Women, You Don’t Have to Live with Genitourinary Syndrome of Menopause


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By Rui Wang, MD

Hot flashes, night sweats and brain fog are some of the most common symptoms women associate with menopause and the years leading up to it.

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However, one aspect of menopause that often remains unspoken about is genitourinary syndrome, a collection of symptoms that affect the genitourinary tract.

From vaginal dryness to recurrent infections, genitourinary syndrome of menopause or GSM can make life uncomfortable to downright miserable for many women. 

But it doesn’t have to.

Safe, simple and effective treatments for GSM are available through Penn Medicine Princeton Urogynecology and the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center (PMC).

Understanding Estrogen’s Role

Estrogen is a hormone that plays a critical role in the sexual and reproductive development of women and is vital to maintaining the health of the genitourinary tract, including the vagina, urethra and bladder.

Among its many jobs, estrogen is responsible for:

  • Maintaining the thickness and elasticity of the vaginal lining and folds, which are what enable the vagina to expand and contract to accommodate intercourse and childbirth.
  • Supporting healthy blood flow to the vaginal tissues, ensuring they receive an adequate supply of oxygen and nutrients, which supports lubrication and overall vaginal health.
  • Promoting the production of glycogen, which supports the growth of beneficial bacteria in the vagina.
  • Helping to maintain the slight acidic pH of the vagina, creating an environment that discourages the growth of harmful bacteria.
  • Supporting the health and thickness of the tissues lining the urethra and maintaining the integrity of the connective tissues around the bladder that provide essential support.

Talk to Your Doctor About Symptoms

As women approach menopause, their ovaries produce less estrogen, leading to a range of symptoms associated with GSM. These symptoms include:

  • Vaginal dryness and thinning of vaginal tissues.
  • Decreased lubrication.
  • Painful intercourse.
  • Burning or itching of the vagina.
  • Recurrent urinary tract infections.
  • Urinary incontinence.

According to the North American Menopause Society, symptoms associated with GSM of menopause affect approximately 27% to 84% of postmenopausal women.

And unlike hot flashes and night sweats, which typically subside after a few years, symptoms of GSM tend to get worse with age.

Unfortunately, research indicates that most women do not seek treatment for symptoms of GSM.

If you experience signs of GSM, you are not alone. Talk to your gynecologist and ask about treatment options. 

Simple, Safe and Effective Treatments

Various treatment options are available to address GSM and improve women’s quality of life during and after menopause.

  • Over the counter moisturizers and lubricants. If dryness or painful intercourse are the main concerns, over the counter vaginal moisturizers and lubricants can bring relief. Look for products with hyaluronic acid, which can help restore moisture. For women who are sensitive to commercial products, coconut oil is often recommended as a simple and safe solution.
  • Low-dose, local estrogen therapy. Not to be confused with hormone replacement therapy, local estrogen therapy delivers low doses of estrogen directly to the genitourinary tract, improving moisture and elasticity, strengthening and thickening tissues of the urethra and bladder, and promoting the growth of good bacteria that helps prevent infection.  Low levels of estrogen can be delivered through creams, tablets or rings that are inserted directly into the vagina. Local estrogen therapy has been proven to be safe and effective treatment for most women. Women who have a personal history of breast cancer should consult with their oncologist before beginning local estrogen therapy. 
  • Vaginal laser therapy.  For women who desire an alternative to over-the-counter products and want a non-hormonal treatment approach, vaginal laser therapy may be recommended.  Vaginal laser therapy involves inserting a laser probe into the vagina and rotating it along the vaginal walls to create microscopic burns that stimulate new tissue growth and restore blood supply to the vagina. The procedure is performed in the doctor’s office and typically takes less than five minutes. It is normally painless, though mild stinging may occur. Most women will have three treatments spaced about six weeks apart and then annual treatments to maintain the treatment effect. It is important to note that vaginal laser therapy is typically not covered by insurance.

Menopause is a natural and inevitable phase in a woman’s life, and GSM is more common than many might realize. Women should not be shy about talking to their gynecologist about uncomfortable symptoms such as vaginal dryness or painful intercourse and seeking treatment so they can improve their quality of life during their postmenopausal years.

To find a physician affiliated with Penn Medicine Princeton Urogynecology or for more information about the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center, call (888) 742-7496 or visit www.princetonhcs.org.

Rui Wang, MD, is board certified in obstetrics and gynecology and specializes in urogynecology. She is a member of the medical staff at Penn Medicine Princeton Health.

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