Managing Genitourinary Symptoms of Menopause: Understanding Your Options

Menopause brings many changes to a woman’s body, and one area often affected is the genitourinary system. This collection of symptoms, often referred to as Genitourinary Syndrome of Menopause (GSM), includes vaginal dryness, irritation, painful intercourse (dyspareunia), urinary frequency, and recurrent urinary tract infections (UTIs). These symptoms are common and can significantly affect quality of life.

The good news? A range of treatment options is available to manage GSM effectively. Below, we’ll explore these options to help you find relief.

1. Over-the-Counter (OTC) Options

For women with mild symptoms, non-prescription products may be a good starting point.

• Vaginal Moisturizers

  • These products (e.g., Replens, HyaloGyn) provide long-lasting hydration to vaginal tissues and can be used regularly to improve comfort.

• Vaginal Lubricants

  • Designed for use during intercourse, lubricants (e.g., Astroglide, KY Jelly, or silicone-based options) reduce friction and make intimacy more comfortable.

  • Look for water-based or silicone-based lubricants free of fragrances or irritating additives.

2. Prescription Vaginal Estrogen Therapy

Vaginal estrogen is highly effective for addressing GSM. Unlike systemic estrogen, these treatments work locally, delivering a low dose of estrogen directly to the vaginal tissues with minimal absorption into the bloodstream.

• Vaginal Creams (e.g., Estrace, Premarin)

  • Applied with an applicator, these creams deliver estrogen directly to the vaginal tissues.

• Vaginal Tablets (e.g., Vagifem)

  • Small tablets inserted into the vagina release a controlled dose of estrogen.

• Vaginal Rings (e.g., Estring)

  • Flexible rings inserted into the vagina release estrogen consistently over 90 days.

3. DHEA (Dehydroepiandrosterone)

• Prasterone (Intrarosa)

  • A non-estrogen option, this vaginal suppository delivers DHEA, which is converted into estrogen and androgen within vaginal tissues, improving dryness and elasticity.

This is a good choice for women who prefer non-estrogen treatments or those with contraindications to estrogen.

4. Systemic Hormone Replacement Therapy (HRT)

For women experiencing GSM alongside other menopause symptoms like hot flashes or mood changes, systemic HRT can provide comprehensive relief.

• Options Include:

  • Oral estrogen (e.g., Estrace).

  • Transdermal estrogen (e.g., patches, gels, or sprays).

  • Combination HRT (estrogen and progestin, if you have a uterus).

While systemic HRT can help with GSM, local vaginal treatments are typically more targeted and effective for this specific issue.

5. Non-Hormonal Prescription Treatments

For women who cannot or prefer not to use hormonal therapy, non-hormonal options are available.

• Selective Estrogen Receptor Modulators (SERMs)

  • Ospemifene (Osphena): An oral medication that mimics estrogen's effects on vaginal tissue, reducing pain during intercourse.

6. Energy-Based Therapies

Emerging technologies using laser or radiofrequency energy can stimulate collagen production and improve vaginal elasticity and lubrication.

• Laser Treatments (e.g., MonaLisa Touch, FemTouch):

  • Non-invasive procedures designed to rejuvenate vaginal tissues by stimulating collagen growth.

• Radiofrequency Devices (e.g., ThermiVa):

  • Uses heat to promote tissue remodeling and increase blood flow to the vaginal area.

While promising, these therapies can be costly and may not yet be covered by insurance. Long-term data on their effectiveness and safety is still being gathered. As such, we do not recommend them at this time.

7. Lifestyle Adjustments

Simple lifestyle changes can also help improve GSM symptoms:

• Stay Hydrated: Drinking enough water supports overall tissue health.

• Avoid Irritants: Reduce exposure to harsh soaps, douches, or scented products that can exacerbate dryness or irritation.

• Pelvic Floor Exercises: Strengthening pelvic muscles through Kegel exercises can improve urinary symptoms.

8. Supportive Therapies and Counseling

For women experiencing emotional or relational difficulties due to GSM, additional support may be beneficial:

• Pelvic Floor Physical Therapy: Helps address pain and muscle dysfunction in the pelvic area.

• Sexual Counseling: Supports communication and intimacy with your partner.

Which Option Is Right for You?

The best treatment for GSM depends on the severity of your symptoms, your health history, and personal preferences. Vaginal estrogen therapies remain the gold standard for many women, but non-hormonal and emerging treatments provide valuable alternatives.

Discuss your symptoms openly with your healthcare provider to find a treatment plan tailored to your needs. Relief is possible, and no woman should feel that GSM is an inevitable or untreatable part of aging.