Genitourinary syndrome of menopause: It’s common and treatable

Many menopausal and post-menopausal women experience vaginal dryness and pain that occurs along with the drop in their estrogen levels.

These are symptoms of a common condition called genitourinary syndrome of menopause (GSM), but many women never seek help.

Unlike hot flashes and night sweats, which usually improve over time, GSM may worsen without treatment, says UCI Health urogynecologist Dr. Carly Crowder.

Many women suffer from at least one of these GSM symptoms:

• Vaginal itching or dryness
• Pain during sex
• Urinary tract infections
• Urinary incontinence, urinary frequency or urgency
• Pain during urination

GSM can also result in false abnormal Pap smears. More rarely, Crowder says, the labia may fuse together and close the vagina.

Vaginal pH changes, false Paps

Crowder says the microbiome and pH changes that increase the alkalinity in the vagina during and after menopause can make it a breeding ground for infection, including recurrent urinary tract infections (UTIs)..

“The changes in vaginal pH and the genitourinary microbiome create an environment that is more prone to recurrent UTIs,” she says.

Though the prevalence of false abnormal Pap smears in women with GSM isn’t well documented, a study in The Menopause Journal estimated a 32% prevalence of them, she notes.

Diagnosing and treating GSM

Crowder, who frequently sees patients experiencing these symptoms at UCI Health Urogynecology Services, says a GSM diagnosis also requires characteristic examination findings, such as vaginal atrophy.

But about 50% of women never seek any kind of treatment for GSM, she says. Lack of treatment for UTIs, for example, may lead to more frequent and more difficult to treat infections. The risk for some of the most severe complications of GSM also increases.

One reason for not seeking help, she says, "may be a lack of patient awareness about the benefits of treatment even if they are not sexually active.”

Fortunately, there is treatment. Topical vaginal medications containing estrogen can halt and even reverse many GSM symptoms , Crowder says. They are also effective at preventing further UTIs.

Raising awareness

Crowder calls for more awareness about GSM in the medical community, including increased education about the symptoms of this common syndrome among primary care, internal medicine, infectious disease and geriatric medicine specialists.

“If your physician is hesitant to prescribe vaginal estrogen or if you have concerns about using it, I suggest asking for a referral to a specialist who is comfortable discussing its risks, benefits and possible alternatives based on your specific medical history and symptoms,” she says.

Such specialists include urogynecologists, sexual medicine and menopause specialists, including gynecologists and urologists. Cancer survivors may also want to see an oncologist for guidance.

The most important thing, Crowder says, is that women get the treatment they need for GSM symptoms that affect their health and their quality of life.

“Women shouldn’t needlessly suffer from these common symptoms of menopause.”