Genitourinary Syndrome of Menopause (GSM)
Genitourinary Syndrome of Menopause (GSM) is a common condition that affects many women beginning in perimenopause and beyond. It occurs due to the natural decline in estrogen levels and can cause a range of bothersome symptoms that impact quality of life and sexual health.
GSM is characterized by both physical changes and uncomfortable symptoms. Common signs include thinning and drying of the vaginal and vulvar tissues, as well as changes to the urethra. Women may experience vaginal dryness, burning, irritation, lack of lubrication, pain during intercourse, urinary symptoms, and recurrent urinary tract infections.
The prevalence of GSM is quite high, with estimates ranging from 27% to 84% of postmenopausal women. Many women suffer silently with these symptoms, unaware that effective treatments are available. That's why it's so important to raise awareness about GSM and why we discuss it openly with patients.
Fortunately, there are several evidence-based treatment options for GSM:
Vaginal moisturizers and lubricants: These over-the-counter products can provide relief for milder symptoms. Moisturizers are used regularly to improve vaginal moisture, while lubricants are used during sexual activity to reduce friction and discomfort.
Lifestyle modifications: Avoiding irritants like fragranced products and maintaining sexual activity can help preserve vaginal health.
Pelvic Floor Physiotherapy: Pelvic floor muscle training (PFMT), which is a key component of pelvic floor physiotherapy, has been shown to have several beneficial effects on GSM symptoms. It can improve blood flow in vulvovaginal tissues, enhance pelvic floor muscle relaxation capacity, and increase vulvovaginal tissue elasticity.
Vaginal estrogen: Low-dose vaginal estrogen is considered the gold standard treatment for moderate to severe GSM. It effectively relieves symptoms with minimal systemic absorption. Options include creams, tablets, or rings inserted vaginally.
Vaginal DHEA: Intravaginal dehydroepiandrosterone (DHEA) inserts are another prescription option that can improve symptoms.
Systemic hormone therapy: For women who also have other menopausal symptoms, systemic hormone therapy can alleviate GSM along with hot flashes and other issues.
The most appropriate treatment depends on symptom severity and individual patient factors.
Naturopathic doctors and pelvic floor physiotherapists can play a crucial role in educating women about GSM, validating their concerns, and offering a range of treatment options. By addressing this common but under-recognized condition, we can significantly improve the quality of life and sexual health of postmenopausal women.
