GSM
One of the lesser known and discussed complications of menopause is Genitourinary Syndrome of Menopause (GSM). GSM is the drying, thinning, and inflammation of the vaginal walls and bladder. We see the results of this as painful intercourse, increased need to urinate and even incontinence. But did you know that there are actually health consequences that result from these symptoms? Dr. Mary Claire Haver, MD, board certified in obstetrics and gynecology, a leading menopause specialist and author of The Pause Life, educates women on this and other important aspects of menopause. Our summary is below.
The Symptoms of GSM
Vaginal Changes
As our hormone levels decline in perimenopause and menopause, vaginal tissue becomes thinner and loses elasticity. This can result in dryness, itching and burning. You are more likely to notice this during sexual intercourse. Less blood flow and diminished tissue health can lead to decreased sexual arousal and pleasure. Changes in vaginal sensitivity and blood flow to the clitoris and vagina can impact sexual arousal and orgasm. This can influence physical relationships. In addition, changes in vaginal pH increase the chance of getting UTIs.
Urinary Complications
A common symptom of menopause are sudden urges to urinate, frequent urination, (often during the night – nocturia) and accidental leakage of urine. This happens due to the weakening of supportive tissues in your bladder.
Consequences of Untreated GSM
Besides the obvious discomfort related to untreated GSM, there are important health implications. UTIs can lead to serious health complications, especially in older adults. Suffering from recurrent UTIs and simply treating them with antibiotics is not resolving the problem. Frequent use of antibiotics has its own set of ramifications. Beyond the danger from the actual infection are the dangers caused by reoccurring antibiotic use on your body.
What You Can Do
The gold standard treatment for GSM is vaginal estrogen therapy. This is because it treats the root cause of the problem by replacing the hormone you are lacking. There are very few contraindications to the use of vaginal estrogen. A vaginal cream will deliver a low dose of estrogen directly to the vagina, minimizing systemic side effects. This treatment can restore the vaginal pH, thickness, and moisture, thus alleviating dryness, itching, burning, and painful intercourse. It also can lead to reduced UTIs and overactive bladder symptoms.
Are There Other Remedies?
Vaginal moisturizers are designed to be used regularly, not just before sex. The important word here is moisturizer, similar to a moisturizer you apply to your face or body. Use them two to three times a week to keep your vagina moist and healthy. Current evidence suggests finding one that contains hyaluronic acid.
Lubricants are applied just before or during sex (the earlier the better here). These products act rapidly to provide short-term relief from vaginal dryness and related pain.
Dehydroepiandrosterone (DHEA) is a hormone precursor that can be converted to estrogen and testosterone in the body. Some studies show promise for DHEA suppositories in alleviating GSM symptoms, particularly dryness and pain during sex.
Lidocaine: For severe pain during intercourse (this is known as dyspareunia), topical lidocaine has been applied to vulvar affected areas before sexual activity.
Small Lifestyle Changes That Can Help
- Pelvic floor exercises can help strengthen the pelvic floor muscles, improving bladder control and reducing urinary incontinence.
- Maintaining a healthy weight, staying hydrated, and avoiding harsh soaps can all contribute to vaginal and urinary tract health. Choose breathable, organic cotton underwear. And don’t forget to urinate after sex.
- Vitamin D and E, plant-based compounds with estrogen-like effects (soy & fenugreek) and probiotics may offer some relief.