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Managing The Symptoms Of Genitourinary Syndrome Of Menopause

Wellness At 50 And Beyond

Genitourinary Syndrome of Menopause (GSM) is a common and often under-discussed condition that affects postmenopausal women. It encompasses a range of symptoms related to the genitourinary tract due to hormonal changes associated with menopause. GSM was formerly referred to as vulvovaginal atrophy or atrophic vaginitis, but the terminology was updated to better reflect the comprehensive impact of the condition on various aspects of the genitourinary system.

During menopause, a woman’s ovaries produce fewer hormones, particularly estrogen and testosterone. This decline begins in the late 30’s and ends with the shutdown of production of estrogen and testosterone by the ovaries in menopause. These dropping levels lead to changes in the vaginal and urinary tissues. The vaginal walls become thinner, less elastic, and more prone to inflammation. There can be shrinking and atrophy of the clitoris resulting in difficulty achieving orgasm. Additionally, there is a decrease in vaginal lubrication, which can result in discomfort, pain, itching, and burning sensations. Urinary symptoms may also arise due to the thinning of the urethral lining, leading to increased frequency of urination, urgency, recurrent urinary tract infections, and even urinary incontinence.

The symptoms of GSM can significantly impact a woman’s quality of life, leading to discomfort during sexual intercourse, reduced sexual desire, and increased vulnerability to urinary tract infections. The end result is that sex (with or without a partner) can be more painful and less satisfying. Further, desire dramatically drops which can lead to couples feeling more like roommates as the sexual aspect of the relationship wanes. These changes can also have psychological and emotional effects, contributing to a decrease in self-esteem and overall well-being as well as relationship issues. 

Hormone Replacement Therapy (HRT), also known as menopausal hormone therapy, is a common approach to managing GSM. It involves hormone optimization, primarily estrogen (and testosterone) and sometimes progesterone, to alleviate the symptoms associated with menopause, including those of the genitourinary tract.

Estrogen therapy is particularly effective in treating GSM as it helps to rejuvenate the vaginal and urinary tissues. By replenishing estrogen levels, the vaginal walls become thicker and more elastic, and the vaginal lining becomes healthier, reducing discomfort, dryness, and pain during intercourse. The clitoris becomes more sensitive and can improve the ability to climax. Estrogen also supports the urethral lining, improving urinary symptoms and can often resolve some forms of incontinence. Testosterone and estrogen further contribute to enhancing sexual desire in addition to the physical changes.

HRT can be administered in various forms, including oral tablets, transdermal patches, gels, creams, and vaginal preparations (creams, tablets, and rings). Subcutaneous pellets, such as the type advocated by the BioTE program have the advantage of consistent levels over time without the need to apply the drug to the skin or ingest orally. Subcutaneous pellets typically replace both estrogen and testosterone and not only treat GSM but also improves bone, cardiovascular, and skin health. 

In summary, Genitourinary Syndrome of Menopause is a multifaceted condition that can significantly impact postmenopausal women’s quality of life and relationships. Hormone Replacement Therapy, estrogen and testosterone, is a common and effective approach to managing the symptoms associated with GSM. However, treatment decisions should be made on an individual basis, considering a woman’s medical history, risk factors and existing measured hormone levels. Open and honest conversations are essential with a doctor, like Dr. Kirk A. Churukian, for selecting the most appropriate treatment strategy, to help women and their partners navigate the challenges of menopause and improve their overall well-being.

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