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TACKLING GSM FOR A BETTER MENOPAUSE EXPERIENCE

Menopause is more than just hot flashes and mood swings. There’s a whole realm of changes happening ‘down there’ that deserve to be talked about. No shame here! Let’s dive into the world of menopause and uncover some key actions to staying comfortable, confident, and fabulous through the transition!

As you may know, menopause marks the end of a woman’s reproductive years and is diagnosed after 12 consecutive months without a menstrual period, typically occurring between ages 49 and 521. Some of the more common, and talked about menopause symptoms include hot flashes, night sweats, sleep disturbances and mood swings, all due to hormonal changes. These symptoms can significantly impact daily life and well-being but are manageable with proper support and treatment – so keep reading! The collection of symptoms that are not often talked about are the vaginal changes that can happen with the loss of hormones. Let’s get into it…

Genitourinary Syndrome of Menopause (GSM)

GSM is a collection of signs and symptoms associated with the decreased levels of estrogen and other sex hormones that occur during menopause. These hormonal changes affect the genitourinary tract, including the vulva, vagina, urethra, and bladder. GSM is a comprehensive term that encompasses various symptoms, which can significantly impact a woman’s quality of life. Unlike many of the other menopausal symptoms, vaginal changes tend to be progressive, meaning that they will continue to worsen over time if not treated1. Despite its prevalence, GSM remains under-discussed and often untreated, leading to unnecessary discomfort.

Symptoms associated with GSM are highly prevalent, affecting approximately 27-84% of postmenopausal women.
NAMS 2020

Some people might think they don’t experience vaginal dryness, but upon closer reflection, they realize they’ve been adjusting their lifestyle to cope with the discomfort. Often, people don’t realize they’re only applying a temporary fix and not addressing the root cause. At IRIS, we emphasize understanding and managing these symptoms to enhance your quality of life. It’s not ideal to miss out on your favourite exercise classes or have to change your wardrobe to mitigate pain and discomfort!

Why is GSM Underdiscussed?

Despite the significant impact GSM can have on the quality of life for many menopausal and postmenopausal women, it remains a topic not often talked about – but why?

Stigma and Embarrassment Many people feel uncomfortable discussing intimate issues related to their vulvovaginal health. The stigma surrounding topics like vaginal dryness and urinary incontinence can make women hesitant to bring up their symptoms, even with their healthcare providers. 

Lack of Awareness GSM is still relatively unknown to the general public. Many women are unaware that their symptoms are part of menopause and can be effectively managed. 

Healthcare Provider Conversations Even in the doctor’s office, conversations about GSM can be brief or overlooked. Healthcare providers might focus on other aspects of menopause, not fully addressing the genitourinary symptoms. In a Spanish study, only 11% of participants said their healthcare providers initiated discussions about vulvovaginal symptoms during menopause2. Reflect on your own experience: Have you discussed your vaginal health with your healthcare provider, and if not, what questions could you ask to start that conversation?

Cultural and Societal Norms Cultural attitudes towards aging and menopause often contribute to the silence around GSM. Many societies view menopause as a topic to be quietly endured rather than openly discussed.

Transitioning from understanding why GSM is under-discussed, let’s explore both effective non-hormonal and hormonal treatment options that can help manage these symptoms and improve your quality of life.

Non-Hormonal Treatment Options

Vaginal/Vulvar Moisturizers Moisturizers can be purchased over the counter and can be used alone or alongside other hormonal treatments for GSM. Moisturizers rehydrate vaginal tissue and increase vaginal secretions, changing the hydration of the vaginal cells, and decreasing pH (which will help to maintain moisture and acidity)3. Moisturizers can be used daily for long-lasting discomfort associated with vaginal dryness and the effects should ideally last for 2-3 days. Many vaginal moisturizers will have hyaluronic acid as the main active ingredient because it has a unique ability to bind water molecules and hydrate the skin3. When GSM is mild, hyaluronic acid may be as effective as vaginal estrogen with regards to vaginal atrophy, vaginal pH and painful sex4

💜The IRIS Vulva Moisturizer, which is specifically formulated with hyaluronic acid to bind water molecules and hydrate the skin, is designed to maintain optimal pH balance, providing long-lasting relief from vaginal dryness and discomfort. The ingredients are evidence-based and the product offers an effective, non-hormonal option for managing GSM symptoms.

Laser Therapy Laser therapy is said to work by stimulating the body to repair and heal tissue, thereby regenerating new cells. The lasers operate by targeting various layers of the skin through different wavelengths. Treatments are typically spaced 4-6 weeks apart and can become quite costly. One notable benefit of laser therapy is that it eliminates the need for daily product application.

