Genitourinary Syndrome of Menopause

Understanding Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM) is a term that encompasses a range of menopausal symptoms affecting the genitourinary tract. Previously referred to as vulvovaginal atrophy, GSM includes changes in the vaginal, vulvar, and lower urinary tract tissues due to decreased estrogen levels. These changes can significantly impact a woman's quality of life, sexual function, and urinary health.

Causes

The primary cause of GSM is the decline in estrogen production associated with menopause. Estrogen plays a critical role in maintaining the elasticity, thickness, and lubrication of the vaginal and urethral tissues. As estrogen levels decrease, the following changes can occur:

  • Vaginal Changes:
    • Thinning of the vaginal epithelium
    • Decreased elasticity and lubrication
    • Increased vaginal pH, leading to changes in the vaginal microbiome and increased infections, including urinary tract infections
  • Urethral and Bladder Changes:
    • Thinning of the urethral lining
    • Reduced urethral closure pressure, contributing to urinary symptoms like urgency and dysuria
  • Vulvar Changes:
    • Decreased fat and collagen in the vulvar tissues, leading to dryness and irritation

Diagnosis

Diagnosing GSM involves a comprehensive approach that includes:

  • Patient History: A detailed medical and sexual history can help identify symptoms associated with GSM, such as vaginal dryness, itching, burning, dyspareunia (painful sex), and urinary symptoms.
  • Physical Examination: A pelvic examination is essential to assess the condition of the vulvovaginal tissues, including any signs of atrophy, irritation, or infection.

Treatment Options

The treatment of GSM aims to alleviate symptoms and improve quality of life. Options include:

  • Non-Hormonal Treatments:
    • Vaginal Moisturizers: Regular use of vaginal moisturizers can help maintain vaginal moisture and elasticity.
    • Vaginal Lubricants: Water-based lubricants can reduce friction and discomfort during intercourse.
  • Hormonal Treatments:
    • Local Estrogen Therapy: Topical estrogen treatments, such as creams, tablets, or rings, can effectively restore vaginal tissue health and alleviate symptoms. They are generally low-dose and have minimal systemic absorption.
    • Systemic Hormone Therapy: In women with additional menopausal symptoms like hot flashes, systemic hormone therapy may be considered, although it requires careful evaluation of risks and benefits.
  • Non-Estrogen Prescription Therapies:
    • Ospemifene: An oral selective estrogen receptor modulator (SERM) that can improve vaginal atrophy symptoms.
    • Prasterone (DHEA): An intravaginal treatment that converts to estrogen and androgen within the vaginal tissues, helping to alleviate GSM symptoms.
  • Lifestyle and Behavioral Interventions:
    • Pelvic Floor Exercises: Strengthening pelvic floor muscles through exercises like Kegels can support urinary function and sexual health.
  • Emerging Therapies:
    • Laser and Radiofrequency Therapy: These newer treatments aim to stimulate collagen production and improve vaginal tissue health, though more research is needed to confirm their long-term efficacy and safety.
  • Patient Education and Support: Educating women about GSM and encouraging open communication with healthcare providers can empower them to seek appropriate care and support.

Genitourinary syndrome of menopause is a common and treatable condition. By understanding its etiology and utilizing a comprehensive diagnostic approach, healthcare providers can offer effective, individualized treatment plans. Please call the Texas Tech Physicians Urology clinic to schedule an appointment to discuss GSM in person with our team.