Genitourinary syndrome of menopause (GSM) is a progressive condition that shows up as various symptoms that affect the vulva, vagina, and urinary tract (bladder and urethra) during and after menopause .e60dc2a1-f33c-4a05-9b50-8e3e8e59762936b3bcf4-866b-4542-a909-3f984216b93d GSM is caused by a drop in estrogen levels, a hormone produced by the ovaries that keeps the vagina and bladder tissue thick, lubricated, and elastic.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292e77eff7-fd37-4fa6-9c91-cb45f24ea9f0 When estrogen drops during menopause, the tissues lining the vagina become thin (called vaginal atrophy), causing symptoms like dryness, burning, itching, pain, and urinary tract infections (UTIs).e60dc2a1-f33c-4a05-9b50-8e3e8e59762936b3bcf4-866b-4542-a909-3f984216b93d GSM often starts five to six years after a woman’s last period, but it sometimes begins in the years leading up to menopause ( perimenopause ).e60dc2a1-f33c-4a05-9b50-8e3e8e597629d8ca7e33-aaef-49d4-93cd-753354c01a7a This condition can be uncomfortable and frustrating, but the symptoms are manageable with over-the-counter remedies and prescription medicines.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e608af96-6da4-47f1-b795-3932bd046b00
Signs and Symptoms of Genitourinary Syndrome of Menopause Symptoms The loss of estrogen during menopause can cause vaginal, urinary, and sexual symptoms. Vaginal symptoms include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab35fd52-fb2a-4f47-a17a-efde387162da Dryness Burning Itching inside and around the vaginae60dc2a1-f33c-4a05-9b50-8e3e8e5976292907b972-8bcb-4a5c-b0cc-d31504232481 Irritation Pain and pressure Urinary symptoms include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629dcf98a1c-b126-4c11-8246-6c85322e0040 Leaking urine ( urinary incontinence ) Pain or burning when you pee Needing to pee more often than usuale60dc2a1-f33c-4a05-9b50-8e3e8e5976292907b972-8bcb-4a5c-b0cc-d31504232481 Urinary tract infections (UTIs) Sexual symptoms include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab35fd52-fb2a-4f47-a17a-efde387162da Loss of sex drive Painful sex Spotting or bleeding during or after sexe60dc2a1-f33c-4a05-9b50-8e3e8e5976292907b972-8bcb-4a5c-b0cc-d31504232481 Inability to reach orgasm
Causes and Risk Factors of Genitourinary Syndrome of Menopause Causes The drop in estrogen during menopause causes GSM.e60dc2a1-f33c-4a05-9b50-8e3e8e59762929da08af-5b3f-47da-be88-84d9e2abe2f1 When estrogen levels are low, the body produces less collagen and other substances that keep tissues inside the vagina lubricated and stretchy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c00bffec-37d3-4def-b355-18297d1f5dce As a result, the vagina gets thinner, drier, and less elastic.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bc7e155-f608-437f-98b8-0bff821725a7 Because the tissue is more fragile, it gets irritated and tears easily. The loss of estrogen also changes the pH in the vagina and alters the balance of helpful bacteria that protect against UTIs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629af566ef5-82bc-4f30-881f-4c8c5e173341 Naturally occurring menopause isn’t the only reason someone might have a drop in estrogen levels. Other life events or treatments can lower estrogen levels and cause these symptoms, such as:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bc7e155-f608-437f-98b8-0bff821725a7e60dc2a1-f33c-4a05-9b50-8e3e8e5976296bc66e6c-4813-4e53-801e-38ba0b9eafa0 Ovary removal surgery Cancer treatments such as chemotherapy, aromatase inhibitors , or radiation to the ovaries or pelvis Medications that lower estrogen levels, such as methotrexate and some birth control pills Breastfeeding Autoimmune disease Smoking can cause early menopause or make GSM worse.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bc7e155-f608-437f-98b8-0bff821725a7e60dc2a1-f33c-4a05-9b50-8e3e8e5976295cd88077-0af5-4d17-b4f5-61818628cfaa
How Is Genitourinary Syndrome of Menopause (GSM) Diagnosed? Diagnosis To diagnose GSM, doctors ask about symptoms like vaginal dryness, pain during sex, and UTIs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297b058514-5858-4f76-861a-4265088529d6 A physical exam may show some or all of the following signs in the vulva and vagina. e60dc2a1-f33c-4a05-9b50-8e3e8e5976297b058514-5858-4f76-861a-4265088529d6 Dryness Redness Swelling Thinning Narrowing or shortening Cuts or tears Lab tests like urinalysis (urine test) or tissue culture usually aren’t needed to diagnose GSM.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ef33f848-80fa-48e3-9747-b3db995ca098 But these tests can be helpful for ruling out other conditions, such as UTIs or sexually transmitted infections (STIs).
