Tackling GSM for a better menopause experience.
*TLDR; Menopause isn't just hot flashes—there's a lot happening 'down there' too! Genitourinary Syndrome of Menopause (GSM) includes symptoms like vaginal dryness that often get overlooked. But don't worry, there are plenty of ways to manage it, from moisturizers to hormone therapy. The key is to talk openly with your healthcare provider and take charge of your vulvar health. Let's break the silence and make menopause a smoother ride! 🚀
*too long didn't read - a quick summary for busy folks.
Menopause is more than just hot flashes and mood swings. Significant changes are happening in the vaginal area that deserve attention. No need for embarrassment here, it’s time to get into the real conversation when it comes to menopause! Let's explore GSM and uncover some essential education to stay comfortable, confident, and informed.
Understanding Menopause and GSM
Menopause marks the end of a woman's reproductive years, diagnosed after 12 consecutive months without a menstrual period, typically occurring between ages 49 and 521. While hot flashes, night sweats, sleep disturbances, and mood swings due to hormonal changes are widely recognized symptoms, the vaginal changes associated with menopause are often overlooked. This collection of symptoms is known as Genitourinary Syndrome of Menopause (GSM).
The Lowdown on GSM
First things first, let’s demystify Genitourinary Syndrome of Menopause (GSM). GSM is a collection of signs and symptoms associated with the decreased levels of estrogen and other sex hormones that occur during menopause. These hormonal changes affect the genitourinary tract, including the vulva, vagina, urethra, and bladder. GSM is a comprehensive term that encompasses various symptoms, which can significantly impact a woman's quality of life. Unlike many of the other menopausal symptoms, vaginal changes tend to be progressive, meaning they will continue to worsen over time if not treated1. Despite its prevalence, GSM remains under-discussed and often untreated, leading to unnecessary discomfort. The time to change that, is NOW - because who has time for unnecessary discomfort?
Symptoms Galore
Here’s a handy graphic to summarize the various symptoms of GSM.
Take a look and ask yourself: Do any of these symptoms look familiar? If you see something that resonates, it might be time to explore further and start a conversation with your healthcare provider.
Genital: Vaginal dryness, irritation, burning, itching, thinning greying pubic hair, decreased vaginal elasticity, tissue fragility, fissures.
Sexual: Loss of libido (decreased arousal, orgasm, and desire), reduced lubrication, bleeding after sex, discomfort or pain during sexual activity, painful orgasm.
Urinary: Urinary urgency and frequency, reccurent UTIs, urethral prolapse, pain with urination, stress/urgency incontinence.
Why GSM is the Elephant in the Room
Despite the significant impact GSM can have on the quality of life for many menopausal and postmenopausal women, it remains a topic not often talked about. But why?
Stigma and Embarrassment: Many people feel uncomfortable discussing intimate issues related to their vulvovaginal health. The stigma surrounding topics like vaginal dryness and urinary incontinence can make women hesitant to bring up their symptoms, even with their healthcare providers. Because, let's face it, talking about dryness is about as fun as discussing tax season.
Lack of Awareness: GSM is still relatively unknown to the general public. Many women are unaware that their symptoms are part of menopause and can be effectively managed. It’s like finding out the secret menu at your favourite café – who knew there were options?!
Healthcare Provider Conversations: Even in the doctor’s office, conversations about GSM can be brief or overlooked. Healthcare providers might focus on other aspects of menopause, not fully addressing the genitourinary symptoms. In a Spanish study, only 11% of participants said their healthcare providers initiated discussions about vulvovaginal symptoms during menopause2.
Reflect on your own experience: Have you discussed your vaginal health with your healthcare provider, and if not, what questions could you ask to start that conversation?
Cultural and Societal Norms: Cultural attitudes towards aging and menopause often contribute to the silence around GSM. Many societies view menopause as a topic to be quietly endured rather than openly discussed. Because apparently, pretending it doesn’t exist makes it go away, right?
Action Plan: Managing GSM
Transitioning from understanding why GSM is under-discussed, let's explore both effective non-hormonal and hormonal treatment options that can help manage these symptoms and improve your quality of life.
Non-Hormonal Treatment Options
Vaginal/Vulvar Moisturizers: Moisturizers can be purchased over the counter and used alone or alongside other hormonal treatments for GSM. They rehydrate vaginal tissue, increase vaginal secretions, change the hydration of the vaginal cells, and decrease pH (which helps maintain moisture and acidity)3. Moisturizers can be used daily for long-lasting discomfort associated with vaginal dryness and the effects should ideally last for 2-3 days. Many vaginal moisturizers contain hyaluronic acid because it has a unique ability to bind water molecules and hydrate the skin3. When GSM is mild, hyaluronic acid may be as effective as vaginal estrogen with regards to vaginal atrophy, vaginal pH, and painful sex4.
