Genitourinary Syndrome of Menopause: What You Need to Know

Hot flashes, night sweats, brain fog, mood changes, weight gain—menopause can bring many unexpected (and unpleasant) symptoms. Although menopause technically starts 12 months after a woman’s last period, menopausal symptoms and many of the physical changes associated with menopause can start months if not years earlier.

In addition to some of the most common and well known symptoms of menopause, many women also experience a syndrome called Genitourinary Syndrome of Menopause, or GSM. 

What is Genitourinary Syndrome of Menopause? (AKA "Vaginal Atrophy")

Genitourinary Syndrome of Menopause is far more common that most people imagine – by some estimates it affects up to 45% of postmenopausal women (1). GSM can cause a host of symptoms involving the urinary and reproductive organs, ranging from genital dryness, irritation, and itching to frequent urination, urinary incontinence, and urinary tract infections. Although some doctors may still use terms like ‘vaginal atrophy’ or ‘atrophic vaginitis’ to describe these changes, genitourinary syndrome of menopause, or GSM, is now preferred.

Most if not all of the symptoms of GSM can be attributed to the declining levels of estrogen associated with menopause.

Common GSM Symptoms

Vaginal Symptoms

• Vaginal dryness
• Vaginal burning or itching

Low estrogen levels, which have far-reaching effects throughout the body, cause the walls of the vagina to thin and become less elastic. Also, vaginal secretions that serve as a natural lubricant are produced in much lower quantities following menopause. Vaginal symptoms of GSM, which include vaginal dryness and vaginal burning or itching, are directly related to these physical changes.

Urinary symptoms of GSM, which include burning with urination, frequent and urgent urination, pain during urination, incontinence, and increased susceptibility to urinary tract infections, reflect the impact of low estrogen on the urinary tract, such reduced bladder tone and pelvic floor weakness.

Urinary Symptoms

• Burning with urination
• The urge to urinate frequently
• A strong, sudden urge to urinate 
• Pain during urination
• Urinary tract infections
• Urinary incontinence

Up to 40 to 50% of menopausal women experience incontinence, which can significantly impact daily life.

Products like the Loona Bedside Urinal offer an elegant, practical solution for managing nocturia (the need to urinate repeatedly at night during sleep). Additionally, absorbent underwear is a great way to provide discreet, comfortable protection against leaks, helping you feel comfortable and confident all day long.

Without treatment, GSM symptoms can be disruptive and significantly impact your quality of life. Fortunately, with proper treatment and support there are effective ways to manage them.

Treatments for vaginal symptoms of GSM include topical estrogen therapy, non-hormonal lubricants and moisturizers, vaginal laser therapy to stimulate collagen production, and pelvic floor physical therapy to strengthen surrounding muscles; in severe cases, surgical interventions may be indicated. The best approach to treating GSM should be individualized and determined through a one-on-one consultation with a healthcare provider.

How to Talk to Your Doctor about GSM

If you’re experiencing menopausal symptoms, one of the most important things you can do is talk to your healthcare provider about them. As simple as that sounds, surveys show that it’s not something most women feel comfortable doing. For many women, talking about menopause is still felt to be taboo. 

To get the most out of conversations with your healthcare provider, consider the following tips:

Prepare a List of Symptoms

Before your appointment, jot down all the symptoms you're experiencing, no matter how minor they seem. Include details like when they started, how often they occur, and what seems to trigger or alleviate them.

Do Your Research

Before heading to your doctor’s office, do a bit of homework so you have at least a basic understanding of menopause. A bit of knowledge will go a long way, allowing you to ask more thoughtful questions and get more out of your visit. That being said, remain open to what your doctor has to say. After all, you’re going to them for their expertise and insights.

Be Open and Honest

It's crucial to be frank with your healthcare provider about your symptoms, even if you feel embarrassed. Remember, they are professionals who are there to help you.

Discuss Your Lifestyle

Share details about your lifestyle, including diet, exercise, and stress, as these factors can have a big impact on the way you feel and may be exacerbating your menopausal symptoms.

Ask About All Treatment Options

Inquire about the full range of available treatments for your menopausal symptoms, including medical therapies like hormones and lifestyle modifications. If you are interested in alternative therapies that may be helpful, be sure to ask about those as well.

Look at the Big Picture

Menopause is a phase of life, not a point in time. While it’s important to work with your healthcare provider to manage uncomfortable menopausal symptoms like hot flashes and incontinence, it’s equally important to consider the long-term health consequences that come with this stage of life. Be sure to talk ‘big picture’ with your doctor.

Bring Up Quality of Life Issues

Make sure to discuss how symptoms affect your daily life, including sleep, sexual health, and emotional well-being. This will help your doctor tailor a treatment plan to your specific needs.

Take Notes

During the appointment, take notes or consider bringing someone with you who can help remember exactly what is said.

Ask for Resources

If you are interested in learning more or connecting with others going through menopause, ask your healthcare provider for credible sources of information and support groups.

Plan for Follow-Up

Before leaving the office, schedule any necessary follow-up appointments and ask how you can communicate with your healthcare provider between visits should the need arise.

Remember, your doctor is your partner. By being prepared and proactive, you can help make the most of your healthcare appointments with them.

Key Takeaways

• GSM affects up to 45% of postmenopausal women, causing symptoms like vaginal dryness and irritation, painful intercourse, and urinary issues such as incontinence.
• Declining estrogen and progesterone levels during menopause lead to changes in the vagina and urinary tract.
• Symptoms of GSM can significantly impact quality of life but can be managed effectively with proper treatment.
• If you’re experiencing symptoms of GSM, be sure to have open discussions with your healthcare providers about treatment and management options.

FAQS

Does vaginal atrophy go away on its own?

No. Vaginal atrophy will not improve without treatment. Treatments may include topical estrogen, moisturizers, lubricants, and, in some cases, oral medications to help restore tissue health and relieve symptoms.

Does taking estrogen help with bladder control?

It can. Estrogen plays a role in maintaining the health of the reproductive and urinary tracts. When estrogen levels drop during menopause, it can lead to thinning and weakening of these tissues, contributing to urinary incontinence and other bladder control issues.

Does vitamin D help vaginal symptoms associated with menopause?

Although some studies suggest that vitamin D may be helpful in alleviating vaginal symptoms associated with menopause, additional evidence is needed before any clear conclusions about its effectiveness can be drawn (2).

What are the benefits of using the Loona for GSM?

Waking up to use the bathroom several times a night is common for many postmenopausal women, particularly those experiencing symptoms of GSM. Getting out of bed and walking to the bathroom not only stimulates the nervous system, making it hard to fall back to sleep, it is potentially dangerous as many injuries occur at night on the way to and from the toilet.  Urinating bedside using a portable female urinal offers several benefits: it allows you to fall back to sleep faster and helps protect you against slips, falls, and other middle-of-the–night mishaps.

References

1.Goldstein, Irwin, et al. “Multidisciplinary Overview of Vaginal Atrophy and Associated Genitourinary Symptoms in Postmenopausal Women.” Sexual Medicine, U.S. National Library of Medicine, Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4184497/. 

2. Riazi, Hedyeh, et al. “Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review.” J Menopausal Med. 2019 Dec; 25(3): 109-16. https://pubmed.ncbi.nlm.nih.gov/32307935/