Genitourinary Syndrome of Menopause
Jul 23, 2022By Kim Vopni, The Vagina Coach — Certified Pelvic Floor Fitness Specialist · Published July 23, 2022
Genitourinary syndrome of menopause (GSM) is also known as vulvovaginal atrophy or atrophic vaginitis. It is caused by a decrease in estrogen production.
Direct Answer
Genitourinary syndrome of menopause (GSM) is a chronic, progressive condition caused by declining estrogen that thins vaginal tissue and weakens pelvic floor muscles, leading to dryness, pain during sex, and urinary symptoms. Nearly 60% of menopausal women experience GSM, and both hormonal and non-hormonal treatments, along with pelvic floor physiotherapy, can effectively manage symptoms.
Key Takeaways
- GSM affects up to 60% of menopausal women, though many don't report it due to embarrassment.
- Symptoms include vaginal dryness, painful sex, and urinary urgency, incontinence, or recurrent UTIs.
- Non-hormonal moisturizers/lubricants and hormonal therapies (vaginal estriol, estradiol, MHT) are both effective options.
- A pelvic floor physiotherapist can assess and treat pelvic floor dysfunction contributing to symptoms.
This condition is progressive and may affect many aspects of a woman's physical, emotional, and sexual health.
As women face menopause, our ovaries begin to reduce the production of estrogen, leading to thinning of their vaginal tissue and weakening of the muscles of the pelvic floor, which are important in supporting the organs of the pelvis and maintaining continence, and the tissues of the vagina, vulva, urethra, and bladder. This leads to the onset of symptoms of Genitourinary Syndrome.
Symptoms
The symptoms of GSM include vaginal dryness, burning, and itching. There may be a loss of libido, pain during or after intercourse (dyspareunia) on entry, within the vagina or deep in the pelvis, and sexual dysfunction of arousal and orgasm. Bleeding or spotting may occur during or after intercourse.
You may also experience painful urination (dysuria), urinary urgency, urinary incontinence, and recurrent urinary tract infections.
It is estimated that nearly 60% of women in menopause experience GSM, but most of these women do not bring up this concern with their health care provider, commonly due to embarrassment.
Pub Med Article - What Is Genitourinary Syndrome of Menopause
You should not feel embarrassed or ashamed to ask for help because getting treatment will improve your overall quality of life. If this is something you find difficult to discuss with your family doctor, reach out to a pelvic floor physiotherapist trained to assess and rehabilitate pelvic floor dysfunction and understand the anatomy of the entire body. They can perform an examination to identify any GSM symptoms that may be impacting your quality of life and sexual function.
Key Points
- GSM is very common as women experience menopause.
- Symptoms have an impact on quality of life and sexual function.
- Women are often embarrassed to discuss concerns with their doctors.
- Examination of the vulva and vagina will provide appropriate treatments.
- Non-hormonal and hormonal therapies are available.
- A multidisciplinary team improves outcomes and quality of life
Treatments
Non-hormonal therapies include personal lubricants and vaginal moisturizers, effective in relieving discomfort, friction, and pain with penetrative sex. Lubricants are used at the time of intercourse, whereas vaginal moisturizers provide longer-term relief.
Hormonal therapies include vaginal estriol cream or pessaries, vaginal estradiol tablets, or menopausal hormone therapy. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks.
For pelvic floor dysfunction, pelvic pain or urinary symptoms, referral to a pelvic floor physiotherapist for pelvic floor training and relaxation will help to reduce symptoms.
Pub med Pelvic Floor Muscle Training as a treatment for GSM
Programs
Our Kegel and pelvic floor exercise programs have been designed to give you the tools to overcome incontinence, prolapse and pelvic pain. Build strength and confidence with exercise and lifestyle tips that will get you back to living life without the distraction and discomfort of nagging symptoms.
Additional Resource:
Alongside medical treatment for GSM, strengthening your pelvic floor can help ease the urinary urgency, leaking, and discomfort that often accompany this condition. My Buff Muff App offers guided pelvic floor and Kegel exercise programs designed to support you through menopause and beyond.
If you enjoyed this article, you might also like our episode:
Genitourinary Syndrome of Menopause and Other Things with Dr Ardelle Piper
Listen to the episode
FAQ
What is genitourinary syndrome of menopause (GSM)?
GSM, also called vulvovaginal atrophy or atrophic vaginitis, is a decline in estrogen during menopause that thins vaginal tissue and weakens the pelvic floor muscles supporting the vagina, vulva, urethra, and bladder.
How common is GSM?
Nearly 60% of women experience GSM during menopause, though most don't discuss it with their healthcare provider, commonly due to embarrassment.
What are the main symptoms of GSM?
Symptoms include vaginal dryness, burning, itching, pain during or after intercourse, bleeding or spotting, painful urination, urinary urgency, incontinence, and recurrent urinary tract infections.
What treatments are available for GSM?
Non-hormonal options include personal lubricants and vaginal moisturizers. Hormonal therapies include vaginal estriol cream or pessaries, vaginal estradiol tablets, or menopausal hormone therapy (MHT), alongside pelvic floor physiotherapy.
Can pelvic floor physiotherapy help with GSM?
Yes. A pelvic floor physiotherapist can assess and treat pelvic floor dysfunction, pelvic pain, and urinary symptoms related to GSM through targeted training and relaxation techniques.