💜IRIS Vulva Moisturizer, which is specifically formulated with hyaluronic acid to bind water molecules and hydrate the skin, is designed to maintain optimal pH balance, providing long-lasting relief from vaginal dryness and discomfort. The ingredients are evidence-based and the product offers an effective, non-hormonal option for managing GSM symptoms.
Laser Therapy: Laser therapy is said to work by stimulating the body to repair and heal tissue, thereby regenerating new cells. The lasers operate by targeting various layers of the skin through different wavelengths. Treatments are typically spaced 4-6 weeks apart and can become quite costly. One notable benefit of laser therapy is that it eliminates the need for daily product application.
Vaginal Lubricants: Lubricants can support the maintenance of healthy sexual function in people after menopause by reducing pain during intercourse or any type of vaginal penetration. They can be either water, silicone, or oil-based and used during intercourse. They are shorter-acting than vaginal moisturizers and should be used only during penetration, whereas a moisturizer should be used daily. Water-based lubricants tend to be favoured because they are the most similar to the body’s natural lubrication. They offer easy clean-up and are compatible with condoms, and both silicone dilators and toys. However, water-based lubricants tend to have the most potential to be irritating because of factors such as pH and osmolarity3. The World Health Organization recommends if lubricants are used for vaginal use, then a pH of 4.5 is preferable and osmolarity should not exceed 1200 mOsm/kg5.
💦 For a water-based option that aligns with these recommendations, consider using IRIS Personal Lubricant. It is formulated to maintain a pH of 4.5, and an ideal osmolarity, ensuring compatibility with the body’s natural lubrication and reducing the risk of irritation. IRIS Personal Lubricant not only alleviates pain during intercourse but also provides a gentle, soothing experience for other intimate activities.
Hormonal Treatment Options
For those with more severe and persistent GSM symptoms, prescription therapies may provide more relief.
Vaginal Hormone Therapy: Vaginal estrogen therapy can provide significant relief from vaginal symptoms and can be administered via cream, suppository, or ring6. Examples include Premarin cream, Vagifem, Imvexxy, and Estring. Another option is vaginal Dehydroepiandrosterone (DHEA), a hormone that the body converts into both estrogens and androgens; an example of this is the product Intrarosa. Both vaginal estrogen and vaginal DHEA have been shown to restore vaginal elasticity, reduce vaginal pH, reduce vaginal dryness, and alleviate local discomfort without increasing hormone levels elsewhere in the body6.
Systemic Menopause Hormone Therapy (MHT): Systemic Menopause Hormone Therapy (MHT) involves the use of hormones that benefit the whole body, rather than targeting the vaginal area alone. This therapy is available as oral medications or topical treatments such as creams and patches. Despite its widespread effects, systemic MHT may not alleviate vaginal atrophy symptoms in 10-22% of women, even at higher doses7. For those on systemic MHT for other symptoms of menopause, like hot flashes, adding a vaginal moisturizer or low-dose vaginal hormone therapy can help address persistent vaginal symptoms.
Let’s Make Some Noise
Despite the prevalence of GSM, it often goes undiscussed due to stigma, lack of awareness, and cultural norms. But breaking the silence is the first step towards better health. Here are some tips:
1. Start the Conversation: Reflect on your own experience. Have you discussed your vaginal health with your healthcare provider? If not, what questions could you ask to start that conversation?
2. Stay Informed: Knowledge is power. Understanding your symptoms and the available treatment options can help you make informed decisions about your health.
3. Seek Support: You’re not alone. Many women experience GSM, and there are communities and resources available to offer support and share experiences.
Flourish and Bloom
Understanding and addressing Genitourinary Syndrome of Menopause (GSM) is essential for maintaining comfort and confidence during menopause. By seeking support from healthcare providers and using effective treatments, you can significantly improve your quality of life during menopause.
Feel free to ask questions so we can continue our mission to educate on all the topics we didn't learn in sex ed. Remember, you don't need to know everything—none of us do.
Reflect on your journey: How can you advocate for your health today? Maybe you share your experience with a trusted friend, book a doctor’s appointment or read more to keep learning. We suggest uncovering The Science of Lubes on the IRIS blog.
Disclaimer The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. While we strive to provide accurate and up-to-date information, it should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.
References
Koothirezhi, R. & Ranganathan, S. Postmenopausal Syndrome. in StatPearls (StatPearls Publishing, 2021).
Palacios, S., Cancelo, M. J., Branco, C. C., Llaneza, P., Molero, F., & Borrego, R. S. (2017). Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: Symptoms, management and treatment perceptions. Climacteric, 20(1), 55–61.
Cox, P., & Panay, N. (2023). Non-hormonal treatments for managing vulvovaginal atrophy/genitourinary syndrome of menopause. Climacteric, 26(4), 367–372.
Santos, C. C. M. dos, Uggioni, M. L. R., Colonetti, T., Colonetti, L., Grande, A. J., & Rosa, M. I. D. (2021). Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. The Journal of Sexual Medicine, 18(1), 156–166.
World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360.
2020 NAMS GSM position statement
Archer, D. F. (2010). Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause, 17(1), 194–203.