Detailed definition
Genitourinary syndrome of menopause (GSM) was named in 2014 by NAMS and ISSWSH to replace older terms (vulvovaginal atrophy, atrophic vaginitis, urogenital atrophy) and to capture the full range of symptoms involving both the vagina and lower urinary tract. The genital component includes vaginal dryness, burning, irritation, decreased lubrication, dyspareunia, and post-coital bleeding. The urinary component includes urgency, dysuria, and recurrent urinary tract infections. The underlying mechanism is estrogen withdrawal: vaginal epithelium thins and loses glycogen, lactobacilli decline, vaginal pH rises, and the urethra and bladder trigone — which are richly populated with estrogen receptors — also atrophy. Approximately 50–70% of postmenopausal women have GSM, and unlike vasomotor symptoms it does not improve over time. Treatment options include vaginal moisturizers and lubricants for milder cases; vaginal estrogen (cream, tablet, ring, insert) for moderate-to-severe; intravaginal DHEA (prasterone); oral ospemifene; and the systemic effects of full HRT for women with overlapping vasomotor symptoms.
Why it matters in menopause
GSM is among the most undertreated conditions in women's health. Women often feel embarrassed to bring it up; clinicians often don't ask. Vaginal estrogen, used at the dose used in modern practice, raises serum estrogen levels by a tiny fraction of systemic HRT and is considered safe even for many breast cancer survivors with their oncologist's OK. Treating GSM substantially improves quality of life, sexual function, and reduces recurrent UTIs.
Related terms
Sources
External references: Wikipedia.