Read about this condition that causes vaginal and urinary symptoms, often after menopause. It's also called genitourinary syndrome of menopause.
Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause.
For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms. Because the condition causes both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.
Simple, effective treatments for GSM are available. Reduced estrogen levels result in changes to your body, but it doesn't mean you have to live with the discomfort of GSM.
Genitourinary syndrome of menopause (GSM) signs and symptoms may include:
Many postmenopausal women experience GSM. But few seek treatment. Women may be embarrassed to discuss their symptoms with their doctor and may resign themselves to living with these symptoms.
Make an appointment with your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge, burning, or soreness.
Also make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others).
Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.
A drop in estrogen levels may occur:
GSM signs and symptoms may begin to bother you during the years leading up to menopause, or they may not become a problem until several years into menopause. Although the condition is common, not all menopausal women experience GSM. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.
Certain factors may contribute to GSM, such as:
Genitourinary syndrome of menopause increases your risk of:
Regular sexual activity, either with or without a partner, may help prevent genitourinary syndrome of menopause. Sexual activity increases blood flow to your vagina, which helps keep vaginal tissues healthy.
Diagnosis of genitourinary syndrome of menopause (GSM) may involve:
In a pelvic exam, your health care provider inserts two gloved fingers inside your vagina. Pressing down on your abdomen at the same time, your provider can examine your uterus, ovaries and other organs.
To treat genitourinary syndrome of menopause, your doctor may first recommend over-the-counter treatment options, including:
If those options don't ease your symptoms, your doctor may recommend:
Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral estrogen does.
Vaginal estrogen therapy comes in a number of forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.
Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe GSM. It is not approved in women who've had breast cancer or who have a high risk of developing breast cancer.
These vaginal inserts deliver the hormone DHEA directly to the vagina to help ease painful sex. DHEA is a hormone that helps the body produce other hormones, including estrogen. Prasterone is used nightly for moderate to severe vaginal atrophy.
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring. Estrogen taken by mouth enters your entire system. Ask your doctor to explain the risks versus the benefits of oral estrogen, and whether or not you would also need to take another hormone called progestin along with estrogen.
You may use vaginal dilators as a nonhormonal treatment option. Vaginal dilators may also be used in addition to estrogen therapy. These devices stimulate and stretch the vaginal muscles to reverse narrowing of the vagina.
If painful sex is a concern, vaginal dilators may relieve vaginal discomfort by stretching the vagina. They are available without a prescription, but if your symptoms are severe, your doctor may recommend pelvic floor physical therapy and vaginal dilators. Your health care provider or a pelvic physical therapist can teach you how to use vaginal dilators.
Available as a prescription ointment or gel, topical lidocaine can be used to lessen discomfort associated with sexual activity. Apply it five to 10 minutes before you begin sexual activity.
If you have a history of breast cancer, tell your doctor and consider these options:
If you're experiencing vaginal dryness or irritation, you may find relief if you:
Some alternative medicines are used to treat vaginal dryness and irritation associated with menopause, but few approaches are backed by sufficient evidence from clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various alternative treatments for genitourinary syndrome of menopause.
Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The Food and Drug Administration doesn't regulate herbal products, and some may interact with other medications you take, putting your health at risk.
You'll probably start by discussing your symptoms with your primary care provider. If you aren't already seeing a doctor who specializes in women's health (gynecologist or internal medicine women's health specialist), your primary care provider may refer you to one.
To prepare for your appointment:
Some basic questions to ask include:
Your doctor will ask questions about your symptoms and assess your hormonal status. Questions your doctor may ask include: