Menopause has several transitional phases associated with the journey, and it is multifaceted when it comes to individuals, symptoms and their unique experience.  At Coastal Well Woman, our comprehensive approach includes screening and assessment of genitourinary syndrome of menopause (GSM).  Unfortunately, because GSM is not openly discussed or understood, it often goes under-treated. Untreated GSM is not simply a quality of life issue; it increases the risk of developing serious urinary tract (UTI) or kidney infection.

GSM occurs due to estrogen depletion which alters the vaginal epithelium, with distinct impairments in lubrication, elasticity, pH, and blood flow. Basically the vaginal microbiome changes, with increasing pH and the loss of lactobacillus predominance (good bacteria), GSM allows for an environment which is prime for (bad) bacterial overgrowth, which then increases the risk of vaginitis and UTI.  Inversely, vaginal estrogen can reduce vaginitis and UTI risk because it increases predominance of lactobacillus and improves vaginal pH, which rebuilds superficial cells, and increases elasticity and connectivity.

According to research presented at The Menopause Society 2024 Annual Meeting [Chicago,September 12, 2024], women seeking care did not receive a prescription for hormonal vaginal therapies prior to being seen at a specialized menopause clinic; specialty clinics are typically associated with long appointment wait times. Many primary care providers are still not comfortable prescribing local vaginal therapies despite guidelines about safety and lack of contraindications.

This particular study assessed the incidence of GSM among patients at a single specialized Canadian institution, St. Joseph’s Healthcare Menopause Clinic in Hamilton, Ontario, Canada, between January 2021 and August 2024. The study included 529 patients, the average age was 51.

Despite about half the participants reporting moderate to very severe vaginal dryness, 85% of them had NOT been prescribed local vaginal hormone therapies before their visit to the menopause clinic. Women were more likely to have been prescribed a localized therapy if they were older, were postmenopausal instead of perimenopausal, or had a female healthcare provider prior to this visit.

GSM symptoms are very common and affect women’s health and quality of life, often worsening over time without effective therapy,” Leticia Hernández Galán, PhD, of the Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada, and colleagues reported.  The risk lies in that what started as a UTI, can ascend to the kidneys or get into the bloodstream, which in some cases, can develop into urosepsis, a sometimes life-threatening condition.

What have we learned; to start, it’s clear more education is needed both for healthcare providers and patients.  GSM can affect overall health in that women may have long term risks, and it affects a women’s quality of life, including sexual health and well being.

At Coastal Well Woman, screening for GSM is always included as part of your Menopause evaluation and plan.  We address this facet of the menopause journey so women can experience optimize their health outcomes and live life to the fullest…in every aspect.

So, whether you are peri-menopausal, menopausal, or post-menopausal and have noticed GSM associated symptoms, it is not normal, and you do not have to live with discomfort or pain.  Some common GSM symptoms you may have noticed includevaginal dryness, vaginal discomfort (itching, burning, raw feeling), pain with intercourse, frequent vaginal or urinary tract infections. Coastal Well Woman is ready to support you with in-depth evaluation and customized treatment plan to address your specific GSM and menopausal needs, and get you back to feeling comfortable! 

Reference:  Most Women With Genitourinary Syndrome of Menopause Do Not Receive Effective Treatment – Medscape – September 17, 2024.