Genitourinary syndrome of menopause
What is Genitourinary syndrome of menopause and why does it matter?
Genitourinary Syndrome of Menopause is a gamut of symptoms that occur during perimenopause and menopause due to a decrease in hormones.
Symptoms include: vaginal dryness, burning, and irritation; lack of lubrication of the vagina with sex, pain with sex, urinary urgency, burning with urination and frequent urinary tract infections
Up until now, we have had no guidelines on how to treat symptoms that are seen in so many women transitioning to menopause. Thanks to the American Urological Association, now we do!
First on the list is low-dose vaginal estrogen cream – It’s cheap, easy to apply and very effective. Think of it as skin care for your vulva and vagina! It increases blood flow and collagen.
Best of all, almost all women can use it:
- All ages
- Safe for breast cancer survivors!
- You can use it along with your estrogen pill or patch
- You can use while on your period
- You don’t need added progesterone if you still have your uterus (it’s low dose and doesn’t increase your risk of endometrial cancer)
- Reoccurring UTI’s? Significantly decreases the incidence
Other options:
- Estradiol inserts
- DHEA inserts (converts to estrogen and testosterone)
- Vaginal rings (replace every 3 months)
- a daily tablet called Ospemifene
These treatments are literally LIFE SAVING! Decreasing UTI’s, especially in those over 65 years old, decreases hospitalizations and death from urosepsis.
Common Questions:
How long does it take to work? Most women see results in 8-12 weeks. It’s rebuilding healthy skin which takes time.
How will it affect my husband when we have sex? Fun fact: after menopause, your husband has more estrogen than you! It will not affect men, even if a little is absorbed through their skin.
What if I’m on my period? Can I still use it? Absolutely!
How can this help with urinary tract infections? With a lack of estrogen, the healthy bacteria, lactobacillus in the vagina dies off and the pH goes up leading to an environment where bacteria can grow.
Low-dose vaginal estrogen also helps to rebuild health tissue, including your labia minor which may slowly disappear in the absence of estrogen. The labia minor protects the vaginal opening and urethra.
Who can’t use vaginal estrogen? Vaginal estrogen should not be used in women with active or a history of a very rare uterine sarcoma but can be used safely in most women with any history of uterine, breast or ovarian cancer.
What if I’m not having sex, do I still need it? Yes! This is about your health and wellbeing. You do not improve your body for any one else.
Shared decision making is key! The benefits are vast but discussion with your provider about the risks and benefits to you is essential. If your provider is not comfortable prescribing low dose vaginal estrogen, I’d recommend directing them to the new guidelines The decision should always be yours!
https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589. https://www.auajournals.org/doi/10.1097/JU.0000000000004589
Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma Chambers, Laura M et al. International Journal of Gynecological Cancer, Volume 30, Issue 4, 515 – 524 https://www.international-journal-of-gynecological-cancer.com/article/S1048-891X(24)00098-7/fulltext