Vaginal Atrophy

Your vagina can become thinner, drier, and inflamed when your body produces less estrogen. This is called vaginal atrophy, and it's most common after menopause.

This thinning and dryness often makes sex uncomfortable. It can also lead to problems with your bladder, like needing to pee more often or having painful urination. Doctors sometimes call this combination of vaginal and urinary issues "genitourinary syndrome of menopause" (GSM).

Fortunately, there are simple and effective treatments for GSM. Lower estrogen levels cause changes in your body, but that doesn't mean you have to live with the discomfort. There are ways to manage these symptoms and improve your quality of life.

Women going through menopause sometimes experience a set of symptoms affecting the urinary and genital areas. This is called genitourinary syndrome of menopause (GSM). These symptoms can include:

• Vaginal dryness: The vagina can become less lubricated, leading to a feeling of dryness and discomfort.

• Vaginal burning or itching: These sensations can be irritating and uncomfortable.

• Vaginal discharge: Changes in vaginal discharge are common. This could be different in amount or consistency.

• Painful urination (dysuria): Burning or stinging when urinating.

• Frequent urination: Needing to urinate more often than usual, especially at night.

• Urgent need to urinate: Feeling a sudden, strong need to urinate.

• Urinary tract infections (UTIs): Women experiencing GSM may be more prone to UTIs due to the changes in the urinary tract.

• Urinary incontinence: This is the involuntary loss of urine. It can be a leak or a sudden urge to urinate.

• Light bleeding after sex (postcoital bleeding): This is bleeding that happens after sexual intercourse.

• Discomfort during sex: Vaginal dryness and other GSM symptoms can make sex painful or uncomfortable.

• Reduced vaginal lubrication: The vagina naturally produces less lubrication during sexual activity, which can make sex uncomfortable.

• Changes in the vagina's size and shape: The vaginal canal might become shorter and tighter, which can also affect sexual comfort.

These symptoms are common in menopausal women, and there are treatments available to help manage them. If you are experiencing these issues, talk to your doctor.

Many women going through menopause experience genitourinary syndrome of the menopause (GSM). This means they may have changes in their vaginal area. Unfortunately, many women don't get help for these issues. They might feel uncomfortable talking to their doctor about it and just put up with the symptoms.

It's important to talk to your doctor if you notice any unusual vaginal bleeding or spotting, unusual discharge, burning, or pain in the vaginal area.

Also, if you're having painful sex that isn't helped by using a vaginal moisturizer (like K-Y Liquibeads, Replens, or Sliquid) or a water-based lubricant (like Astroglide, K-Y Jelly, or Sliquid), schedule an appointment with your doctor. These products can help some women, but if the pain persists, it's essential to get checked out.

Menopause can cause a condition called Genitourinary Syndrome of Menopause (GSM). This happens because your body produces less estrogen. Lower estrogen levels make the tissues in your vagina thinner, drier, less stretchy, and more easily damaged.

This drop in estrogen can happen for several reasons:

• After menopause: This is the most common time for GSM to develop.
• During perimenopause: The time leading up to menopause, when estrogen levels start to change.
• After having both ovaries removed: This is sometimes called surgical menopause.
• While breastfeeding: Changes in hormones during breastfeeding can also affect estrogen levels.
• From certain medications: Some birth control pills and other medications can impact estrogen production.
• After cancer treatments: Radiation therapy to the pelvic area or chemotherapy can sometimes lower estrogen levels.
• As a side effect of breast cancer treatment: Some breast cancer treatments can also affect estrogen levels.

Symptoms of GSM might start during perimenopause, or they might not appear for a while after menopause. It's a common problem, but not everyone going through menopause experiences it.

Staying sexually active, whether with a partner or not, can help keep your vaginal tissues healthy. Regular sexual activity can help maintain good elasticity and moisture in the vagina.

Several things might play a role in developing genitourinary syndrome of menopause (GSM). GSM is a collection of symptoms affecting the vagina and surrounding areas, often related to menopause.

• Smoking: Smoking can harm your blood flow. This means less blood and oxygen reach the vagina and nearby tissues. Smoking also reduces the amount of estrogen your body naturally produces. Estrogen helps keep the vagina healthy and flexible. Less estrogen can make the vagina drier, thinner, and less elastic.

• No vaginal deliveries: Studies have shown that women who haven't had a vaginal birth are more likely to experience GSM symptoms than women who have. Vaginal delivery can help keep the vaginal tissues strong and healthy. The stretching and changes during labor and delivery can make a difference.

• Lack of sexual activity: Having sex, whether with a partner or solo, helps increase blood flow to the vagina. This increased blood flow helps keep the vaginal tissues healthy and flexible. Regular sexual activity can help maintain the natural elasticity and moisture of the vaginal area.

