Vaginal atrophy (or GSM) isn’t a ‘normal’ side effect of menopause or aging — treatments can help

Vaginal dryness, burning, itching, discomfort with intercourse, vaginal discharge or spotting, increasing trips to the bathroom, discomfort in the urethra and recurrent urinary tract infections are all symptoms associated with genitourinary syndrome of menopause (GSM), sometimes called vaginal atrophy. They’re all symptoms that can gradually worsen over time as female bodies produce less estrogen.

These symptoms also sound pretty uncomfortable, yet studies suggest that up to 70% of people with these issues don’t discuss them with their health care provider. However, when these problems become bothersome and start interfering with your quality of life, it’s time to call a doctor. And since there are a variety of hormonal and non-hormonal treatment options, we shouldn’t chalk these issues up to normal aging.

What’s happening when someone has vaginal atrophy or genitourinary syndrome of menopause (GSM)?

GSM is the thinning of the lining of the vagina, which commonly occurs when reproductive hormones (estrogen) are no longer present. This often occurs after natural menopause, but some people could experience this after ovary removal (surgical menopause), while they’re on certain medical treatments that block estrogen production, with rare tumors that block estrogen production, or while they’re breastfeeding.

Because all bodies with female reproductive systems eventually go through menopause, this condition is extremely common, although not everyone who goes through menopause will be affected. Some studies suggest that anywhere between 50% and 85% of postmenopausal people experience symptoms related to vaginal atrophy.

Can anything prevent vaginal atrophy/GSM?

Avoiding smoking or stopping smoking can help prevent some of the symptoms associated with vaginal atrophy or GSM. Regular sexual activity also can help maintain the elasticity of the vaginal canal and its ability to lubricate, though some may still develop GSM symptoms despite regular intercourse.

Treatments available for vaginal dryness and discomfort

For those with vaginal dryness or discomfort during or outside of sexual intercourse, an option is to use non-hormonal moisturizers two to three times per week, along with using a lubricant during intercourse.

There are a variety of options available, including organic oils, such as coconut oil, and over-the-counter products at drug stores and online retailers. Water-based, oil-based and silicone-based lubricants can be used during sexual activity.

If those don’t provide enough relief of symptoms, then second-line therapies include low-dose hormonal medication with vaginal estrogen. These treatments act directly on the vaginal and urethral tissue to reintroduce the hormone that those tissues are missing, and they can improve the moisture, elasticity and ability to lubricate, similar to when the ovaries were naturally producing estrogen. They come in different formulations, including creams, suppositories, tablets for the vagina and even slow-release rings.

The good news with these hormonal treatments is that, when used as prescribed, the amount of hormone that actually gets into the blood stream is very low, making them a very safe and well-tolerated treatment option.

Other hormonal treatment options for GSM include:

• The oral medication ospemifene, which acts at the vaginal tissue
• Vaginal DHEAS suppositories, which are converted into estrogen at the level of the vaginal tissue
• Testosterone, which would be off-label use of the hormone

These three treatment options require a discussion with a specialist, because they’re not preferred treatments for GSM symptoms, compared to vaginal estrogen.

What if none of those treatments works?

For someone whose body doesn’t respond to any of the above treatments, who has severe symptoms, or who can’t use hormonal therapy, there are newer, vaginal laser or other energy-based devices available for office-based procedures.

These procedures act to stimulate collagen production and improve elasticity in the vagina, which can help with GSM symptoms.

The Food and Drug Administration (FDA) warns against using these devices for “vaginal rejuvenation” as a cosmetic procedure, but there’s emerging evidence that these procedures show promise for improving the quality of life for people suffering from GSM. At The Ohio State University Wexner Medical Center, we have a CO2 laser that can provide this treatment.

Treatments to avoid when it comes to vaginal atrophy or GSM

Douches or any treatments that are heavily fragranced, flavored or colored aren’t recommended. Certain brands of menstrual pads can also irritate the vulva and worsen symptoms.

Who makes a good candidate for vaginal atrophy or GSM treatments?

Anyone born with female reproductive organs and symptoms of GSM can be a good candidate for vaginal moisturizers and lubricants for intercourse. When these don’t alleviate symptoms, it’s time to talk to your health care provider more about whether vaginal estrogen or other therapies might be right for you.