What is Genito-Urinary Syndrome of Menopause (GSM)?
During menopause, women experience many physical changes caused by a decrease in estrogen and other hormones and the effects of aging. In addition to vasomotor symptoms, sleep disturbances, and mood alterations, menopausal women may experience an increase in vulvo-vaginal symptoms which have traditionally been called vulvovaginal atrophy (VVA) and atrophic vaginitis.
In 2014, the new term genitourinary syndrome of menopause (GSM) was adopted to more accurately describe a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule / introitus, vagina, urethra, and bladder.
How common is GSM?
Menopause-related genitourinary symptoms affect up to 50% of midlife and older women.
What are the symptoms of GSM?
Symptoms associated with GSM may include but is not limited to:
- Genital symptoms of dryness, burning, and irritation;
- Sexual symptoms of lack of lubrication, discomfort or pain, and impaired function;
- Urinary symptoms of urgency, dysuria, and recurrent urinary tract infections.
What are the signs or changes of GSM?
Low levels of circulating estrogen after menopause result in anatomic, physiologic, biologic, and clinical changes in the urogenital tissues affecting labia majora/minora, clitoris, vestibule / introitus, vagina, urethra, and bladder.
Anatomic changes include:
- reduced collagen content and hyalinization, decreased elastin,
- thinning of the epithelium,
- altered appearance and function of smooth muscle cells,
- increased density of connective tissue,
- and fewer blood vessels.
Consequently, the labia minora thin and regress, the introitus retracts, and the hymenal carunculae involute and lose elasticity, often leading to significant entry dyspareunia. The urethral meatus appears prominent relative to the introitus and becomes vulnerable to physical irritation and trauma.
[Image from Jill Jin. JAMA 2017]
Physiologic changes result in:
- reduced vaginal blood flow, diminished lubrication,
- decreased flexibility and elasticity of the vaginal vault,
- decreases in vaginal tissue strength and increased friability
- Epithelial thinning with decreased glycogenated superficial cells leads to changes in vaginal flora and loss of lactobacilli,
increased pH, and a change in the microbiome.
These anatomic and physiologic changes predispose to epithelial damage with vaginal penetrative sexual activity, leading to vaginal pain, burning, fissuring, irritation, and bleeding after sex .
Women suffering from GSM may present with some or all of the signs and symptoms.
When to seek help?
Many women who experience GSM symptoms during menopause
do not see their doctors because they believe it is just a normal part of aging. However, these symptoms can become chronic, progressive, not improve over time.
It is important to be aware that when symptoms are bothersome, treatment is available and can improve quality of life. Also, it is important to seek medical assessment to rule out more serious conditions that can cause vaginal pain, vaginal bleeding as well as urinary symptoms.
What treatments are available to help GSM?
Treatments for GSM include:
- Non-hormone: over-the-counter vaginal lubricants or moisturizers https://yesyesyesaustralia.com.au/
- Hormone options: vaginal or systemic oestrogen
- Mona Lisa laser https://www.monalisatouch.com.au/about-monalisa-touch-vaginal-atrophy-treatment.php