Genitourinary Syndrome of Menopause

By Parveen Vahora, M.D.

Genitourinary Syndrome of Menopause (GSM) is a term used to describe a collection of symptoms and signs that affect the genital and urinary tracts in postmenopausal women. It is a common condition resulting from the hormonal changes associated with menopause, particularly the decline in estrogen levels. GSM encompasses a range of symptoms and physiological changes that can significantly impact a woman’s quality of life.

Symptoms include but are not limited to the following:
. Vaginal dryness
. Vaginal irritation/burning/itching
. Thinning/graying pubic hair
. Vaginal pelvic pain/pressure
. Sexual Symptoms
. Painful sexual intercourse
. Decreased lubrication during sexual activity
. Bleeding after sexual activity
. Decreased arousal/loss of libido
. Inability to orgasm
. Urinary Symptoms
. Painful urination
. Urinary urgency
. Urinary incontinence (stress and urge)
. Recurrent urinary infections
. Urethral caruncle (red vascular growth on urethra)

GSM was previously described as atrophy, either vaginal or vulvar atrophy. However, Genitourinary syndrome of menopause (GSM) is a more accurate and medically appropriate terminology to describe the changes women experience in menopause.

How is Genitourinary syndrome of menopause (GSM) different from Overactive Bladder (OAB)? Symptoms can overlap in both conditions, but women with OAB tend to experience more urinary incontinence symptoms. Women with GSM tend to experience both vaginal and urinary symptoms together.

What is the difference between Genitourinary syndrome of menopause (GSM) and urinary tract infection (UTI)? Both GSM and UTIs can cause painful urination (dysuria). A UTI is diagnosed via urinary testing that shows inflammation and infection due to abnormal bacterial growth in the urinary tract. GSM tends to cause painful urination when the urine touches the thin vaginal tissue resulting in a burning sensation.

How can we treat GSM?
NON-HORMONAL THERAPY Lifestyle changes (maintenance of sexual activity, smoking cessation, avoidance of vulvovaginal irritants including personal hygiene products in the vulvovaginal area) Nonhormonal vaginal lubricants or moisturizers Mucosal lidocaine (Examples of over-the-counter nonhormonal vaginal moisturizers include Revaree, Replens, Refresh, Good Clean Love, and Luvena)

HORMONAL THERAPY Vaginal estrogen therapy (cream, tablet or ring) Estrogen: A type of hormone that promotes and maintains female traits in the body. Also referred to as a female sex hormone. Non Estrogen – DHEA suppositories (Intrarosa) – DHEA converts to Estrogen, progesterone & testosterone in the pelvic area.

How do vaginal prescriptions/therapy work?
Vaginal estrogen or DHEA is an effective treatment for GSM, however, it may take 3-4 months to see improvement. It improves the quality of the vaginal skin and tissues in and around the vagina. It thickens the skin of the vaginal canal and increases natural lubrication. It also restores the normal pH of the vagina. It has been shown to reduce the risk of UTI in many studies.

Are prescription vaginal estrogen or DHEA therapy safe?
Overall, the answer is yes! Local vaginal hormonal therapy is associated with minimal to no side effects/risks when used as prescribed, as very little is absorbed into the bloodstream. Before prescribing, we will ask you if you have a history of breast cancer or a history of blood clots in the legs or lungs. If you have a history of either of these problems, we may consult your Oncologist or Vascular specialist before prescribing any prescription products. We may also obtain a pelvic ultrasound if you still have your uterus.

Alternative Treatment: Energy-Based Devices Laser treatments have shown significant results with GSM (Genitourinary syndrome of Menopause). The Mona Lisa Touch is a CO2 laser used to revitalize the tissue of the vulva and the vagina. It is an effective treatment for GSM. The Mona Lisa Touch entails three sessions done on the vagina and the vulva several weeks apart. You may be prescribed a topical anesthetic to be used prior to and post-sessions. Please speak to Dr. Vahora to see if you are a candidate for the Mona Lisa Touch.

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DR. PARVEEN S. VAHORA, MD, FACOG: Our practice’s mission is to inspire women to live their best lives by providing compassionate and personalized care. We do everything we can to make you feel as comfortable as possible. For all your women’s health needs, we are here by your side through all phases of life.

Our gynecologist’s office is small, intimate, and welcoming. Women under our care are treated with the utmost respect, which means we offer personalized care, educating them on conditions, treatment options, and preventive measures. Our focus is on sexual health. We are proud to offer the MonaLisa Touch® for patients going through menopause as well as post-menopausal women, breast cancer survivors, and those suffering from pain during intercourse or intense dryness. We also offer genetic testing for breast, ovarian, and colon cancer. From birth control to robotic surgery, we have got you covered.

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9332 State Road 54, Suite 403, Trinity, FL 34655
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