Genitourinary Syndrome of Menopause (GSM)

Ever heard of genitourinary syndrome of menopause, or GSM? A lot of women haven’t, despite it affecting between 27 to 84 percent of postmenopausal women. This condition can be uncomfortable, impacting one’s quality of life. However, it is often left untreated with as many as 70 percent of women with symptoms not raising their concerns to their healthcare provider (1). Let’s dive deeper into what this condition is and how its treated.

What is GSM?

GSM is a condition of the urinary and genital systems that is associated with menopause. During menopause, women experience shifts in their hormone levels, specifically a decline in estrogen levels. Estrogen levels can decrease by as much as 95 percent during menopause. This change can have widespread effects throughout the body, including impacts to the vulva, vagina, bladder, and urethra (1).

What are the signs of GSM?

The term GSM was developed to encompass the signs and symptoms associated with these changes to the urinary and genital systems. Common indicators of GSM include:

Vaginal symptoms: These include vaginal irritation, dryness, burning/itching, pelvic pain and pressure, and graying/thinning pubic hair.
Sexual symptoms: These include painful intercourse, libido loss, bleeding after intercourse, low lubrication, and difficulty orgasming.
Urinary symptoms: These include recurrent urinary tract infections, painful urination, and urinary incontinence (2).

Individuals with GSM may experience difficulty with sexual activity because of alterations in the vaginal mucosa, leading to decreased sexual function. Others experience recurrent urinary track infections because of vaginal pH changes and alterations to the vaginal flora.

Vasomotor symptoms such as hot flashes and night sweats are common with menopause, and luckily these usually resolve over time. GSM symptoms, on the other hand, differ in that they tend to be more progressive in nature. Without intervention or treatment, discomfort can continue to persist (1).

How is GSM managed?

There are several ways in which we can manage GSM, including both hormonal and non-hormonal options.

Non-hormonal treatment

First-line therapy for GSM typically includes topical and vaginal lubricants and moisturizers. Lubricants provide short-term comfort, specifically when it comes to combatting vaginal dryness during intercourse. Moisturizers on the other hand provide more long-term relief when used multiple times a week.

Local estrogen therapy

Local estrogen therapy is a hormonal treatment that is used vaginally. It can include intravaginal capsules or tablets, vaginal creams, or a vaginal ring. The aim with this type of treatment is to relieve vaginal atrophy symptoms by increasing estrogen levels.

Systemic hormone therapy

If individuals are experiencing other menopausal symptoms in addition to GSM, systemic hormone therapy might be right for them. Symptoms can significantly improve when treated with estrogen alone or estrogen-progestin formulations, with alleviation occurring in as many as 75 percent of women with GSM.

Other options

Other treatment options include vaginal DHEA, ospemifene, and pelvic floor physical therapy (1).

Conclusion

Think you may be experiencing GSM? For further information, listen our podcast here on GSM and recurrent UTIs and consult your healthcare provider to explore treatment.

References

https://www.ncbi.nlm.nih.gov/books/NBK559297/?utm_source=chatgpt.com
https://www.brighamandwomens.org/obgyn/urogynecology/genitourinary-syndrome-menopause

Author

David J. Bauder, PA-C David Bauder, PA-C, is a certified physician assistant and the assistant medical director at Weight Loss and Vitality in Manassas and Alexandria, Virginia, Washington, DC; and Gaithersburg, MD. He enjoys helping patients optimize their physical and mental health to improve their overall well-being. He earned his physician assistant degree from the University of Texas Health Science Center at San Antonio. Afterward, he gained admission into the reputable graduate program for physician assistant studies at the University of Nebraska Health Science Center in Omaha. David has over 26 years of experience working as a physician assistant. He’s practiced in podiatry, family medicine, emergency medicine, general surgery, urgent care, and functional medicine.