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Conditions & Treatments

Genitourinary Syndrome of Menopause

What is it?

Genitourinary syndrome of menopause (GSM) is a diagnosis that was created to describe the vaginal, sexual and urinary changes associated with menopause. Menopause is defined by the absence of any menstrual period for one year. This happens because the ovaries finally stop producing estrogen. The average age that women begin to experience menopause is 52, and many have symptoms such as sleep disturbance, hot flashes or night sweats, mood changes, as well as genitourinary syndrome of menopause. In fact, about 50% of menopausal women suffer from GSM. Since most women are expected to live a good 20-30 years after menopause, maximizing quality of life during this time should be a priority.

Why does it happen?

Without estrogen, the vaginal lining thins and is not as well lubricated. The blood supply to the walls of the vagina is not as robust, and the delivery of nutrients that keep the cells healthy and well moisturized is no longer as good. We refer to this condition as, “atrophic vaginitis.” Atrophic vaginitis leads to dryness and pain with intercourse, and when the tissue is thin, it can be more prone to small tears, burning and itching. The vaginal environment and lack of estrogen also affect the bladder and urethra. When the vaginal cells are not as healthy, women lose the presence of a good bacteria which helps maintain the normal acidic pH. Without a healthy vaginal microbiome, post-menopausal women can be more susceptible to both vaginal and urinary tract infections. When it comes to the bladder and urethra, post-menopausal women are more susceptible to overactive bladder and urinary leakage, in addition to urinary tract infections.

What can I do about it?

As a certified menopause practitioner, Dr. Kumar can guide you through whether some of the issues you are experiencing may be due to menopause. For symptoms of atrophic vaginitis, topical estrogen therapy is a safe and effective therapy which will restore the normal estrogen effects that the vagina needs and can certainly help with GSM. If you are suffering from other menopausal symptoms as well, Dr. Kumar can discuss non-hormonal options as well as hormone replacement therapy.

Before being diagnosed with GSM, it is very important to have a physical exam to rule out other pathology in the tissue, such as other types of vaginitis, or dermatological problems such as lichen sclerosus or lichen planus. These can occur alongside GSM and may require addition of a topical corticosteroid. There can also be coexisting problems, such as urinary leakage, that are aggravating the irritation to the tissue.

For women who are not comfortable using any hormonal options or for whom hormones are contraindicated, Dr. Kumar will discuss other types of vaginal moisturizers or medications that can help alleviate symptoms. For women with atrophic vaginitis who are not good candidates for topical estrogen, or in whom this therapy has not worked well enough, Mona Lisa Touch laser therapy is a simple office procedure that uses laser energy to regenerate healthy tissue and restore the thickness and elasticity.


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