Vaginal atrophy or genitourinary syndrome (GSM) describes a constellation of symptoms due to declining estrogen levels after menopause. This condition is seen in 15% of pre-menopausal women and 40-50% of post-menopausal women. Yet despite how common this condition is, it is often under-diagnosed due to patient embarrassment or disregarded as part of normal aging.
Women with this condition often have symptoms affecting their vulva, vagina and urinary tract systems. Vaginal dryness is the most common symptom, affecting 75% of women. Due to dryness in the vaginal lining, ulcers and cuts can also form during intercourse, leading to complaints of painful intercourse in 38% of women. 15% of women may also experience symptoms of vaginal itching, discharge and discomfort. Common urinary complaints include frequency, urgency or recurrent urinary tract infections. Other women will experience a change in the sexual function and complain of decreased libido, arousal and vaginal lubrication.
Women with this common condition should discuss their concerns with their physician. During your office visit, your doctor may collect a vaginal culture to rule out other infections such as bacterial vaginosis, trichomonas and yeast infections. Your doctor will also look carefully at your vulva and vagina to confirm that there is no evidence of vaginal or vulvar precancers or cancers, which can also present with pain or bleeding.
Management options for GSM depend on the severity of your symptoms. Your doctor may counsel you to avoid soaps, lotions, powders and panty-liners, all of which may be irritating to your vulva and vagina. Women with mild symptoms may choose to use vaginal lubricants or moisturizers. These are available over the counter but usually only provide relief for <24 hours. Since GSM is due to a natural decline in your estrogen level, the most common therapy is estrogen therapy. Vaginal application of estrogen works very well and up to 90% of women report some relief of their symptoms with this treatment. For women who have hot flashes or who desire additional protection from osteoporosis, oral estrogen may be a better fit. With oral estrogen, there is a slightly increased risk of stroke and blood clots in the circulatory system. Patients who are interested in oral estrogen should discuss the risks vs. benefits of this therapy with their physician. Patients who cannot take estrogen may benefit from a class of drugs called selective estrogen receptor modulators (SERMs). These medications specifically target the estrogen receptors in your vagina and vulva and are less likely to affect your breast or uterine tissue, which also contain estrogen receptors.
The latest innovative therapy is laser therapy. In our office, we offer the Femilift, a gentle carbon dioxide laser that is minimally invasive and not associated with any post-procedural down-time. Femilift resurfaces and regenerated the vagina, increasing moisture and elasticity. This laser has also been shown to increase collagen and can also be used for women who suffer from stress incontinence (i.e. loss of urine with cough or sneeze).