Vaginal Lubricants Lubricants can support the maintenance of healthy sexual function in people after menopause by reducing pain during intercourse or any type of vaginal penetration. They can be either water, silicone or oil-based and used during intercourse. They are shorter-acting than vaginal moisturizers and should be used only during penetration, whereas a moisturizer should be used daily. Water-based lubricants tend to be favoured because they are the most similar to the body’s natural lubrication, offer easy to clean up and are compatible with condoms, and both silicone dilators and toys. However, water-based lubricants tend to have the most potential to be irritating because of factors such as pH and osmolarity3. The World Health Organization recommends if lubricants are used for vaginal use, then a pH of 4.5 is preferable and osmolarity should not exceed 1200 mOsm/kg 5.

💦 For a water-based option that aligns with these recommendations, consider using the IRIS Personal Lubricant. It is formulated to maintain a pH of 4.5, and an ideal osmolarity, ensuring compatibility with the body’s natural lubrication and reducing the risk of irritation. The IRIS Personal Lubricant not only alleviates pain during intercourse but also provides a gentle, soothing experience for other intimate activities.

Hormonal Treatment Options

For those with more severe and persistent GSM symptoms, prescription therapies may provide more relief. 

Vaginal Hormone Therapy Vaginal estrogen therapy can provide significant relief from vaginal symptoms and can be administered via cream, suppository, or ring6. Examples include Premarin cream, Vagifem, Imvexxy, and Estring. Another option is vaginal Dehydroepiandrosterone (DHEA), a hormone that the body converts into both estrogens and androgens; an example of this is the product Intrarosa. Both vaginal estrogen and vaginal DHEA have been shown to restore vaginal elasticity, reduce vaginal pH, reduce vaginal dryness, and alleviate local discomfort without increasing hormone levels elsewhere in the body6.

Systemic Menopause Hormone Therapy (MHT) Systemic Menopause Hormone Therapy (MHT) involves the use of hormones that benefit the whole body, rather than targeting the vaginal area alone. This therapy is available as oral medications or topical treatments such as creams and patches. Despite its widespread effects, systemic MHT may not alleviate vaginal atrophy symptoms in 10-22% of women, even at higher doses7. For those on systemic MHT for other symptoms of menopause, like hot flashes, adding a vaginal moisturizer or low-dose vaginal hormone therapy can help address persistent vaginal symptoms.

At the end of the day… 

Let’s break the silence and take control of our under-discussed health together! Understanding and addressing Genitourinary Syndrome of Menopause (GSM) is essential for maintaining comfort and confidence during menopause. Despite its prevalence, GSM is often under-discussed due to stigma, lack of awareness, and cultural norms. Effective management includes non-hormonal treatments such as moisturizers, personal lubricants or laser therapy, which provide evidence-based relief, and hormonal treatments like vaginal hormone therapy and systemic MHT. By seeking support from healthcare providers and using effective treatments, you can significantly improve your quality of life during menopause. 

We invite you to follow IRIS for more insights and support. Feel free to ask questions so we can continue our mission to educate on all the topics we didn’t learn in sex ed. Remember, you don’t need to know everything—none of us do. Let’s flourish and bloom together!

Hungry for more learning? Uncover the The Science of Lubes on the IRIS blog.  

Disclaimer: The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. While we strive to provide accurate and up-to-date information, it should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.

References

  1. Koothirezhi, R. & Ranganathan, S. Postmenopausal Syndrome. in StatPearls (StatPearls Publishing, 2021).
  2. Palacios, S., Cancelo, M. J., Branco, C. C., Llaneza, P., Molero, F., & Borrego, R. S. (2017). Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: Symptoms, management and treatment perceptions. Climacteric, 20(1), 55–61. 
  3. Cox, P., & Panay, N. (2023). Non-hormonal treatments for managing vulvovaginal atrophy/genitourinary syndrome of menopause. Climacteric, 26(4), 367–372.
  4. Santos, C. C. M. dos, Uggioni, M. L. R., Colonetti, T., Colonetti, L., Grande, A. J., & Rosa, M. I. D. (2021). Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. The Journal of Sexual Medicine, 18(1), 156–166.
  5. Organization WHO. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360.
  6. 2020 NAMS GSM position statement
  7. Archer, D. F. (2010). Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause, 17(1), 194–203. 

Written by: Dr. Dolores Fernandez, ND, MSCP from IRIS Inc.

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