Understanding Vaginal Atrophy (Genitourinary Syndrome of Menopause - GSM)

Vaginal atrophy is a common condition, especially during and after menopause. Healthcare providers often use the broader term Genitourinary Syndrome of Menopause (GSM) because it affects not just the vagina but often the urinary tract too. Let's explore what this condition is, why it happens, and what it can feel like.

What is Vaginal Atrophy / GSM?

Think of estrogen as a key hormone that helps keep the tissues of the vagina and urinary tract healthy. It keeps them thick, moist, and elastic (stretchy).

During perimenopause and menopause, estrogen levels drop significantly. When this happens, the tissues in the vaginal and lower urinary tract can change:

• They become thinner and more delicate.
• They produce less natural moisture, leading to dryness.
• They lose some of their stretchiness, becoming less elastic.

These changes collectively are known as vaginal atrophy or GSM.

Why Does It Happen During Menopause?

The main reason GSM develops during this life stage is the natural decrease in estrogen production by the ovaries as a woman approaches and goes through menopause. This hormonal shift is the primary trigger for the tissue changes described above.

What Are the Common Symptoms?

GSM can cause a range of symptoms, affecting both the vaginal and urinary areas:

Vaginal Symptoms:

• Vaginal dryness
• Vaginal burning or itching
• Discharge (usually watery or slightly colored)
• Pain or discomfort during sexual intercourse (dyspareunia)
• Light bleeding after intercourse
• A feeling of tightness or shortening of the vagina
• Introital contracture/stenosis (narrowing and tightening of the vaginal opening)
• Reduction in size/fullness of the labia minora (inner lips) and sometimes labia majora (outer lips)

Urinary Symptoms:

• Urinary urgency (sudden, strong need to pee)
• Urinary frequency (needing to pee more often)
• Pain or burning during urination
• Increased risk of urinary tract infections (UTIs)
• Potential worsening of urinary incontinence (leakage)

It's More Than Just Physical Discomfort

These symptoms aren't just minor annoyances. They can significantly impact a woman's quality of life, self-esteem, and intimate relationships. Many women hesitate to discuss these symptoms, but it's important to know they are common and treatable.

Is It Treatable? Finding Help and Advocating for Yourself

Absolutely! Vaginal atrophy/GSM is very treatable, and you don't have to just live with the discomfort. There are many effective options available, including:

• Over-the-counter vaginal moisturizers and lubricants
• Low-dose vaginal estrogen therapies (creams, tablets, rings)
• Other prescription medications

Finding the right support is key. While many healthcare providers are knowledgeable about GSM, some may require prompting or may not immediately suggest all available options. Be prepared to clearly describe your symptoms and how they affect your life. Don't hesitate to ask specific questions about treatments like vaginal estrogen if they aren't offered. Seeking a provider specializing in menopause or women's health, or getting a second opinion, can also be very helpful. Remember, advocating for your own health and comfort is essential to getting the care you deserve.