In an estimated 50 percent of women, hormonal changes attributable to menopause can lead to vaginal dryness and other symptoms of genitourinary syndrome of menopause (GSM). Despite the availability and efficacy of local vaginal estrogen therapy (estrogen creams), only about 60 percent of those experiencing GSM seek—or are provided—medical help and guidance. Many women wait a year or more to consult a healthcare provider but the majority will use over-the-counter lubricating gels and creams to alleviate GSM. In other words, a breakdown in the system attributable to both providers and patients keeps several million older women suffering from GSM—a condition that is readily treated with estrogen creams and other low-dose vaginal estrogen products.
What Is Genitourinary Syndrome of Menopause?
According to a 2014 article published in the journal Maturitas:
“GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria [painful urination] and recurrent urinary tract infections.”
Of note, according to the authors of this study, in order for you to be diagnosed as having GSM, your symptoms must be bothersome and unattributable to another etiology or cause. Moreover, many women with GSM may experience some but not all of these symptoms.
Research on Low-Dose Vaginal Estrogen Products
In a 2014 study titled “Vaginal Estrogen for Genitourinary Syndrome of Menopause,” investigators analyzed commercially available vaginal estrogen (estrogen creams, estradiol rings, and estradiol vaginal tablets).
Ultimately, these researchers suggest the following:
In women with a single GSM complaint—such as vaginal dryness, pain during sex, painful urination, and vaginal itching or burning—a nonhormonal lubricant or moisturizer may work. However, some of these women may also benefit from vaginal estrogen, too. In women with a constellation of GSM symptoms—especially urinary symptoms like frequency and incontinence—vaginal estrogen products work. The choice of vaginal estrogen cream, tablet, ovule, suppository, or ring depends on patient preference. Although such estrogen products are generally considered safe, long-term studies need to be done. Thus, a person with family history and bothersome GSM must carefully consider estrogen treatment under physician supervision. Little is known about ospemifene (used to treat dyspareunia or painful intercourse), compounded vaginal estrogen products, or herbal or natural alternatives. Further study is needed.
If you or a loved one is experiencing GSM, please meet with an obstetrician-gynecologist to discuss possible treatment. Although in some people with single symptoms of GSM like vaginal dryness, over-the-counter nonhormonal lubricants or moisturizers may help, if you have more extensive symptoms, you may find relief in the form of prescription estrogen products like low-dose estrogen creams and vaginal estrogen rings and suppositories.
A Word From Verywell
Please keep in mind that although such estrogen therapy is generally considered safe, proceed with caution and physician advice if you have a history of breast or endometrial cancer.
We know little about the efficacy or safety of nonprescription estrogen alternatives available for purchase on the Internet so please steer clear of purchasing and applying such products without your physician’s input. Let your physician prescribe what is right for you.
If interested in naturopathic alternatives like soy and yam extracts, in addition to a gynecologist, you should also meet with a naturopathic physician.
Please remember that if you experience vaginal dryness and other symptoms of GSM, there’s absolutely nothing to be ashamed of. In many, GSM is a natural process that reflects a normal change in your body’s physiology. It’s unfortunate that a majority of women with GSM fail to receive the medical attention or advice that they need especially when effective prescription vaginal estrogen treatments are widely available.
To be fair, this dearth of GSM treatment is in large part also attributable to physician providers themselves. For example, for years, the medical community referred to GSM as atrophic vaginitis, an inaccurate term that carries connotes stigma. (Atrophy means wasting away and vaginitis means inflammation.) Additionally, research suggests that many older women feel uncomfortable or embarrassed discussing GSM with younger, female healthcare providers.
Remember that it’s a provider’s duty and obligation to address GSM in an open, empathetic and constructive fashion. Finally, if you feel uncomfortable discussing your medical problems with your healthcare provider, it’s a good idea to find a physician with whom you do feel comfortable. After all, your physician should be an empathetic guide to better health and advocate for your well-being in every way.
