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Understanding Menopause and Genitourinary Syndrome (GSM): A Comprehensive Overview

What is menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. It can be defined as the permanent end of menstruation and is diagnosed after 12 consecutive months without a period. Menopause typically occurs between the ages of 45 and 55 but can occur earlier or later. While menopause is a normal part of aging, it can be accompanied by a variety of symptoms, including hot flashes, night sweats, mood changes, and vaginal dryness. Additionally, menopause can come with other symptoms associated with genitourinary syndrome of menopause (GSM).

What is genitourinary syndrome of menopause (GSM)?

The genitourinary syndrome of menopause (GSM) is a condition that affects many menopausal women but is often underdiagnosed and undertreated. GSM refers to a group of symptoms that result from the decline in estrogen levels that occurs during menopause. These symptoms include vaginal dryness, itching, burning, and pain during sexual activity. GSM can also cause urinary symptoms, such as frequent urination, urinary urgency, and urinary tract infections (UTIs).

The decline in estrogen levels that occurs during menopause can cause a thinning of the vaginal walls and a decrease in vaginal lubrication. This decline can lead to vaginal dryness, which can cause discomfort and pain during sexual activity. Vaginal dryness can also increase the risk of vaginal infections, as the lack of lubrication can cause small tears in the vaginal tissue that can allow bacteria to enter.

In addition to vaginal dryness, GSM can also cause urinary symptoms. The decline in estrogen levels can weaken the muscles of the pelvic floor, which can lead to urinary incontinence, or the involuntary loss of urine. GSM can also cause urinary urgency, or the sudden and strong need to urinate, as well as urinary tract infections, which are more common in menopausal women due to the changes in the urinary tract that occur during menopause.

The symptoms of GSM can have a significant impact on a woman's quality of life. Women with GSM may experience pain or discomfort during sexual activity, which can lead to a decrease in sexual desire and intimacy. The urinary symptoms associated with GSM can also be embarrassing and can limit a woman's ability to engage in social activities or exercise.

Potential treament options

Fortunately, there are treatments available for GSM that can help relieve symptoms and improve a woman's quality of life. One of the most effective treatments for GSM is hormone therapy. Hormone therapy involves taking estrogen and, in some cases, progesterone to replace the hormones lost during menopause. Hormone therapy can help alleviate vaginal dryness and improve vaginal lubrication, which can reduce pain and discomfort during sexual activity. Hormone therapy can also improve urinary symptoms by strengthening the muscles of the pelvic floor and reducing the risk of urinary tract infections.

However, hormone therapy is not without risks. Women who take hormone therapy may have an increased risk of certain health problems, such as blood clots, stroke, and breast cancer. The decision to take hormone therapy should be made in consultation with a healthcare provider, and the risks and benefits should be carefully considered.

For women who cannot or do not want to take hormone therapy, there are other treatments available for GSM. Vaginal moisturizers and lubricants can help alleviate vaginal dryness and improve vaginal lubrication. These products can be applied directly to the vagina and can provide relief for several hours. Vaginal moisturizers are designed to be used regularly, while vaginal lubricants are designed to be used as needed.

Another treatment option for GSM is vaginal estrogen. Vaginal estrogen comes in several different forms, including creams, tablets, and rings, and is designed to be applied directly to the vagina. Vaginal estrogen can help alleviate vaginal dryness and improve vaginal lubrication, and can also improve itchiness, redness and soreness. 

*This article is intended for informational purposes only and should not be substituted for medical advice. For medical questions and advice, it is always best to consult with your trained physician.

Sources:

Angelou, K., Grigoriadis, T., Diakosavvas, M., Zacharakis, D., & Athanasiou, S. (2020, April 8). The genitourinary syndrome of menopause: An overview of the recent data. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212735/

Mayo Foundation for Medical Education and Research. (2021, September 17). Vaginal atrophy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 

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