Everything You Need To Know About Genitourinary Syndrome Of Menopause

One of the biggest repercussions of menopause is something that’s rarely spoken about: genitourinary syndrome of menopause (GSM), once called vaginal atrophy. GSM encompasses a wide range of changes that occur in the labia majora and minora, the clitoris, the vaginal opening and vestibules and the vagina itself, as well as in the urethra and bladder.

Common GSM-related complaints include loss of elasticity, painful sex, dryness, burning, itching and an increased occurrence of urinary tract infections. So what gives? “After menopause, the vagina becomes shorter, it becomes narrower, it becomes thinner, it loses its pleat like a pleated skirt and all of a sudden it becomes very thin and almost rigid,” explains Dr. Christine Derzko, an associate professor of obstetrics and gynecology at the University of Toronto.

Related: Setting The Record Straight On Menopause Hormone Therapy 

The good news is that there are ways to restore the pleat to the skirt, so to speak. Vaginal estrogen (in cream, tablet or ring format) is the gold standard when it comes to reversing GSM symptoms. For a small fraction of the population—including people who have breast cancer—a non-estrogen solution is required. Derzko suggests asking your doctor about prasterone, marketed under the name Intrarosa. “Unlike using estrogen alone, there is no stimulatory effect on the breast or on the uterine lining, so it can be used on cancer patients.”

If, for whatever reason, you’re not comfortable with hormones, there are some specially formulated moisturizers made with hyaluronic acid or silicone that are bio-adhesive. (In other words, they adhere to vaginal tissue and last for several days.) A few words of caution: “Moisturizers tend to be less effective when people have multiple symptoms. They also won’t protect you from bladder infections or loss of elasticity,” notes Dr. Jen Gunter, ob-gyn and author of The Menopause Manifesto. “And they must be used as directed, every three days, so that you’re never missing that coating on the vagina.”

Pelvic-floor therapy can also help—both Derzko and Gunter often recommend it to their meno patients. This type of physiotherapy is aimed at reducing muscle spasms in the pelvic floor and improving control over how these muscles function. “Often, when people describe that ‘shards of glass’ feeling, it’s associated with GSM or tightness in the muscles or both,” explains Gunter. “Estrogen alone won’t be enough to reverse the muscle spasm.”

One treatment to steer clear of, according to both doctors? Laser therapy, such as MonaLisa Touch. It’s costly and has no data-supported proven benefits.

Read more: Everything You Need To Know About Menopause