at your visit. Ospemifene is a SERM which is a treatment for patients who cannot take estrogen therapy. It improves both vaginal structure and pH.

If you desire non-medication treatment of your GSM symptoms, homeopathic remedies and lifestyle changes may be considered. Homeopathic treatment studies show no improvement in the vaginal tissue, but does show improvement in vaginal flexibility. These treatments include black cohosh, dong quai, phytomedicines, nettle, comfrey root, motherwort, soy foods, and chaste tree extract. Some herbs can interact with certain medications, so make sure to contact your physician prior to starting any herbal medications. Increasing your sexual activity can also aid in relieving GSM symptoms. This maintains vaginal muscle conditioning, elasticity, and the natural lubricative response.

Another option for non-pharmacologic treatment is Thermiva, which is an in office procedure using radiofrequency energy to gently heat the vaginal tissue. Treatments are intended to tighten vaginal tissue and stimulate collagen production for the treatment of vaginal atrophy and dryness.

Genitourinary syndrome of menopause can severely affect your quality of life. If you suffer from any of these symptoms, call for an appointment for more information or to discuss your treatment options. 

Brian A Levitt, MD

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