Vaginal Dryness and Pain During Menopause? It Could Be GSM—Here’s How To Treat It
From OTC vaginal moisturizers to HRT, see what eases symptoms
If you’re experiencing vaginal discomfort during menopause, you’re far from alone—up to 84 percent of postmenopausal women deal with the issue, according to a study in Menopause. In fact, the changes to your vagina that occur during menopause are so common, they have an official name: genitourinary syndrome of menopause (GSM). The good news? A leading gynecologist says there are effective treatments that can restore your comfort and confidence.
What is genitourinary syndrome of menopause?
To help understand this common but often overlooked condition, we spoke with gynecologist Robin Noble, MD, Chief Medical Officer of Let’s Talk Menopause. She explains that the term genitourinary syndrome of menopause was introduced in 2014 to capture the full range of symptoms women experience, replacing the narrower term vaginal atrophy. “GSM affects not only the vagina, but also the vulva,” Dr. Noble says.
“Declining estrogen levels and decreased blood flow to the vagina and vulva cause the tissue to become thinner and drier,” she says, adding that reduced collagen production can also affect elasticity. “Women may notice that after cycling or exercising, things feel more uncomfortable. Sometimes, even wiping and cleaning themselves can cause discomfort.”
Woman's World Answers
Common GSM symptoms to watch for
Here, Dr. Noble reveals signs of genitourinary syndrome of menopause that women need to know:
- Vaginal dryness
- Irritation similar to that of a yeast infection
- Discomfort or pain during sex
- Changes in discharge or odor
- Itching
- Urinary incontinence
- Urinary frequency
4 treatments to ease symptoms of GSM
If you’ve been diagnosed with genitourinary syndrome of menopause, there are effective treatment options—from drugstore products to prescriptions to increased intimacy—that can help manage your most bothersome symptoms. Here’s what works.
Vaginal estrogen cream
The most all-encompassing remedy for the vast majority of people with GSM is local vaginal estrogen therapy, says Dr. Noble. “It’s easy to apply, resolves most symptoms and it’s minimally absorbed, meaning it won’t increase hormone levels in the blood—even breast cancer survivors can use it without worry.”
Vaginal moisturizer
Dr. Noble recommends experimenting with different textures of vaginal lubricants and moisturizers to prevent vaginal tissues from becoming painfully dry. “A lubricant is going to be a little bit more slippery, alleviating some friction, while a moisturizer might be enough to ease dryness or discomfort.” So if it’s more of a functional issue with intimacy, she adds, a lubricant might be the better option.
One brand she recommends is Replens. “It’s inexpensive, very easy to come by and has been studied in academic journals,” she explains.
Hormone replacement therapy (HRT)
“[HRT] is incredibly helpful for so many symptoms, but if somebody were only complaining about the vaginal symptoms, you can address them with a more limited, focused treatment like estrogen creams or vaginal moisturizers,” says Dr. Noble.
But since HRT (also called system estrogen therapy) gets estrogen to the whole body, that of course includes the vagina and can help ease symptoms of GSM. “It’s very dose-dependent,” she adds. “Some people who are on a pretty low dose of hormone therapy—what we call a systemic dose—may feel relief from other symptoms like hot flashes. But because it’s a low dose, they may still have vaginal symptoms. In that case, they should use the vaginal estrogen cream as well.”
The timing of when you start HRT can also play a role in how effective it is at alleviating GSM. “If someone has been taking a higher, physiologic dose of hormone therapy to get their hormones almost to where they always were to begin with, they probably won’t have any vaginal symptoms,” says Dr. Noble.
But, sometimes, depending on when women start hormone therapy, they may need the extra help from vaginal estrogen creams. “Let’s say someone’s had menopausal symptoms—like hot flashes, sleep issues and joint pain—for two years, and they’re already having vaginal symptoms as well. If they’re on systemic hormone therapy, I’ll often tell them, at least in the beginning, let’s start the vaginal cream too. If they find it a little bit messy and don’t need it, that’s fine. But typically, we need to play catch-up if they’ve experienced these symptoms for a little while.”
Sexual intercourse
“There is some data that regular, penetrative intimacy actually seems to improve some of the symptoms of GSM,” says Dr. Noble. The proof: A new study in Menopause found that women ages 40 to 79 who engaged in regular sexual activity over the past three months reported significantly less vaginal dryness and irritation.
That makes sense, because intimacy and arousal trigger increased blood flow, says Dr. Noble. “If we imagine that people experience declining blood flow and reduced elasticity and collagen, staying sexually active—or even using penetrative toys—can help maintain those functions better than in someone who isn’t engaging in penetrative activity.”
The bottom line on treating GSM
Whether you want a more targeted approach with a vaginal cream, favor a more holistic strategy with systemic hormonal treatments or try a combination of both, you have choices, says Dr. Noble. “I think just reminding people to get more information and individualized care is so important. Do what’s comfortable for you, because you’re the ultimate decision-maker.”
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