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Understanding Genitourinary Syndrome of Menopause (GSM)

Genitourinary syndrome of menopause (GSM) is a collection of symptoms affecting the genital and urinary systems that many women experience during and after menopause. These symptoms can include vaginal dryness, pain during intercourse, and urinary discomfort.

What Is GSM?

Around age 50, most women experience menopause—defined as the point 12 months after their final menstrual period. As reproductive function slows and the body produces less estrogen, various physical changes occur throughout the body.

While hot flashes and weight changes are commonly discussed menopausal symptoms, many women also experience significant changes in their genitourinary tract—the system of organs involved in urination and reproduction.

Genitourinary syndrome of menopause (GSM) is the term medical professionals use to describe this specific group of symptoms affecting the genital and urinary systems.

A Relatively New Medical Term

GSM is actually a relatively new medical term, first introduced in 2014. Previously, conditions like vulvovaginal atrophy and atrophic vaginitis were used to describe the physical changes in the vagina during menopause. However, these older terms failed to encompass the full range of symptoms—particularly urinary symptoms—that many women experience.

According to the American Academy of Family Physicians, approximately half of all postmenopausal women experience GSM, making it an extremely common condition.

Common Symptoms of GSM

The symptoms of GSM can be grouped into three main categories:

Vaginal Symptoms

• Vaginal dryness
• Discomfort or itching
• Irritation
• Occasional bleeding
• Decreased elasticity in vaginal tissues

Sexual Symptoms

• Lack of natural lubrication
• Discomfort or pain during intercourse (known as dyspareunia)
• Decreased sexual satisfaction
• Potential avoidance of intimacy due to discomfort

Urinary Symptoms

• Dysuria (burning or painful urination)
• Increased urinary frequency
• Greater urgency to urinate
• More frequent urinary tract infections (UTIs)
• Mild urinary incontinence

It's important to understand that GSM symptoms are typically progressive, meaning they tend to worsen over time if left untreated, potentially causing increasing discomfort and affecting quality of life.

Treatment Options for GSM

While GSM has no permanent cure, several effective treatments can provide significant relief:

Non-Hormonal Approaches

• Vaginal moisturizers: Regular use can help maintain vaginal moisture and comfort
• Lubricants during sexual activity: Can reduce friction and discomfort
• Regular sexual activity: Helps maintain vaginal health and elasticity
• Avoiding irritants: Fragrance-free soaps and detergents may reduce irritation

Hormonal Treatments

• Local estrogen therapy: Applied directly to affected areas in the form of:
  • Vaginal creams
  • Vaginal tablets
  • Vaginal rings
  • Vaginal suppositories
• Systemic hormone therapy: Oral or transdermal estrogen, which is often prescribed for other menopausal symptoms, may also help alleviate GSM

Discussing GSM With Your Healthcare Provider

Many women find it challenging to discuss GSM symptoms with their healthcare providers, and sometimes providers may be hesitant to bring up the topic. However, these symptoms are completely normal and extremely common during and after menopause.

Being open with your healthcare provider about your symptoms is crucial for receiving appropriate treatment. The earlier GSM is detected and addressed, the more effectively it can be managed.

Remember: You're Not Alone

The bodily changes and symptoms that accompany menopause can be difficult to navigate, but it's important to remember that millions of women share these experiences. GSM affects approximately 50% of postmenopausal women, making it one of the most common menopausal conditions.

With proper medical support and treatment, the symptoms of GSM can be effectively managed, allowing you to maintain comfort and quality of life throughout the menopausal transition and beyond.

If you're experiencing symptoms that might be GSM, consider speaking with a healthcare provider who specializes in menopausal health. Treatment options are available whether you're in perimenopause (the symptomatic phase leading up to menopause) or have already gone through menopause.

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