GSM: It’s Not Just Painful Intercourse!

Are you over 40 and experience any of the following symptoms?

  • Vaginal symptoms
    • Dryness, irritation, burning
    • Itching, Redness
    • Painful intercourse
    • Lack of lubrication during sexual activity
  • Urinary symptoms
    • Increased urinary frequency
    • Increased urinary urgency
    • Burning with urination
    • Leakage of urine (incontinence)
    • Urinary tract infections
  • Sexual symptoms
    • Decreased Sex Drive
    • Loss of arousal
    • Lack of lubrication
    • Painful intercourse (dyspareunia)
    • Inability to have an orgasm
    • Pelvic pain with sexual activity

If the answer is YES, you may be experiencing a condition called Genitourinary Syndrome of Menopause.

Genitourinary Syndrome of Menopause (GSM) is a term used to describe progressive vulvar, vaginal, lower urinary tract, and sexual symptoms related to a clinical state of low estrogen after the onset of menopause. Menopause is a term that describes the end of menstrual cycles, and is diagnosed after a woman has gone 12 months without a period. Menopause can occur gradually as a woman ages, or abruptly as a result of surgery called a hysterectomy or oophorectomy to remove the uterus or ovaries. Additionally, some non-menopause related causes of estrogen deficiency such as hormone therapies to treat breast cancer can also cause symptoms of GSM. While the average age for menopause is 51, the ovaries begin to produce markedly less estrogen and progesterone in a woman’s late 30s and early 40s as fertility declines. Symptoms of GSM can occur anytime once the level of estrogen in a woman’s body begins to decrease.

As a woman approaches menopause, and estrogen levels decrease, the tissues in this area lack estrogen resulting in a myriad of lower urinary tract and vaginal symptoms described above. The tissues in a woman’s genital area including the vaginal vestibule (opening), vagina, lower part of the bladder, and entire urethra are dependent on estrogen to maintain their normal functions. These functions include producing vaginal lubrication, regulating a healthy pH and microbiome, increasing  blood flow, and improving elasticity and muscle tone during sexual activity / childbirth and preventing leakage of urine.

Estrogen is vital for regulating the body’s natural defenses against urinary tract and vaginal infections.  Normal estrogen levels in the bladder, urethra, and vaginal tissues promote healthy growth of normal bacteria called lactobacillus which metabolizes glucose into lactic and acetic acid, lowering the vaginal pH to a range of 3.5-4. This acidic environment is ideal and provides a natural protection against pathogenic bacteria which can cause urinary tract and vaginal infections such as bacterial vaginosis and yeast infections. When there is a lack of estrogen in these tissues, normal flora can not flourish, resulting in a less acidic environment with higher pH values resulting in overgrowth of pathogenic “bad” bacteria which cause urinary tract and vaginal infections. In addition to infection prevention, estrogen plays a role in sexual function and continence (ability to hold urine).

When the vaginal tissues lack estrogen they become atrophic, or decreased in tone and elasticity which results in a shortened and narrowed vagina which can lead to painful intercourse called dysparueinia.

As estrogen levels drop, the bladder and urethra also become atrophic leading to urinary leakage, frequency, and urgency.

At least half of women approaching or in menopause experience symptoms of GSM, but only 4% of women attribute vaginal, urinary, or sexual symptoms to this decrease in hormones (estrogen & progesterone), and 33% of women do not discuss their genital symptoms at all!

Women do not need to endure or “just live with” symptoms of GSM any longer. These symptoms signify a progressive medical condition that will not improve without treatment and can adversely affect many women’s quality of life. There are a number of lifestyle modifications, homeopathic treatments, and prescription medications available to treat the vaginal, urinary, and sexual symptoms of GSM and prevent further worsening of symptoms and sequela related to the condition.

Treatment options vary depending upon each individual woman’s symptoms, age, and medical history. Some common therapies are listed below:

Estrogen Therapy: Vaginal estrogen is the most common form of estrogen used to treat GSM, and offers the fastest and most effective symptom relief for vaginal symptoms. Estrogen therapy should only be prescribed by a licensed healthcare provider after all risk factors and benefits have been reviewed. In most cases, vaginal estrogen is an extremely safe option with very little systemic absorption or side effects. In some cases estrogen therapy is not recommended. For example, for women with a history of breast or gynecologic cancers, vaginal estrogen is contraindicated.

DHEA: DHEA is an androgen precursor to estrogen in the body. DHEA is particularly helpful to treat painful intercourse. When used daily, DHEA suppositories have been shown to improve vaginal pH, lubrication, and irritation.

Hyaluronic Acid: Hyaluronic acid is a hormone free, naturally occurring lubricant produced by the body that plays an important role in cell hydration and healing. Hyaluronic vaginal suppositories used daily can help retain moisture in the vaginal lining and repair and replenish irritated vaginal tissues, decreasing vaginal symptoms and painful intercourse. Hyaluronic acid is over the counter and does not require a prescription.

Lactobacillus vaginal suppository: Lactobacillus vaginal suppositories help replenish the vaginas normal, healthy bacteria flora. Lactobacillus metabolize glucose into lactic and acetic acid which promote an acidic pH necessary for infection prevention and proper lubrication.

Boric Acid: Boric acid vaginal suppositories help to restore a healthy, acidic pH, and promote growth of good bacteria which serve as the body’s natural defense against organisms that cause infection. Boric acid also has mild antiseptic and antifungal properties to help prevent infection. Boric acid is over the counter and does not require a prescription.

Estrogen / Testosterone Cream: Daily E/T cream can significantly improve vaginal irritation and burning in post-menopausal women. In pre-menopausal patients, it can be used to treat clitoral phimosis and may have beneficial effects on sensation and climax.

Testosterone Cream: Small amounts of daily topical testosterone can help improve libido in post-menopausal women and may improve or restore orgasmic function.

The bottom line is that bothersome vaginal and urinary symptoms are not something women should be expected to live with.

These complaints have historically been undertreated by the medical profession. Genitourinary Syndrome of Menopause is a legitimate health concern affecting over half of all women approaching or completing menopause. Without treatment, GSM is a progressive condition with serious implications such as recurrent urinary tract infections, painful sex, pelvic prolapse, and urinary incontinence. There are many treatment options available that can be individualized based on each woman’s need. Women should be encouraged to discuss these symptoms openly with their healthcare providers. If you are interested in discussing your symptoms visit to talk with one of our expert providers. As women with years of experience successfully treating these and many other common conditions that affect women, we know firsthand that today, more than ever before, there are safe and effective treatment options available to you.

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