Treatment and Medication Options for Genitourinary Syndrome of Menopause Treatment Over-the-counter vaginal lubricants and moisturizers and prescription hormone therapy are the main treatments for GSM.e60dc2a1-f33c-4a05-9b50-8e3e8e597629215fa0d6-9b9d-4b4e-90c8-d44acb389a78 The choice of medicine depends on the severity of symptoms. Lifestyle changes can also make GSM more manageable. Hormonal Treatments Prescription hormonal medicines for GSM include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629215fa0d6-9b9d-4b4e-90c8-d44acb389a78 Topical Estrogen Therapy Low-dose hormone therapy replaces some of the estrogen your body no longer makes. This treatment comes as a tablet, ring, insert, or cream.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a46794e-7709-45d3-a588-ab1901f268e3 Estrogen thickens tissue and increases lubrication inside the vagina. It also improves the pH, which helps prevent UTIs. Topical estrogen works for mild symptoms like irritation, dryness, and pain during sex. It has fewer side effects than oral hormone therapy, because very little is absorbed into the bloodstream. But talk to your oncologist before using estrogen therapy if you have a history of breast cancer or blood clots. Systemic Estrogen Therapy More severe symptoms may need treatment with estrogen pills,e60dc2a1-f33c-4a05-9b50-8e3e8e597629527bdb4c-8b88-48c1-8298-c4dad0beb797 which work throughout the body to treat GSM and other menopause symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629215fa0d6-9b9d-4b4e-90c8-d44acb389a78 Synthetic DHEA DHEA is a sex hormone that your body converts into estrogen and testosterone.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bb53e898-7246-4dfb-9c3d-306e93d3b927 A synthetic version of DHEA, prasterone (Intrarosa), can be inserted vaginally once a day at bedtime to relieve vaginal dryness, burning, and pain. Nonhormonal Treatments These nonhormonal products may be used with hormone therapy or on their own for mild symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629527bdb4c-8b88-48c1-8298-c4dad0beb797 Vaginal Lubricants These over-the-counter options are often the first treatment for mild GSM symptoms. Lubricants reduce friction and pain, and increase comfort during sex. They are either water-based (K-Y, Astroglide) or oil-based.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291a98e826-bf33-4f94-b94c-879c7a9ef7b6 Some oil-based lubricants can damage latex condoms and increase the risk of STIs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bb53e898-7246-4dfb-9c3d-306e93d3b927 Vaginal Moisturizers These over-the-counter products (Replens, Sliquid) absorb moisture through the skin and trap it in the lining of the vagina to treat dryness and thinning.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291a98e826-bf33-4f94-b94c-879c7a9ef7b6 Because their effects last longer than lubricants, moisturizers are applied two to three times a week. Selective Estrogen Receptor Modulators (SERMs) SERMs are nonhormonal treatments that can both activate and inactivate estrogen in different tissues. Ospemifine (Osphena) is a SERM that acts like estrogen on tissues of the vagina to improve dryness and pain without increasing breast cancer risks. You need a prescription for this medication, and it’s taken as a pill.e60dc2a1-f33c-4a05-9b50-8e3e8e597629527bdb4c-8b88-48c1-8298-c4dad0beb797 Other Treatments The following can be used as additional or alternative treatments to lubricants, moisturizers, and medications.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f7db7b69-ce71-429c-b42a-78c2a916974b Pelvic Floor Therapy Pelvic floor exercises strengthen muscles that support the bladder and uterus, making them stretchier and preventing urine leaks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f7db7b69-ce71-429c-b42a-78c2a916974b A physical therapist can teach you how to do pelvic floor exercises and you can do them at home. Vaginal Laser Ablation A newer GSM treatment uses a laser or radiofrequency energy to treat the vaginal lining.e60dc2a1-f33c-4a05-9b50-8e3e8e597629603d0f4c-7039-4b1b-807f-38c1736ebbe1 The energy stimulates the production of collagen — a protein that improves skin firmness — and promotes the growth of new tissue. Laser treatment works quickly and it doesn’t use hormones. But while early studies showed that it helped with symptoms like pain during sex, newer research hasn’t found any benefit. Plus, this treatment can cause side effects like scarring and chronic pain. The American Urological Association says there isn’t enough evidence to support the use of laser treatment for GSM, but it may be an option for people who can’t use hormone therapy or who prefer an alternative.e60dc2a1-f33c-4a05-9b50-8e3e8e59762911a6977e-9e5a-411a-bea9-7c5a03fd804e
