Understanding Genitourinary Syndrome of Menopause (GSM): Symptoms, Causes, and Treatment Options
As women transition through menopause, hormonal changes can bring about a variety of physical changes. One condition that affects many women but is not always openly discussed is Genitourinary Syndrome of Menopause (GSM). Affecting up to 50% of postmenopausal women (Portman & Gass, 2014), GSM is a chronic and progressive syndrome that encompasses a collection of symptoms involving the vaginal, vulvar, and lower urinary tract.
What Is Genitourinary Syndrome of Menopause (GSM)?
GSM refers to a group of symptoms caused by the decline in oestrogen and other reproductive hormones during menopause. Unlike temporary symptoms like hot flashes, GSM tends to persist and worsen without treatment, significantly impacting a woman’s quality of life.
Common Symptoms of GSM:
- Vaginal Symptoms: Dryness, burning, itching, and pain during intercourse (dyspareunia).
- Urinary Symptoms: Increased frequency, urgency, incontinence, and recurrent urinary tract infections (UTIs).
- Physical Changes: Loss of elasticity and thinning of the vaginal walls, decreased lubrication, and atrophy of vaginal and vulvar tissues.
These symptoms can affect physical comfort, emotional wellbeing, and intimacy. Many women hesitate to discuss these issues, but they are both common and treatable.
What Causes GSM?
The primary cause of GSM is the reduction in oestrogen levels during menopause. Oestrogen plays a key role in maintaining the health and function of the urogenital tissues by:
- Stimulating blood flow to the vaginal and vulvar tissues.
- Maintaining the thickness and elasticity of the vaginal walls.
- Supporting healthy lubrication and the balance of the vaginal microbiome.
When oestrogen levels decline, these protective effects diminish, leading to the symptoms associated with GSM.
How Common Is GSM?
GSM affects an estimated 27% to 84% of postmenopausal women, depending on the population studied and the criteria used to diagnose the condition (Kingsberg et al., 2017). However, less than 25% of affected women seek medical help, often due to embarrassment or the misconception that these symptoms are an inevitable part of aging.
Evidence-Based Treatment Options for GSM
While GSM can significantly impact quality of life, there are a variety of effective treatments available. It’s important to consult a qualified healthcare professional, such as a women’s health physiotherapist or GP, to determine the most appropriate treatment for your needs.
1. Non-Hormonal Treatments
Non-hormonal options can be used as a first-line treatment or for women who cannot use hormonal therapies.
- Vaginal Moisturisers: Used regularly to improve hydration and elasticity of the vaginal tissues.
- Lubricants: Provide temporary relief from dryness and pain during intercourse.
2. Hormonal Treatments
Local oestrogen therapy is considered the gold standard for GSM treatment.
- Vaginal Oestrogen: Delivered via creams, pessaries, or rings, this treatment restores the health of vaginal tissues without affecting systemic hormone levels.
Research demonstrates that local oestrogen therapy can improve vaginal symptoms by 80-90% within 12 weeks of treatment (Naumova & Castelo-Branco, 2018).
3. Pelvic Floor Physiotherapy
A physiotherapist with expertise in women’s health can provide exercises and techniques to support pelvic floor function, and reduce urinary symptoms.
Breaking the Silence Around GSM
It’s crucial to normalise conversations about GSM and empower women to seek help. Left untreated, GSM can significantly affect a woman’s physical and emotional wellbeing, as well as her intimate relationships. By raising awareness and providing access to evidence-based care, we can help women navigate menopause with confidence and comfort.
When to Seek Help
If you’re experiencing symptoms of GSM, don’t hesitate to seek support. A women’s health physiotherapist or GP can guide you through diagnosis and treatment options tailored to your needs. Remember, GSM is common, manageable, and nothing to be ashamed of.
References
1. Kingsberg, S. A., et al. (2017). "Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey." *Journal of Sexual Medicine, 14*(4), 413-424.
2. Naumova, I., & Castelo-Branco, C. (2018). "Current treatment options for postmenopausal vaginal atrophy." *International Journal of Women's Health, 10*, 387-395.
3. Portman, D. J., & Gass, M. L. S. (2014). "Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society." *Climacteric, 17*(5), 557-563.