Menopause can affect your urinary and genital health. This is often called Genitourinary Syndrome of Menopause (GSM). GSM happens because of changes in your body during menopause, especially a drop in estrogen. These changes can lead to some common problems:

• Vaginal Infections: The natural balance of acidity in your vagina is affected by menopause. This altered balance makes it easier for bacteria or yeast to grow, increasing your risk of vaginal infections. These infections can cause discomfort, itching, and discharge.

• Urinary Issues: Menopause also affects the urinary system. The changes can lead to more frequent or urgent urination, a burning sensation when you urinate, and even urinary tract infections (UTIs). Some women may also experience leaking urine, a condition called incontinence.

Having sex, whether with a partner or alone, might help prevent problems related to menopause, like vaginal dryness and discomfort. Sexual activity boosts blood flow to the vagina. This increased blood flow helps keep the vaginal tissues healthy and strong. Regular activity can therefore potentially lessen the symptoms associated with a decrease in estrogen during menopause.

Checking for Genitourinary Syndrome of Menopause (GSM)

Doctors use several methods to diagnose Genitourinary Syndrome of Menopause (GSM), a group of symptoms related to changes in the female reproductive system after menopause. These symptoms can include vaginal dryness, pain during sex, and urinary problems. Here's how doctors typically diagnose GSM:

Pelvic Exam: A healthcare provider will gently insert two gloved fingers into your vagina while simultaneously pressing on your abdomen. This allows them to examine your uterus, ovaries, and other pelvic organs. During this exam, they will also visually inspect the external genitals, vagina, and cervix. This helps them identify any physical changes that might be related to GSM.

Urine Test: If you're experiencing urinary problems such as frequent urination, painful urination, or urinary tract infections, a urine test may be part of the diagnosis. A sample of your urine is collected and tested to check for signs of infection or other issues.

Vaginal Acid Balance Test: Sometimes, a doctor might check the acidity level of your vaginal fluids. This is done by taking a sample of vaginal discharge or using a special paper strip that changes color to indicate the pH level. The vagina's natural acidity helps protect against infection. Changes in this balance can be a sign of GSM.

In short, diagnosing GSM involves a physical examination of your pelvic area, a urine test if needed, and potentially a test to check the acidity of your vaginal fluids. These steps help your doctor pinpoint the specific changes happening in your body and develop an appropriate treatment plan.

Dealing with Genitourinary Syndrome of Menopause (GSM)

GSM, a common issue during menopause, can cause vaginal dryness, discomfort, and painful sex. Your doctor might first recommend over-the-counter solutions to ease these symptoms.

Over-the-Counter Options:

• Moisturizers: Products like K-Y Liquibeads, Replens, and Sliquid can help restore moisture to the vaginal area. They may need to be applied a few times a week.
• Lubricants: Water-based lubricants like Astroglide and K-Y Jelly can reduce friction during sex. Look for lubricants without glycerin or warming properties, as these can irritate some women. Avoid petroleum jelly, especially if using condoms, as it can damage latex.

Prescription Options (if OTC solutions aren't enough):

If over-the-counter remedies don't work, your doctor might suggest prescription treatments. It's essential to discuss the risks and benefits of each option with your doctor.

• Vaginal Estrogen: This is a very effective treatment for GSM. Vaginal estrogen comes in various forms, and they all work similarly well. It's delivered directly to the vagina, so it's more targeted than oral estrogen and has fewer side effects. Forms include creams (Estrace, Premarin), suppositories (Imvexxy), rings (Estring, Femring), and tablets (Vagifem). The frequency of application varies depending on the form and your specific needs.

• Vaginal DHEA (Prasterone): This hormone helps the body produce estrogen. It's a direct treatment for vaginal atrophy. This is typically used nightly.

• Oral Estrogen (if needed): Sometimes, if vaginal dryness is part of a larger array of menopausal symptoms like hot flashes, oral estrogen (pills, patches, gel, or higher-dose ring) might be necessary. Your doctor will help you understand the potential risks and benefits, and whether you'll need progestin too. Oral estrogen affects the whole body.

• Vaginal Dilators: These are non-hormonal devices that gently stretch the vaginal muscles to improve flexibility and reduce discomfort during sex. They can be used alone or alongside estrogen therapy. A pelvic floor physical therapist can teach you how to use them properly.

• Topical Lidocaine: This numbing cream can lessen discomfort during sexual activity. Apply it 5-10 minutes before intercourse.

Important Considerations for Women with a History of Breast Cancer:

If you have a history of breast cancer, discuss your treatment options with your doctor and oncologist (cancer specialist).

• Vaginal estrogen: Low-dose vaginal estrogen might be considered if other options don't work, but there's a slight concern about a potential link to breast cancer recurrence, especially if your cancer was hormone-sensitive. Your oncologist will help you weigh the pros and cons.
• Systemic estrogen (oral, patches, etc.): This is generally not recommended for women with a history of hormone-sensitive breast cancer.

Starting Treatment:

Your doctor will work with you to find the best treatment plan based on your individual needs, symptoms, and medical history. Remember to discuss all your concerns and questions with your doctor.