Genitourinary Syndrome of the Menopause (GSM) also known as Vulvovaginal atrophy (VVA) or atrophic vaginitis....sounds pretty awful...especially as 50% of postmenopausal women will experience symptoms.
Symptoms
Symptoms commonly include, increased frequency and urgency to pass urine, waking at night to pass urine, itching, discomfort and irritation, simply walking or wearing underwear may cause intense irritation. Vaginal dryness causes discomfort during intercourse (Dyspaurenia). The atrophy of tissue may also affect sensation reduction during orgasm.
What exactly is happening ?
The vaginal epithelium is a stratified squamous epithelium, which until menopause is moist and thick with rugae ( folds). At menopause, with declining levels of oestrogen, the vaginal epithelium thins. Fewer epithelial cells result in less exfoliation of cells into the vagina. As epithelial cells exfoliate and die, they release glycogen, which is hydrolyzed to glucose. Glucose, in turn, is broken down into lactic acid by the action of lactobacillus, a normal vaginal commensal organism. Without this cascade, the pH in the vagina rises, resulting in a loss of lactobacilli and an overgrowth of other bacteria.
Women can feel that they have a fungal infection or urinary tract infection and may be treated multiple times for such when the reality is the cause is easier to treat with topical oestrogen
Topical vaginal oestrogen treatment
Topical vaginal oestrogen treatment has been shown to be effective in improving symptoms related to vaginal atrophy, such as vaginal dryness and superficial dyspareunia.
Oestrogen also has a proliferative effect on bladder and urethral epithelium and may help
relieve symptoms of urinary frequency, urgency and possibly reduce the incidence of
recurrent urinary tract infections in women with urogenital atrophy. Using topical oestrogen is very safe even in most women who cannot use HRT.
The dosage of topical oestrogen is very low and can be used for as long as required
All topical oestrogen preparations have been shown to be effective.
There is no requirement to combine vaginal estrogens with systemic progestogen treatment
for endometrial protection, as low-dose vaginal estrogen preparations do not result in
significant systemic absorption or endometrial hyperplasia.
Ospemifene
Ospemifene is a selective oestrogen receptor modulator is an effective treatment for
the symptoms of VVA/GSM and has recently been licensed in the UK. It is an oral preparation
which may be a personal preference for some and may offer an alternative option to
many older women who may find inserting vaginal preparations technically difficult.
Discussing genitourinary symptoms isn't easy, but should be a routine part of a menopause consultation. Topical oestrogen can help symptoms within weeks, but usually takes around 6 weeks to become effective and must continue to be used for as long as needed, which is not always discussed during a rushed consultation. It may also be helpful to use vaginal moisturisers such as SYLK or YES rather than lubricants or as well as lubricants for more instant relief.
For more information on how these symptoms may be affecting you and how I can help get in touch today.
Regards
Amanda
