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Every person with a uterus will experience menopause during their lifetime.

Genitourinary syndrome of menopause (GSM) is a term that describes the different genital, sexual, and urinary signs and symptoms that can occur during menopause.

The symptoms of GSM can greatly affect quality of life, so it is important to be aware the signs so that you can seek out appropriate care and support from your healthcare team.

What is Menopause?

Every person with a uterus will experience menopause during their lifetime and it is a normal part of aging. Menopause marks the end of a woman's reproductive years. It typically happens naturally in a woman’s late 40s to early 50s, but it can also be triggered by surgical removal of the ovaries.

What is GSM?

Genitourinary syndrome of menopause (GSM) is a relatively new term that describes the different genital, sexual, and urinary signs and symptoms that can occur during menopause.

Here is a table that outlines the different signs and symptoms of GSM, originally printed in Portman, 2014:

GSMchart

Why should you know about GSM?

Every person with a uterus will experience menopause during their lifetime, and the symptoms of GSM can greatly affect quality of life. Therefor it is important to be aware the signs so that you can seek out appropriate care and support from your healthcare team.

Genital Symptoms

Genital symptoms including vaginal dryness can affect your sex life and general comfort. These symptoms include vaginal dryness, pain with penetration (dyspareunia), vaginal irritation, genital itching, vaginal tenderness, and vaginal bleeding or spotting during intercourse. According to a study by Nappi et al. (2010), between 45% to 63% of postmenopausal women have these symptoms, so it is quite common. It is also apparent that these symptoms negatively affect satisfaction with sex; according to Levine et al. (2008), sexually active postmenopausal women with sexual dysfunction are four times more likely to genital symptoms than those without sexual dysfunction.

These symptoms relate to the reduction of estrogen circulating in the blood. The tissues of the vagina, vulva, pelvic floor muscles, urethra, and bladder respond to estrogen levels. When there is less available estrogen in the system, the tissues of these areas can thin, have less elasticity, and become more vulnerable to irritation and damage.

Urinary Tract Symptoms

Estrogen deficiency after menopause can cause lower urinary tract symptoms, including painful or difficult urination (dysuria), urgency, frequency, increased night time urination (nocturia), urinary incontinence (UI), and recurrent UTI (Robinson, 2003).

In one study by Robinson (2003), 20% of postmenopausal women reported urinary urgency and almost 50% had stress urinary incontinence (SUI). Again, estrogen deficiency seems to affect the health and function of the tissues and muscles of the urinary tract, including the bladder, urethra, and associated tissues.

Do you have GSM? What you can do.

Go see your doctor. The most important thing for you to do is be under the regular care of a doctor. Gynecologists and women's health nurse practitioners can be a great resource as you transition to menopause. Your doctor will also be able to discuss treatment options with you, including hormone therapy, non-hormonal treatment options, and also give you a referral to pelvic floor therapy.

Contact a pelvic floor therapist. Pelvic floor therapy can help with common menopausal pelvic health issues including urinary incontinence, bowel issues, pain with sex, and pelvic pain. Check out our past blog post on Menopause and Pelvic Health.

 

References

Kim, H. K., Kang, S. Y., Chung, Y. J., Kim, J. H., & Kim, M. R. (2015). The Recent Review of the Genitourinary Syndrome of Menopause. Journal of menopausal medicine, 21(2), 65–71. doi:10.6118/jmm.2015.21.2.65

Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21:1063–1068. [PubMed] []

Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: results from an international survey on vaginal atrophy. Maturitas. 2010;67:233–238. [PubMed] [Google Scholar]

Levine KB, Williams RE, Hartmann KE. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause. 2008;15:661–666. [PubMed] []

Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003;62:45–51. [PubMed] [Google Scholar]

Callan, N. G. L., Mitchell, E. S., Heitkemper, M. M., & Woods, N. F. (2018). Constipation and diarrhea during the menopause transition and early postmenopause. Menopause, 25(6), 615–624. doi:10.1097/gme.0000000000001057

Castellani, D., Saldutto, P., Galica, V., Pace, G., Biferi, D., Paradiso Galatioto, G., & Vicentini, C. (2015). Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence. Urologia Internationalis, 95(4), 417–421. doi:10.1159/000381989

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186-97

Minkin, M. J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause, 22(11), 1231–1238. doi:10.1097/gme.0000000000000464

Mehta, R. S., & Staller, K. (2018). Menopausal transition and bowel disturbances. Menopause, 25(6), 589–590. doi:10.1097/gme.0000000000001110

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Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

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Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

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Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

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Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

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