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Treatment options


When a woman goes through menopause, her estrogen levels decrease along with the levels of other steroid hormones. These decreases can lead to changes in certain areas of her body, like the vagina, vulva, and bladder.

For example, estrogen helps keep the vagina moist and flexible. But when estrogen levels decline, the vagina can become dry and tight.

These hormonal drops can lead to a group of genital and urinary symptoms that are called genitourinary syndrome of menopause (GSM).

GSM is thought to affect about half of postmenopausal women. Symptoms include:

• Dryness, burning sensations, and irritation in the genital area

• Poor vaginal lubrication during sex, discomfort or pain with intercourse, and impaired sexual function

• An urgent need to urinate, painful urination, or recurrent urinary tract infections (UTIs)

Menopause can be natural or due to surgery or medications like chemotherapy. 

There are several options for the treatment of GSM. 

  • Vaginal moisturizers

  • Systemic hormones

  • Vaginal estrogen

  • Selective estrogen receptor modulators

  • Fractional laser therapy

Vaginal moisturizers include Rephresh, Replens, or Luvena. These are non-hormonal options that can help with daily dryness and maintenance of a healthy pH, but likely won't help with urinary symptoms or pain with intercourse. 

Systemic hormones include estrogen and progesterone taken as a pill, a cream, or a patch on the skin. This is can be a good option for women who also experience other menopause symptoms like hot flashes or night sweats. These kinds of hormones also can have significant risks including increased risk of breast cancer or heart disease. Women who have had breast cancer are usually not candidates for this treatment. 

Vaginal estrogens are applied inside the vagina for a local effect. These can be creams, tablets, or in plastic rings. Many women who can continue regular use find these options to help the problem significantly. The risks of hormones with this form seem to be lower than with systemic hormones, but there is not enough information to say for certain. Insurance coverage can be poor, especially for women on Medicare. Women who have had breast cancer should use caution with these treatments and discuss it carefully with their providers. 

Selective estrogen receptor modulators for the treatment of GSM include only ospemiphene in the US. This is a pill taken by mouth with food daily. Initial studies show it to be effective, but it may carry the same risks as systemic hormones. There is not enough data to warrant the use of this medication in women who have had breast cancer. 

Fractional laser therapy has been shown in studies to help with vaginal dryness, pain with intercourse, and some urinary symptoms of GSM. These studies have been small, but more are ongoing. Our review of the data suggests that the best therapy is with the Hologic device Mona Lisa Touch. This option is an excellent choice for women who have had breast cancer because it is totally non-hormonal and treats all the symptoms of GSM. 

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