Updated June 10, 2015.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
The myth that the normal process of aging causes profound physical loss or disability has fueled ageism for eons; a healthy older person has no problem seeing, hearing or thinking. Moreover, many healthy older people still have vigorous libidos and sex lives. In fact, an estimated 56 percent of women who have experienced menopause and are aged 50 to 79 still have sex.
However, in an estimated 50 percent of women, hormonal changes attributable to menopause can lead to vaginal dryness and other symptoms of genitourinary syndrome of menopause (GSM).
Despite the availability and efficacy of local vaginal estrogen therapy (think estrogen creams), only half of those with GSM seek--or are provided--medical help and guidance. Moreover, only half of these women seeking help are satisfied with the guidance or information that they receive, and many discontinue use of estrogen creams. In other words, a breakdown in the system attributable to both patients and providers keeps several million older women suffering from GSM--a condition that is readily treated with estrogen creams and other low-dose vaginal estrogen products.
What is Genitourinary Syndrome of Menopause (GSM)?
According to a 2014 article published in the journal Maturitas:
GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria [painful urination] and recurrent urinary tract infections.
Of note, according to the authors of this study, in order for you to be diagnosed as having GSM, your symptoms must be bothersome and unattributable to another etiology or cause. Moreover, many women with GSM may experience some but not all of these symptoms.
The research on low-dose vaginal estrogen products
While researching this article, I ran across a systematic review titled "Vaginal Estrogen for Genitourinary Syndrome of Menopause" and published in Obstetrics & Gynecology in 2014. Although the study was inherently (and inevitably) limited by the quality and design of the randomized-control trials and prospective comparative studies that it examined, the investigators did an excellent job of analyzing commercially available vaginal estrogen (estrogen creams, estradiol rings and estradiol vaginal tablets).
Ultimately, these researchers suggest the following:
- In women with a single GSM complaint like vaginal dryness, dyspareunia (pain during sex), painful urination and itching or burning, a nonhormonal lubricant or moisturizer may work. However, some of these women may also benefit from vaginal estrogen, too.
- In women with a constellation of GSM symptoms especially urinary symptoms like frequency and incontinence, vaginal estrogen products work.
- The choice of vaginal estrogen cream, tablet, ovule, suppository or ring depends on patient preference.
- Although such estrogen products are generally considered safe, long-term studies need to be done. Thus, a person with a family history and bothersome GSM, must carefully consider estrogen treatment under physician advisement.
- Little is known about ospemifene (used to treat dyspareunia or painful intercourse), compounded vaginal estrogen products, or herbal or natural alternatives.
- Further study is needed.
If you or a loved one suffers from GSM, please meet with an obstetrician-gynecologist to discuss possible treatment. Although in some people with single symptoms of GSM like vaginal dryness, over-the-counter nonhormonal lubricants or moisturizers may help, if you have more extensive symptoms, you may find relief in the form of prescription estrogen products like low-dose estrogen creams and vaginal estrogen rings and suppositories.
Please keep in mind that although such estrogen therapy is generally considered safe, proceed with caution and physician advice if you have a history of breast or endometrial cancer. Of note, we know little about the efficacy or safety of nonprescription estrogen alternatives available for purchase on the Internet so please steer clear of purchasing and applying such products without your physician's input. (If interested in naturopathic alternatives like soy and yam extracts, in addition to a gynecologist, you should also meet with a naturopathic physician.) In other words, let your physician prescribe what is right for you.
Please remember that if you experience vaginal dryness and other symptoms of GSM, there's absolutely nothing to be ashamed of. In many, GSM is a natural process that reflects a normal change in your body's physiology. It's unfortunate that a majority of women with GSM fail to receive the medical attention or advice that they need especially when effective prescription vaginal estrogen treatments are widely available.
To be fair, this dearth of GSM treatment is in large part also attributable to physician providers themselves. For example, for years, the medical community referred to GSM as atrophic vaginitis, an inaccurate term that carries connotes stigma. (Atrophy means wasting away and vaginitis means inflammation.) Additionally, research suggests that many older women feel uncomfortable or embarrassed discussing GSM with younger, female health care providers. Remember that it's a provider's duty and obligation to address GSM in an open, empathetic and constructive fashion. Finally, if you you feel uncomfortable discussion your medical problems with your health care provider, it's a good idea to find a physician who you do feel comfortable. After all, your physician should be an empathetic guide to better health and and advocate for your well being in every way.
Selected Sources
Article titled "Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society" by DJ Portman and MLS Gass published in Maturitas in 2014. Accessed on 3/1/2015.
Article titled "Vaginal Estrogen for Genitourinary Syndrome of Menopause" by DD Rahn and co-authors from Obstetrics & Gynecology published in 2014. Access on 3/1/2015.