GSM: The Menopause Syndrome Nobody Mentions

What is genitourinary syndrome of menopause?

Genitourinary syndrome of menopause is a group of vaginal, vulvar, and urinary symptoms driven by the drop in estrogen around and after menopause. The tissues of the vulva, vagina, urethra, and bladder all depend on estrogen, so when levels fall they become thinner, drier, and less elastic 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Menopause and sexual-health societies introduced the term GSM in 2014 to replace narrower labels such as vaginal atrophy and atrophic vaginitis 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature.

The newer name matters because it captures the urinary side too. According to the North American Menopause Society, GSM spans genital dryness and irritation, discomfort with sex, and urinary symptoms including urgency and recurrent infections 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Naming the full picture helps women and clinicians treat it as one condition rather than a string of unrelated complaints 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature.

How common is GSM, and why is it under-discussed?

GSM is remarkably common, affecting roughly 1 in 4 to more than 8 in 10 postmenopausal women, yet it is one of the least reported menopause problems 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Surveys find that most affected women never raise it with a clinician, often assuming the changes are an unavoidable part of aging 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Embarrassment and the belief that nothing can help keep the conversation from happening.

That silence has a cost. Unlike hot flashes and night sweats, which tend to ease over time, GSM usually persists or worsens if left untreated 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. According to the North American Menopause Society, effective treatments exist and are underused, largely because the syndrome goes unmentioned 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature2Ref 2Lethaby A, Ayeleke RO, Roberts H (2016).Local oestrogen for vaginal atrophy in postmenopausal women.Systematic review showing local estrogen effectively treats the vaginal tissue changes of GSM, evidence that these symptoms respond well to available treatment. Only a minority of affected women receive any treatment, according to survey data summarized by menopause specialists 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature.

What symptoms fall under GSM?

GSM covers far more than dryness, touching comfort, sex, and bladder function at once. The genital symptoms include vaginal dryness, burning, itching, and thinning tissue, along with discomfort or pain during sex 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature3Ref 3American College of Obstetricians and Gynecologists (2019).Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213.Describes discomfort and pain with sex as part of the genitourinary symptom picture and supports moisturizers, lubricants, and local estrogen among management options. Many women first notice vaginal dryness after menopause or that intimacy has become uncomfortable.

The urinary symptoms are just as real and often overlooked. GSM can bring urinary urgency, frequency, discomfort with urination, and a higher rate of recurrent urinary tract infections 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Because these urinary and genital changes share one cause — estrogen loss — treating the tissue often improves several symptoms together, which is why recognizing the pattern helps 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature3Ref 3American College of Obstetricians and Gynecologists (2019).Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213.Describes discomfort and pain with sex as part of the genitourinary symptom picture and supports moisturizers, lubricants, and local estrogen among management options.

When does GSM start across the menopause transition?

GSM tends to build gradually across the menopause transition rather than arriving overnight. Symptoms are uncommon before perimenopause but can begin as estrogen becomes erratic in a woman's 40s, and they often deepen in the years after the final period 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Because the tissue change is progressive, GSM commonly becomes more noticeable a decade or more into postmenopause 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature.

Estrogen loss from other causes can produce the same picture earlier. Women who enter menopause abruptly through surgery or cancer treatment may develop GSM years ahead of the typical timeline 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. The syndrome reflects low estrogen, whatever the age at which it happens 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature. Because the change is driven by hormones rather than the calendar, two women of the same age can differ widely 1Ref 1The North American Menopause Society (Menopause Society) (2020).The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.Defines genitourinary syndrome of menopause, its introduction in 2014 to replace vaginal atrophy and atrophic vaginitis, its genital and urinary symptom range, prevalence in postmenopausal women, and its progressive, treatable nature.

When GSM symptoms need a menopause clinician

A clinician who treats menopause — a gynecologist, a menopause-focused practitioner, or a primary care clinician — can confirm that symptoms come from GSM rather than an infection or other cause, and can walk through the range of treatments, from non-hormonal moisturizers and lubricants to low-dose vaginal estrogen. Bringing up genital and urinary symptoms together gives the fullest picture, since they often share one cause. Many women are relieved to learn how treatable the syndrome is once it has a name. Gale can help you prepare for that conversation.