What is GSM (Genitourinary Syndrome of Menopause)?

Genitourinary syndrome of menopause (GSM) is a term that describes the various symptoms and signs associated with the decrease in estrogen and other sex steroids that occur during menopause. These changes can affect the vaginal tissue as well as the lower urinary tract. (A wildly outdated term for GSM is “vaginal atrophy” which brings to mind other wildly outdated phrases like “Wow, that mod mini skirt is groovy!” or “She’s the bees knees”.) Modern women with GSM can be be treated with  (DHEA), systemic hormone therapy, and Ospemifene, and can use Emme to track their experiences and remind them to take their pills. 

Symptoms and signs of GSM include:

• Vaginal symptoms:
• Dryness
• Burning
• Irritation
• Dyspareunia (pain during sexual intercourse)
• Post-coital bleeding (bleeding after intercourse)
• Urinary symptoms:
• Urgency (a sudden and strong urge to urinate)
• Dysuria (painful urination)
• Recurrent urinary tract infections (UTIs)
• Urinary incontinence (both stress incontinence, which is leakage of urine during activities that increase intra-abdominal pressure like sneezing or coughing, and urge incontinence, which is leakage of urine following an overwhelming need to urinate)

Diagnosis: A healthcare provider will often diagnose GSM based on a patient's clinical symptoms and physical findings. This might include a pelvic exam, during which the doctor will look for changes in the vaginal and vulvar tissues such as paleness, dryness, and thinning.

Treatment: Treatment aims to alleviate symptoms and can include:

• Topical estrogen therapy: This is the most common treatment for GSM and involves applying estrogen directly to the vaginal tissues. This could be in the form of creams, tablets, or rings.
• Systemic hormone therapy: If a woman has other menopausal symptoms, such as hot flashes, a systemic treatment might be recommended, which could include oral hormone therapy or transdermal patches.
• Over-the-counter products: Lubricants and moisturizers can be used to reduce the symptoms of vaginal dryness and discomfort.
• Vaginal laser treatment and radiofrequency: These treatments aim to stimulate collagen production and rejuvenate the vaginal tissues, although more research is needed to fully determine their long-term efficacy and safety.
• Ospemifene: An oral selective estrogen receptor modulator (SERM) that helps alleviate painful intercourse related to menopause.
• Dehydroepiandrosterone (DHEA): This is a hormone that the body converts to estrogen and testosterone. A vaginal insert version is available for treating painful sex due to menopause.

It's important to consult with a healthcare provider to determine the best treatment approach for GSM, taking into consideration individual symptoms, health history, and personal preferences.