Genitourinary Syndrome of Menopause

Menopause atrophy

Genitourinary Symptoms of Menopause: Causes, Symptoms, and Treatment Options

Menopause is a natural transition, marking the end of the reproductive years. Along with the more commonly known symptoms like hot flashes and mood swings, menopause can bring about a range of genitourinary symptoms that impact quality of life. In this blog post, I will explore the causes, symptoms, and treatment options for genitourinary symptoms of menopause, with a particular focus on non-hormonal treatments and vaginal estradiol options. Please note that while hormone replacement therapy (HRT) is a treatment option, I will cover that in a separate post.

Genitourinary Symptoms of Menopause:

Causes:

Genitourinary symptoms during menopause are primarily due to the hormonal changes that occur as a body ceases its reproductive functions. The decline in estrogen levels plays a significant role in these symptoms.

1. Vaginal Dryness: A common symptom, it can cause discomfort, itching, and pain during sexual intercourse.
2. Vaginal Atrophy: Thinning and inflammation of the vaginal walls.
3. Dyspareunia: Painful sexual intercourse due to dryness and tissue changes.
4. Urinary Incontinence: Increased risk of urinary leakage.
5. Recurrent Urinary Tract Infections (UTIs): Changes in vaginal pH can make women more susceptible to UTIs.

Non-Hormonal Treatment Options:

1. Vaginal Lubricants and Moisturizers:
   • Lubricants:These provide immediate relief during sexual activity. Silicone based are preferred.
   • Moisturizers: Applied regularly, these help maintain vaginal moisture over time. This can include different moisturizing suppositories. Ex: Replens
   • Suppositories: Ex: Revaree
   • Hyaluronic acid is a natural compound that improves tissues and moisturizes. Its available in a variety of over the counter products.
2. Pelvic Floor Exercises (Kegels):
   • Strengthening pelvic floor muscles can help improve urinary incontinence symptoms.
3. Laser Therapy:
   • Some women explore laser treatments to rejuvenate vaginal tissues and improve symptoms

Vaginal Hormone Treatments

1. Vaginal Creams:

Vaginal estrogen (estradiol) creams or compounded hormone creams are applied directly to the vaginal tissues. They help restore moisture, improve tissue health, and alleviate symptoms. Common brand names include Premarin and Estrace. They are typically inserted/applied 1-2 times per week for maintenance.

1. Vaginal Hormone Suppositories (inserts):

Vaginal estradiol or other hormone suppositories are inserted into the vagina, where they gradually release low dose hormone that directly treats problems with atrophy and poor tissues health. Vagifem and Imvexxy are well-known brands. Intrarosa is prasterone (DHEA) which is a natural hormone that converts to estrogen and testosterone in the tissues and improves vaginal and bladder health. Compounded versions of estrogen, testosterone and DHEA are available as options for almost all women.

1. Vaginal Rings:

Vaginal estrogen rings, like Estring, are placed in the upper vagina and release low dose estrogen continuously. It is kept in place and changed every 3 months. This option offers convenience and sustained relief.

1. Oral medications:

There are certain medications which act as Selective Estrogen Receptor Modulators, to help stimulate tissues that are responsive to estrogen. A brand name example is Osphena, and it is indicated to help with painful intercourse.

Of course most women are candidates for menopausal systemic or whole body hormone treatment which is beneficial to overall and also improves vaginal, sexual and bladder health as do the vaginal only treatments.

Management and Monitoring:

It's essential to consult a healthcare provider before initiating any treatment. They can recommend the most suitable option based on individual symptoms and health considerations. Regular follow-ups are crucial to monitor progress and adjust treatment if necessary.