NAMS releases new position statement on GSM
By Lisa Larkin, MD, FACP, NCMP, IF Founder and CEO, Ms.Medicine
In observance of September as Sexual Health Awareness Month, we want to address an unmet concern for many midlife and older women that can greatly affect their sexual health and well-being: Genitourinary Syndrome of Menopause (GSM.)
What is GSM?
Genitourinary Syndrome of Menopause (GSM) is the term for a variety of symptoms and conditions women experience due to a decrease of estrogen during and after the menopause transition. As women reach menopause (naturally, surgical or due to chemotherapy), this decrease in estrogen production causes thinning of the vaginal lining, making the tissue much more fragile, less elastic and susceptible to drying and irritation. Symptoms of GSM include genital symptoms, such as burning, dryness, discomfort and irritation, as well as sexual health disfunction, such as dryness or lack of lubrication, pain with sex and vaginal atrophy. Patients may also experience urinary discomfort including urinary tract infections and symptoms without the presence of infection, such as burning, pain and frequency.
GSM is very common in menopausal women. Some studies suggest that as many as 70% – 90% of women experience some symptoms consistent with GSM, yet so few women seek or are given treatment. Research suggests that only a quarter to one-third of women with GSM (clinically present) report symptoms when surveyed. Shockingly, far fewer are actually provided treatment—a disturbing finding considering the negative impact of GSM on a women’s quality of life and the number of available, evidence-based treatments.
How is GSM treated?
The North American Menopause Society (NAMS,) the leading women’s health organization in the U.S., recently release a position statement updating the organization’s recommendations on the most current, safe and effective treatments for GSM. The NAMS’ statement reviewed available treatment options and created guidelines based on the severity of a woman’s symptoms, her preference of therapies, and the effectiveness of those therapies available.
For women with mild symptoms, NAMS recommends over-the-counter treatment options to address women’s symptoms of dryness and pain with sex including vaginal lubricants (for use during intercourse) and long-acting vaginal moisturizers (used several times a week). Regular ‘gentle stretching’ –through sexual activity, either with a partner or with a dilator—also may improve mild symptoms.
For mild to moderate and/or persistent symptoms, the NAMS’ panel suggests low-dose vaginal estrogen (low dose ET). Low dose ET is shown to be effective especially for genital-specific symptoms, such as pain with sex and dryness, as well as for recurrent urinary tract infections. It is available in many forms including creams, inserts, intravaginal rings and an oral tablet, and it is considered safe for most women. Each product has advantages and disadvantages, but the efficacy remains fairly consistent for each. Women should talk with their provider about the pros and cons of each to determine the best therapy for them.
For women with mild to moderate GSM symptoms and vasomotor symptoms (VMS) of menopause, such as hot flashes and night sweats, low dose systemic estrogen may be considered.
The panel also noted that more studies are needed on available treatments, including the use of energy-based therapies, such as vaginal lasers, which are newer to the market. These products have come under fire recently by the FDA for their marketing tactics, promoting the therapy as a treatment for GSM despite the lack of clinical data. In all, the panel notes that more education—for both clinicians and their women patients—is required to help improve the quality of life for women who suffer with GSM symptoms. Women deserve better healthcare, and sexual health IS health. Talk with your provider if you are experiencing any symptoms that are causing you discomfort to learn more about safe and effective treatments.