Lifestyle Changes and Prevention of Genitourinary Syndrome of Menopause Lifestyle Though you can’t prevent GSM, you can manage symptoms and avoid complications like chronic vaginal dryness and repeat UTIs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291907815a-867a-42ec-a113-667318177f77 About 70 percent of people with GSM symptoms don’t report their symptoms to their doctor.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291907815a-867a-42ec-a113-667318177f77 Many are too embarrassed to ask for help or think their symptoms are a normal part of the aging process. Don’t be afraid to speak with your doctor about these symptoms and changes. Your doctor can help you find treatment or suggest lifestyle practices that may help preserve vaginal health. Make Time for Sexual Activity Have safe sex as often as possible.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d79fb99-a660-43d6-a261-2dfd0e1497f5 Penetrative sex increases blood flow to the vagina, maintains a healthy vaginal lining, and stimulates the release of natural lubricants. Sex doesn’t have to involve a partner. Using a device like a vibrator works just as well. Use a Vaginal Dilator A vaginal dilator stretches out the walls of the vagina and makes them more elastic so that sex is more comfortable.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d79fb99-a660-43d6-a261-2dfd0e1497f5 Dilators are sold online and in some stores. A physical therapist or a specialist in sexual medicine can show you how to use it. Quit Smoking People who smoke start menopause earlier and have more severe symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e59762962fff54a-aa05-4008-9897-02f89338ff5fe60dc2a1-f33c-4a05-9b50-8e3e8e5976290f3b4505-3b79-496e-a48b-2a46f8a968a6 Quitting smoking isn’t easy, but tools like nicotine replacement therapy, prescription medicines, and transcranial magnetic stimulation can help reduce the urge to smoke.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bd4aadd-ed3e-4646-a0af-3af24a5fc2aa Avoid Irritants Clean your vagina with only water and gentle soap. Avoid cleansers, douches, bubble baths, and feminine hygiene sprays.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d3e4c31d-c989-49f8-b15f-aa88e636c7ff These products may contain ingredients that irritate sensitive tissues and worsen GSM symptoms like dryness and pain. Stay Hydrated Drink extra fluids, especially water, to prevent urinary symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629784885ae-0376-435d-8d3b-872defe8d993 Avoid sodas and other carbonated beverages , because they can irritate the bladder.e60dc2a1-f33c-4a05-9b50-8e3e8e59762910637a7e-7dae-449a-8fd3-ca56f04c2d4d
Genitourinary Syndrome of Menopause Prognosis Prognosis and Outlook Without treatment, GSM will get worse.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a189c245-cc70-4f7e-ba99-04cd9529cceb See a gynecologist for a diagnosis and get treated early. Relieving GSM symptoms can improve both your quality of life and sex life.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299e238bd8-39a1-4d11-9822-afa9354cdfc3 Over-the-counter vaginal lubricants and moisturizers are often enough to manage mild GSM. Moderate to severe symptoms may require estrogen therapy or other prescription medications.
Complications of Genitourinary Syndrome of Menopause Complications Untreated GSM could lead to complications like chronic vaginal dryness, painful sex, urinary incontinence, repeated UTIs, and other infections.e60dc2a1-f33c-4a05-9b50-8e3e8e597629080ef626-985c-48fd-8893-c9c4782c2532 These problems not only affect day-to-day life, but they can lead to emotional distress and relationship issues.
Related Conditions to Genitourinary Syndrome of Menopause Related Conditions A few conditions often go together with GSM. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762949acda05-002a-4e5e-8b11-e69c5ff90d12 Painful Sex (Dyspareunia) Less lubrication and thinner tissues inside the vagina make sex uncomfortable, and even painful. UTIs A thinner vaginal lining and changes in the pH balance increase the risk for urinary tract infections. Urinary Incontinence A more frequent or urgent need to pee is another problem linked to GSM. Low Libido Having lubrication in the vagina makes sex comfortable. Dryness and thinning tissue cause discomfort that makes some people lose their desire for sex.e60dc2a1-f33c-4a05-9b50-8e3e8e59762927a26739-0d4e-4f21-a400-a5d0875fef7a
Support for Genitourinary Syndrome of Menopause Support The Menopause Society This nonprofit organization is devoted to improving the health of women during menopause. Its website offers information on choosing a doctor and navigating menopause symptoms. Let’s Talk Menopause The aim of this organization is to reduce the stigma surrounding menopause through education. Let’s Talk Menopause empowers women to take control over their symptoms, and offers a support community.
The Takeaway GSM is a collection of symptoms that start during or after menopause and include vaginal dryness, pain, and frequent UTIs. Many women experience GSM during or after menopause, but few see a doctor or get treated for their symptoms. Without treatment, symptoms will gradually get worse. Low-dose estrogen therapy, vaginal lubricants, moisturizers, and lifestyle changes can relieve symptoms and improve quality of life.
Resources We Trust Cleveland Clinic: Vaginal Atrophy Mayo Clinic: Vaginal Atrophy The Menopause Society: Genitourinary Syndrome of Menopause Canadian Urological Association: Genitourinary Syndrome of Menopause Cedars-Sinai: What You Should Know About Genitourinary Syndrome of Menopause
What Is Genitourinary Syndrome of Menopause (GSM)?
