Genitourinary Syndrome of Menopause: A Common but Underdiagnosed Condition that Impairs Women’s Quality of Life

If you are a woman who has gone through menopause, you may have noticed some changes in your genital and urinary health. You may experience dryness, irritation, or pain in your vulva and vagina, as well as problems with sexual function and urinary function. These symptoms are not uncommon and they are not something to be ashamed of. They are part of a condition called the genitourinary syndrome of menopause (GSM).

I learned a lot about GSM when I was doing my urology rotation in Pocatello, Idaho. Many women came to us with problems in their genitals, sex life, and urination that they did not understand, did not know how to connect, and felt embarrassed about. GSM is the new term that describes the changes in the genitourinary system that happen after menopause. Before, people used to call it vulvovaginal atrophy or atrophic vaginitis, but those names were not accurate or comprehensive enough. In 2013, a group of experts from the International Society for the Study of Women's Sexual Health (ISSWSH) and the North American Menopause Society (NAMS) agreed on a new terminology that would better reflect the reality of GSM. The ISSWSH and NAMS Boards officially adopted the term GSM in early 2014. (1)

GSM is a term that covers a range of symptoms and signs that affect the vulva, vagina, and lower urinary tract after menopause. These symptoms are caused by the decrease in estrogen levels that occurs during this stage of life. Estrogen is a hormone that helps maintain the health and function of these tissues. Without enough estrogen, these tissues become thinner, drier, less elastic, and more prone to inflammation and infection.

Some of the symptoms of GSM include:

Genital symptoms: dryness, burning, irritation, decreased lubrication, and discomfort or pain during sexual activity.

Sexual symptoms: reduced desire, arousal, or satisfaction, difficulty reaching orgasm, and impaired function.

Urinary symptoms: urgency, frequency, leakage, pain or burning when urinating, and recurrent urinary tract infections (UTIs).

GSM can affect your quality of life in many ways. It can interfere with your intimacy, your self-esteem, your mood, and your overall well-being. It can also increase your risk of developing other health problems, such as vaginal atrophy and pelvic organ prolapse. (2)

Fortunately, there are treatments available for GSM that can help you manage your symptoms and improve your quality of life. Depending on your individual needs and preferences, you may benefit from different types of treatments:

Local Treatments

These are medications that act only on the affected tissues and do not affect your overall hormone levels. They include nonhormonal treatments (such as vaginal lubricants and moisturizers that you can buy over-the-counter) and hormonal treatments (such as estrogen tablets, creams, or rings that you insert into your vagina). Nonhormonal treatments are the first-line treatment for GSM. (3)

Systemic Treatments

These are medications that affect your whole body and restore some of the estrogen levels that you lost after menopause. They include hormonal therapy (such as pills, patches, gels, or injections), selective estrogen receptor modulators (SERMs), bazedoxifene (a type of SERM), and conjugated estrogens. (4)

The choice of treatment depends on several factors, such as the severity of your symptoms, your medical history, your personal preferences, and the potential benefits and risks of each option. You should talk to your doctor about the best treatment for you.

GSM is a common and treatable condition that affects many women after menopause. You do not have to suffer in silence or feel embarrassed about it. You can find relief and enjoy a healthy and satisfying sexual and urinary life. If you have any questions or concerns about GSM or its treatment options, do not hesitate to contact your doctor.

References:

1. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-1068. doi:10.1097/GME.0000000000000329

2. Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. Published 2020 Apr 8. doi:10.7759/cureus.7586

3. ACOG Practice Bulletin No. 141: management of menopausal symptoms [published correction appears in Obstet Gynecol. 2016 Jan;127(1):166] [published correction appears in Obstet Gynecol. 2018 Mar;131(3):604]. Obstet Gynecol. 2014;123(1):202-216. doi:10.1097/01.AOG.0000441353.20693.78

4. Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015;21(2):65-71. doi:10.6118/jmm.2015.21.2.65

5. Image 2 (book) credit: <a href="https://www.freepik.com/free-photo/pensive-senior-woman-sitting-bed-feeling-worried-about-something-her-husband-is-sleeping-background_25777425.htm?query=vaginal%20pain%20old%20woman#from_view=detail_alsolike#position=9&query=vaginal%20pain%20old%20woman">Image by Drazen Zigic</a> on Freepik

6. Image 3 (pills) credit: <a href="https://www.freepik.com/free-photo/pensive-senior-woman-sitting-bed-feeling-worried-about-something-her-husband-is-sleeping-background_25777425.htm?query=vaginal%20pain%20old%20woman#from_view=detail_alsolike#position=9&query=vaginal%20pain%20old%20woman">Image by Drazen Zigic</a> on Freepik