The Changes Down Below: Everything You Need to Know About The Genitourinary Syndrome of Menopause (GSM)

As women move into their 40s and 50s, they often face significant changes in their intimate health. This transitional phase can bring about feelings of uncertainty, as it is filled with various emotions and physical transformations that can disrupt daily life. Many women experience symptoms such as vaginal irritation, discomfort during sex, and frequent urination, leaving them wondering whether these issues are simply a part of aging or if they warrant medical attention.

Understanding these changes is essential. They are often linked to pelvic floor disorders and a decrease in estrogen levels due to perimenopause or menopause. These symptoms all fall under the umbrella of Genitourinary Syndrome of Menopause (GSM). Unfortunately, many women are unaware that what they're experiencing falls under this category, and they may not seek treatment due to feelings of embarrassment or a belief that these changes are "normal."

Fortunately, based on the latest research, the American Urological Association recently developed a guide for doctors. This guide, supported by notable organizations, provides insights from experts like Dr. Rachel Rubin, whom we interviewed on the CTD Podcast. You can listen here, but let's dive into the details in the meantime!

What is Genitourinary Syndrome of Menopause (GSM)?

Genitourinary Syndrome of Menopause (GSM) refers to various urinary and genital symptoms occurring during the menopause transition. This condition affects the vulva, vagina, and bladder. Recent studies indicate that a staggering 50% to 70% of menopausal women report experiencing some form of GSM symptoms. Despite the prevalence, many women shy away from discussing these intimate health issues, often leading to discomfort and reduced quality of life.

Common symptoms of GSM include:

• Vaginal dryness or irritation: Over 87% of women experiencing GSM report these symptoms, which can disrupt daily activities and intimate relationships.

• Pain during intercourse: Many women find it difficult or painful to engage in sexual activities due to decreased lubrication and elasticity.

• Increased urinary urgency or frequency: About 30% of women report a need to urinate often, which can interfere with daily tasks.

• Recurrent urinary tract infections (UTIs): The risk of UTIs can rise due to changes in the urinary tract, affecting up to 30% of women during this stage.

  
  

Recognizing GSM is crucial to addressing these concerns openly and effectively with healthcare professionals.

Why Do These Symptoms Occur?

Menopause triggers a decrease in estrogen levels, which leads to various changes in vaginal and urinary health. The delicate tissues in the vaginal area may become thinner and less elastic, leading to discomfort and heightened risk of injury. This hormonal decline can drastically affect lubrication, which is essential for comfortable sexual experiences.

Beyond hormonal changes, it’s essential to consider factors such as pelvic floor health, mental well-being, and lifestyle choices. Improving these aspects can empower women to reclaim their intimate health and enhance their quality of life.

Overcoming Embarrassment: Seeking Help

Stigma surrounding intimate health issues can prevent women from seeking help. Many feel embarrassed or fear judgment from healthcare providers. However, these symptoms are common. The fact of the matter is that every menopausal person who goes untreated will experience some symptoms associated with GSM.

Talking to friends and family members of the same age who are going through the same thing can be surprisingly empowering, and you'd be surprised how many folks quickly come to the understanding that they are not suffering alone!

What Can You Do?

• Screening and Diagnosis Guidelines: Finding the right kind of doctor can be daunting. I always suggest starting with The Menopause Society, where you can punch in your zip code to find a menopause specialist near you.

  
  

  Your doctor should perform a comprehensive medical exam, obtain your sexual and mental health history, and conduct a genitourinary exam. They should discuss the link between decreased hormone levels and GSM and make recommendations based on your needs and concerns. This may include pharmaceutical intervention, lifestyle change, and mental health support.

  
  

• Hormonal Treatment Guidelines: Doctors should consider prescribing low-dose vaginal estrogen for women experiencing vaginal discomfort, dryness, or painful sex. Those on systemic estrogen (gel, oral, patch etc.) can benefit from low-dose topical estrogen or vaginal DHEA suppositories. For patients with GSM and recurrent urinary tract infections, low-dose vaginal estrogen may reduce infection risk. Vaginal DHEA or oral ospemifene can also help with dryness and pain. Additionally, low-dose vaginal estrogen can improve an overactive bladder.

  
  

  It's important to recognize that low-dose vaginal estrogen, DHEA, and ospemifene do not increase the risks of breast or endometrial cancer. Breast cancer survivors should talk to their healthcare providers to evaluate the risks and benefits of using low-dose vaginal estrogen for genitourinary syndrome of menopause (GSM).

• Non-Hormonal Treatment Guidelines: Doctors should recommend vaginal moisturizers and lubricants for dryness, irritation, or painful intercourse. It's essential to inform patients that supplements lack scientific support for GSM. They should also avoid vaginal washes, deodorants, and cleansing products that may cause irritation. Hyaluronic acid products have received some great feedback!

  
  

• Laser and Radio frequency: Currently, there is no solid evidence that lasers (like CO2 and YAG) or radio frequency treatments effectively address GSM, such as discomfort and dryness. CO2 lasers are considered experimental.

  
  

  Some research suggests red light therapy with a pelvic wand may aid vaginal rejuvenation, but further studies are needed to determine the duration of its effects. So be wary of expensive products like Joy Lux, despite the endorsement of Halle Berry.

  
  

Self-Care Practices

In addition to professional help, incorporating self-care strategies into your daily routine can significantly boost your intimate health. Here are a few practices to consider:

• Stay Hydrated: Drinking enough water not only supports overall health but also helps maintain vaginal lubrication.

  
  

• Use Lubricants: Water-based lubricants or vaginal moisturizers can greatly reduce discomfort during sex, making intimacy more enjoyable.

  
  

• Regular Exercise: Engaging in pelvic floor exercises can enhance bladder control and improve sexual function. Activities like Kegel exercises can strengthen the muscles involved.

Empower Yourself: Take Charge of Your Health

Navigating changes in intimate health during your 40s and 50s can feel overwhelming, but remember: you are not alone. A significant number of women go through similar experiences related to Genitourinary Syndrome of Menopause, yet many choose to remain silent.

Educating yourself about GSM provides clarity and encourages open discussions with healthcare providers. Avoid letting embarrassment prevent you from seeking the support you need. Numerous treatment options are available, and by openly sharing your symptoms and concerns with your doctor, you can develop a personalized plan that enhances your health and well-being.

Starting with the American Urological Association is a great place to begin!

Remember, your intimate health is vital at every stage of life. Addressing these challenges can lead to a more rewarding and comfortable experience during the menopause transition. Always prioritize your well-being—it's never too late to advocate for yourself because you deserve to feel your best at every age!