Genitourinary Syndrome of Menopause Treatment
Miami Urologist, Dr. Amy Pearlman, specializes in the diagnosis and treatment of
Genitourinary Syndrome of Menopause (GSM) that many women experience.
What is genitourinary syndrome of menopause?
DR. Amy PEARLMAN EXPLAIns
The loss of estrogen with menopause may impact the genitourinary system in many
ways. Symptoms include bothersome vaginal, vulvar, and urinary symptoms that may
affect quality of life.
What are common symptoms of Genitourinary Syndrome of Menopause?
- Recurrent urinary tract infections
- Urinary urgency or frequency
- Urinary incontinence (leakage)
- Pain with urination
- Vaginal dryness, itching, or burning
- Decreased lubrication
- Diminished orgasm or arousal
- Pain with sexual activity
What to expect with treatment
Treatments may relieve vaginal dryness, discomfort with sexual activity, reduce urinary tract infections, and improve urinary symptoms.
What treatments are available?
There are many choices when it comes to treatment for the genitourinary syndrome of menopause.
Treatments include over-the-counter and prescription medications. For less severe symptoms, vaginal lubricants may help during sexual activity to reduce discomfort and increase pleasure. Vaginal moisturizers may be used on a more regular basis to help maintain moisture. Prescription topical hormonal therapies include low-dose vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), and vaginal testosterone, which address the underlying cause of many symptoms women experience- the lack of vaginal estrogen and testosterone associated with menopause.
Sexual wellness products, including pelvic wands and vibrational devices, may also help with genital tissue arousal, blood flow, and lubrication. Pelvic floor physical therapy with specialized pelvic physical therapists can often be instrumental in providing additional strategies for pelvic floor muscle strengthening and/or relaxation techniques.
Treatment benefits
- Well-tolerated
- Non-invasive
- Minimal risk
FAQ
FREQUENTLY ASKED QUESTIONS
As women get older, the vaginal pH becomes less acidic. When the pH increases, genitourinary symptoms worsen, as does the microbiome, and women are more susceptible to urinary tract infections.
Your vaginal pH can be tested in the office using a cotton swab and pH testing strip. Repeat pH testing during treatment is also helpful to evaluate whether or not topical hormone therapy is effective.
Vaginal hormones acidify the pH to 4.5, which is the target vaginal pH.
Vaginal estradiol restores estrogen levels locally in the vaginal tissues, improving vaginal and vulvar tissue health to help alleviate dryness, itching, pain during
intercourse, and urinary symptoms.
Vaginal hormone therapy targets the vaginal and urinary tissues without significantly affecting systemic hormone levels. Systemic hormone therapy, such as oral or
transdermal options, impacts the entire body and is typically used for broader menopausal symptoms like hot flashes and sleep disturbances.
It is very common for women, even on systemic hormone therapy, to also benefit from vaginal hormone therapy.
Some women don’t like the cream because they can be messy, especially if not completely rubbed into the tissue. In these cases, vaginal inserts may be considered.
Vaginal DHEA (dehydroepiandrosterone) is converted locally into estrogen and testosterone, which may be helpful to improve the genital tissue in cases where topical estradiol isn’t enough. For example, if a woman using topical estradiol continues to have pain with insertion during intercourse, DHEA may be considered. DHEA has also been shown to reduce urinary tract infections by half and improve urinary urgency and frequency.
Yes, topical testosterone may help genital tissue health and would be considered in specific cases, especially when topical estradiol isn’t enough for symptomatic relief.
Vaginal hormone therapy takes 2-3 months for maximal benefit. Consistent application is key to achieving and maintaining benefits.
Yes, periodic follow-ups with a healthcare provider are important to assess symptom improvement, ensure proper application, and monitor for any side effects or complications.
Side effects are rare and typically mild, including localized irritation that may be due to product ingredients or the process of tissue healing (much like a sunburn would initially be irritated with the application of aloe vera). Systemic absorption is minimal, so systemic side effects would be uncommon.
Vaginal estrogen does not increase the risk of cancer recurrence in women with a history of ovarian, uterine, or cervical cancers. Furthermore, research suggests that vaginal estrogen in women with a history of breast cancer is generally safe, as well, though does necessitate a nuanced conversation with a healthcare provider.
There is no increased risk for blood clots with vaginal hormones even in women with a history of blood clots.
There is no harm to the penis as estrogen also plays an important role in the male body.
Well-respected leaders in the menopause space are actively trying to get this black box warning changed as there is no evidence that vaginal hormone therapy poses any of these risks.
CHOOSING THE RIGHT PROVIDER
Dr. Amy Pearlman is a fellowship-trained urologist specializing in sexual health and genital concerns. She takes a patient-centered approach, providing comprehensive care for individuals experiencing genitourinary syndrome of menopause. Dr. Pearlman ensures that all treatment options are thoroughly discussed, helping you create a personalized plan tailored to your unique symptoms, goals, and quality-of-life needs.
