Dr. Heather Hirsch is a Boston-area internist with a large following on social media platforms plus a podcast, Health by Heather. Her work is dedicated to informing and empowering women as they navigate menopause, perimenopause, and post-menopause.
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Recently she shared with her followers that studies show that half of all post-menopausal women suffer from a condition called genitourinary syndrome of menopause (GSM). She believes that it’s actually more prevalent: “If you ask me, 100% of women going through menopause will have GSM.” So what is it? And what can we do about it?
What Is Genitourinary Syndrome Of Menopause?
Estrogen levels start to decline during perimenopause and menopause. The decrease in these levels can cause fluctuations in your skin, hair, and mood.
GSM is yet another symptom caused by estrogen loss. The syndrome is associated with vaginal dryness, painful sex, vaginal burning, painful or difficult urination, discharge, and recurrent urinary tract infections.
Other symptoms of GSM include urinary incontinence, bleeding after intercourse, and shortening and tightening of the vaginal canal. It’s all thanks to declining estrogen, which results in thinning, drying, and inflammation of the vaginal walls.
Diagnosis Of GSM
If you suspect you might have GSM, share your symptoms with your doctor. Your doctor may follow up with a pelvic exam, urine test, and/or an acid balance test.
“When we make estrogen our pH levels are actually a little bit more acidic,” Hirsch said. Meaning a healthy vagina will have a lower pH and will be more naturally acidic. The acid test will check the pH levels of the vagina to tell if it’s more acidic or alkaline.
Why Is GSM Underdiagnosed?
Despite the overwhelming evidence that GSM affects a large percentage of women, the condition is underdiagnosed and underrated.
Some women may believe that these symptoms are inevitable and that there are no treatments available, so they don’t seek medical care. Other women may be embarrassed to discuss the symptoms associated with GSM. And some women don’t realize that their symptoms are correlated with menopause. But suffering in silence isn’t necessary.
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To get treatment and a correct diagnosis, women should speak up about changes during their annual gynecological or primary care appointments. In addition, The North American Menopause Society has suggested that doctors screen all women over 40 for GSM. Because GSM can cause disruption of daily life, a decrease in quality of life, and put a strain on relationships, it’s important to acknowledge these symptoms and seek treatment.
Treatment Of GSM
Lifestyle changes might help you avoid or lessen the severity of GSM. Tobacco use has been linked with earlier menopause and vaginal atrophy, so quitting smoking is a good idea. Wearing cotton underwear and avoiding fragrance-containing products can help avoid vaginal irritation. Hormonal and non-hormonal therapies are also options.
Non-Hormonal
Lubricants can help reduce friction, which could help with discomfort during intercourse. And vaginal moisturizers replace natural vaginal secretions. Lubricants are typically water-based, whereas moisturizers may contain hyaluronic acid or polycarbophil, a gel that promotes hydration. Moisturizers are typically longer lasting than lubricants.
You might also want to seek out over-the-counter options—several companies have sprung up in recent years with non-prescription menopause treatments.
Laser therapy is another treatment for mild-to-moderate GSM. It’s also an option for women who have undergone breast or uterine cancer and others who aren’t able to use hormone therapies. The MonaLisa Touch Laser Therapy is the only FDA-approved laser therapy available in the U.S.
Hormonal
Replacing lost estrogen is another treatment for GSM. Your doctor might prescribe hormone replacement therapy, which can be delivered by rings, tablets, patches, or other methods. A low dose of estrogen can treat the urinary and vaginal symptoms of GSM.
If you think you might be suffering from GSM, make sure to talk to your doctor about your options. From over-the-counter treatments, hormones, and lasers, there’s no reason to suffer in silence.