Genitourinary syndrome of menopause (GSM) is a term that encompasses changes that can happen to the vagina, bladder, vulva and/or clitoris in response to lower levels of estrogen. It is very common; in their 2020 report the North American Menopause Society (NAMS) estimated that GSM affects 27-84% of women post-menopause.

The women’s  vulva, vagina and urinary tract undergo significant changes in menopause due to the lack of estrogen, decreasing collagen, elastin and hyaluronic acid production that happens with age. The result is increased fragility of the tissue, decreased elasticity, vaginal shrinking, changes to vaginal flora (good bacteria) and decreased blood flow to the area. All of these factors contribute to a range of symptoms that can happen as soon as estrogen starts to fall in perimenopause, or years after menopause.

Symptoms of GSM can be variable, including but not limited to:

• Dryness, burning and itching of the vagina and surrounding tissue
• Lack of vaginal lubrication
• Pain or discomfort with vaginal penetration
• Increased urinary frequency and/or urgency
• Frequent urinary tract infections or increase in bladder infections
• Decreased orgasm or arousal
• Irritation of the vulvar and/or perianal skin

The Study of Women’s Health Across the Nation (SWAN) reported that women with sexual dysfunction considered vaginal dryness affected their physical pleasure and emotional satisfaction.

Many women with GSM do not get the care that they need! Many women are dismissed by their providers, “that is normal,” some are embarrassed or ashamed to bring it up, some women ignore it if they are not sexually active, others believe that there is nothing that can be done, and many women and their providers are afraid of estrogen. BUT, all women experiencing changes to their genitourinary tract with age deserve to be assessed and treated.

If you are experiencing symptoms of GSM there are things that you can do to relieve symptoms:

Take care of your vulvar skin

• Don’t use soap! It can be too drying.
• You DO NOT need a vaginal cleaner, or a feminine “odour” product as these can be very damaging to the health of the vagina and vulva.
• Anything used in that area should be gentle and unscented.
• Don’t use baby wipes or antiseptic wipes. Toilet paper only!
• If you are experiencing incontinence, use pads specifically for that, menstrual pads may irritate the skin.
• Do not completely remove pubic hair- trim only, no waxing, sugaring or shaving.

Use a lubricant

• These are only meant for sex- either on your own or with a partner.
• Product chosen matters! STAY AWAY FROM WARMING AND SCENTS
  • Best options are silicone or water based
  • I usually recommend “Good Clean Love- Almost Naked”

Try a long acting vaginal moisturizer

• A vaginal moisturizer is a great non-hormonal option for mild vaginal dryness.
• Very well tolerated, with benefits that can last for a few days.
• I like recommending products that contain hyaluronic acid which is great for hydrating and moisturizing

Local hormone treatments

• Vaginal estrogen is the most effective treatment for GUSM. It increases blood flow to the area, it can improve tissue strength and elasticity, and reverse drying.
  • There are many preparations of vaginal estrogen including creams, intravaginal tablets and rings.
  • It can take up to 6 weeks for this to take full effect
  • There is very limited systemic absorption of estrogen from this application.
• DHEA is another hormonal option approved in both Canada and the US for GSM. DHEA is a hormone that can be transformed into estrogens and androgens in the vagina. This may be an affective option for women who do not respond well to vaginal estrogen. Though this cannot be prescribed by Naturopathic Doctors in Ontario, we are able to advise and advocate for this prescription when indicated.

Systemic Estrogen Therapy

• This is especially useful in women that have other symptoms of menopause as well. Sometimes this is used with local estrogen applications.

GSM is not something that should be ignored. There are treatment options that have been proven to improve the quality of life of women post menopause. If you are looking for comprehensive health care that is going to address all of the changes your body is facing during menopause, book an Alignment Call to find out about The Well Woman Assessment

In health.

Dr. Lisa

References

1. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609
2. Tan O, Bradshaw K, Carr BR. Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review. Menopause N Y N. 2012;19(1):109-117. doi:10.1097/gme.0b013e31821f92df
3. Levine KB, Williams RE, Hartmann KE. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause N Y N. 2008;15(4 Pt 1):661-666. doi:10.1097/gme.0b013e31815a5168
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