What is Genitourinary syndrome of menopause?
Genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms, and sexual symptoms, but also urinary symptoms. The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased estrogen level in menopause.
-Ref: Journal of Menopausal Medicine
What causes Genitourinary syndrome of menopause?
A lack of estrogen, due to being post-menopausal. The hypoestrogenic state results in hormonal and anatomical changes in the genitourinary tract.
What are the signs and symptoms of Genitourinary syndrome of menopause?
3 main categories of symptoms:
Urinary:
- Painful urination
- Frequency
- Urgency
- Recurrent UTIs
Sexual:
- Painful penetration
- Decreased lubrication
- Painful orgasm
- Decreased arousal, orgasm, and desire
Vulvar/skin:
- Burning
- Itching
- Dryness
- Irritation
- Chafing
- Decreased elasticity/ Tissue fragility
- Changes in vulvar skin color
- Fissures
What does treatment include? How can physical therapy help?
- Vaginal estrogen is the gold standard because it is safe and effective. You apply cream to your vulva and vagina to give hormones directly to the tissue. This is not systemic. This does require a prescription from your doctor (although in other countries, this is over-the-counter).
- Hormone therapy that is via oral pill, patch, or inserted ring which are all systemic. Estrogen exists all over our bodies, not just in our vulva/vagina. This is an appropriate course of action if you are within a 10 year window of your last period (aka menopause). Please speak with a trusted provider about your specific health history, current symptoms, how it impacts your quality of life, and goals in order to determine if hormone therapy is a good option for you.
- Pelvic Health Physical Therapists can be a great resource to start some of these conversations about estrogen and your vulva tissue health. Ultimately, estrogen is going to resolve a lot of these issues. However, if you have had long-standing pain (with urination, sex, or in your low back and hips), bladder symptoms, or prolapse-related symptoms it is likely that the pelvic floor muscle tissue is in a protective mode and therefore is tight or clenching. This is where pelvic health PT can be helpful, to retrain the muscle tissues to lengthen as well as strengthen in order to restore function and improve wellness.
Resources to learn more about Genitourinary syndrome of menopause:
