Menopause and Genitourinary Syndrome

Let’s talk about genitourinary syndrome of menopause (GSM as we will call it). That sounds scary, right??!! Well, it’s not really scary, but a little education can go a long way. So, let’s get to it.

What is GSM?

GSM is a collection of symptoms that can occur during peri-menopause (~10 years leading up to menopause) and into menopause years (12 months after last menstrual cycle and beyond). The symptoms are noted by changes in the vulva, vagina, and lower urinary tract. Symptoms can include:

• Vaginal dryness

• Vaginal itching/burning/irritation

• Pelvic pain/pressure in the vaginal area

• Pain with sexual intercourse

• Decreased lubrication with sexual arousal

• Vaginal bleeding after intercourse

• Inability to orgasm

• Loss of libido

• Recurrent urinary tract infections (UTIs)

• Painful urination

• Urinary urgency

• Increased frequency of urination

• Urinary incontinence

• Urethral caruncle (red vascular growth on urethra)

What causes GSM to occur?

As a natural part of peri-menopause and menopause, the hormone estrogen drops significantly. The tissue of the vulva is highly responsive to estrogen and without sufficient estrogen, the tissue of the vulva can begin to become thin and fragile. With the increase fragility of the tissue in the vulvar area, skin breakdown and infection risk can increase - leading to symptoms of painful urination, UTIs, pain during intercourse, etc. The tissue of the vulva is less supportive without sufficient estrogen, therefore symptoms of urinary incontinence and urinary urgency can increase during this time as well.

What can I do if I’m experiencing these symptoms?

Many women can benefit from talking to their physician about these symptoms and possibly starting a prescription topical estrogen cream to be applied to the vulvar tissue and possibly internally in the vaginal canal. Topical estrogen can be highly effective in treating the symptoms of GSM and comes with much lower risk than using hormone replacement therapy (HRT) to replace estrogen systemically. Talking to your doctor about these options is important.

Outside of hormonal treatments, using an over the counter vaginal moisturizer is a great option as well. Think about our daily skin care routine for our face or how often we moisturize other sensitive skin on our body such as our lips. Our vulvar tissue deserves the same routine care for optimal moisture levels!! Just like we apply a nightly face moisturizer, we should do the same for our vulvar tissue. It is extremely important to use a vaginal moisturizer and not just any old lotion or cream we might have lying around. The skin of the vulva is very sensitive and can react poorly to creams, washes, and other products that are not meant to be used in the vulvar area. Cleaning the vulvar tissue should only involve warm water, as soaps and other products can further “dry” the tissue and cause additional tissue breakdown or irritation.

It is also important to avoid smoking, as this will further decrease blood supply to the vulvar tissue and again contribute to further tissue breakdown.

It is very healthy to maintain sexual intercourse during this time of life, or utilizing vibrators and/or dilators to maintain the vaginal opening. Without insertion, the vaginal opening can start to atrophy or shrink in regards to elasticity. Utilizing appropriate lubrication during insertion is important for comfort and reducing friction to the vaginal tissue that may be more susceptible to irritation.

Seeking help from a pelvic floor physical therapist to help address pelvic floor symptoms is also important. If you are experiencing pelvic pain, urinary or fecal incontinence, urgency or other pelvic floor related symptoms, a pelvic floor physical therapist can help guide your individual recovery from these symptoms.

Don’t let menopause or GSM be scary! Know that there are pelvic floor physical therapists at Shift Physical Therapy to help you overcome these bodily changes and symptoms. We will listen to the individual symptoms you are experiencing and help you get on the right path to feeling well!

Written by: Renee Hancock, Pelvic Floor Specialist, Physical Therapist