Genitourinary syndrome of menopause (GSM) is when the skin and tissue of the vagina and the vulva change during and after menopause. These tissues can become thin, pale, and dry. The opening of the vagina can get smaller, and the vagina can get shorter when a person does not have sex. The lining inside the vagina can also get less stretchy.
GSM can change the amount of blood flow, secretions, and lubrication in the vagina. It may also cause swelling. Up to 45 out of 100 people in midlife and older may have GSM. Many people do not ask for help, but the symptoms can get worse without treatment.
How is GSM treated?
Treatment depends on your symptoms, level of pain, and your goals. Treatment options may include:
- Vaginal moisturizers that are free or hormones
- Low-dose vaginal estrogen
Some people may feel better after a short period of treatment. If you stop treating GSM, the symptoms may come back.
Vaginal moisturizers:
Using a vaginal moisturizer regularly can help hydrate dry tissue. These products can make the tissue thicker and more flexible, which helps prevent tearing and irritation. You may use them every day or several times each week.
- Sesame oil (Aura Cacia®)
- Coconut oil
- Replens®
- K-Y Silk-E®
- Luvena®
- NeoGyn®
- Hyaluronic acid with moisturizers (Hyalofemme®)
Lubrication:
Lubricants help any act that will penetrate the vagina, such as sex or using vaginal dilators. A silicone-based lubricant works best because it lowers friction, adds moisture, and prevents tearing and irritation.
- Jo Premium®
- Uber Lube®
- KY Silk® or Intrigue®
- ID Millennium®
- Astroglide X®
- Sesame or coconut oil (do not use with latex condoms)
- Good Clean Love®
Vaginal estrogen:
Vaginal estrogen is not the same as hormone replacement therapy (HRT). It should only be used to treat local symptoms, not general symptoms like hot flashes or night sweats. You may use it every night for 1 to 2 weeks, then 2 to 3 times each week.
- Vagifem® (estradiol hemihydrate)
- Estrace® (17 beta-estradiol/plant based)
- Premarin (conjugated equine estrogens)
- Estring®
Other options:
- Intrarosa: This is a vaginal suppository you can use every day. It is often used before starting estrogen and testosterone. It works inside the cells of the vaginal wall and lowers hormones levels in the whole body.
- Vaginal laser therapy: This can help with GSM, painful sex, and dryness. It can also lower urinary incontinence, frequent peeing, and vaginal infections.
Systemic therapies:
These are used if vaginal treatments do not work, or for people who also have whole-body issues.
- Osphena is a selective estrogen receptor modulator (SERM). This medicine acts like estrogen in the vagina, but blocks estrogen in the breasts. It may cause hot flashes and raises the risk of blood clots and breast cancer. It has not been tested in people who have had breast cancer or are at a higher risk.
- HRT is often used as an estrogen gel or skin patch. This is preferred over taking estrogen by mouth due to its side effects. If you still have your uterus, you may need to take progesterone by mouth to prevent the uterine lining from getting too thick.
Physical therapy (PT):
A pelvic floor physical therapist can help lengthen, retrain, and stretch the muscles and tissues that limit sex acts.
- Some people may have vaginal narrowing (vaginismus) that makes penetration difficult.
- Using lubricated vaginal dilators of different sizes can help keep or restore vaginal function.
- You can start normal sex acts as soon as penetration is comfortable. This will help with your vaginal health.
- Vaginal estrogen may help before starting vaginal stretching or pelvic floor therapy.
Sex therapy and counseling:
Pain with sex or not being able to have sex can cause emotional stress for you or your partner. Even the most supportive and understanding partner may be worried or feel helpless. A sex therapist can support you and help you work through fears, relationship stress, or concerns related to GSM.