Body changes that start with menopause can significantly impact the quality of a woman’s life, affecting her physical and emotional well-being. Recently, doctors have started using the term genitourinary syndrome of menopause (GSM), replacing vaginal atrophy or atrophic vaginitis. The term better describes the symptoms of vaginal discomfort, such as vaginal dryness, itching, burning, pain during intercourse, spotting, more frequent bouts of UTIs (urinary tract infections), and the need for increased urination (urinary incontinence).
Causes of and treatments for genitourinary syndrome of menopause (GSM)
One of the most common and distressing changes in menopause is the vaginal discomfort triggered by the sharp falls in levels of the primary female hormones: estrogen and progesterone, which typically starts in a woman’s mid-forties, marking the end of her fertility.
GSM is primarily attributable to the changes in the lining of the vagina because it may get drier and thinner due to the lower levels of hormones, and there could also be inflammation of the vaginal walls.
The main changes that can occur during menopause that result in vaginal atrophy are:
- Loss of vaginal lubrication. The vagina is lined with cells that secrete fluid to keep it moist and lubricated. This is important for comfortable sexual intercourse and to prevent friction and irritation.
- Loss of vaginal elasticity and thickness. This is what allows the vagina to stretch during sexual activity.
- Maintenance of acidity. This is crucial for preventing infections and supporting the growth of beneficial bacteria within the vagina. These keep the vaginal ecosystem in balance and create an inhospitable environment for potential pathogens.
- Maintenance of adequate blood flow through the vaginal blood vessels. This ensures a sufficient supply of nutrients and oxygen to the vaginal tissues.
Keeping estrogen levels high in menopausal women can help prevent the onset of vaginal atrophy and its related discomforts. Estrogen also impacts aspects of sexual health, such as libido and arousal, and can play an important role in maintaining a healthy sex life in menopausal women.
Healthcare providers may recommend any of the many forms of Hormonal Replacement Therapy (HRT), which are treatment options available to help alleviate these symptoms and restore vaginal health. There are no cures for GSM, but by restoring estrogen levels with safe medications, it can be possible to reduce the symptoms substantially.
Hormonal Replacement Therapy’s role in managing menopausal symptoms
Hormonal Replacement Therapy (HRT) can be the preferred treatment option for managing menopausal symptoms, including GSM. The primary objective of HRT is to replace the hormones lost during menopause and relieve vaginal discomfort and other symptoms.
The main choices available for HRT are vaginal creams or suppositories, oral medication, skin gels, and patches. For many women, a doctor may advise avoiding oral dosing because there have been warnings of higher risks of breast cancer.
When vaginal atrophy is the main problem, doctors can recommend a treatment route that provides multiple direct and ancillary benefits: Premarin Vaginal Cream. Some of the main reasons for making such a choice are:
- Premarin Vaginal Cream provides a targeted delivery route, unlike oral HRT, which circulates throughout the body. Vaginal creams are applied directly to the vaginal area, allowing for a higher concentration of estrogen to be delivered onto the vaginal tissues, effectively addressing the symptoms of vaginal atrophy without significantly impacting other body tissues.
- Oral HRT can lead to unnecessarily elevated systemic estrogen levels, raising the risk of health issues like blood clots and breast cancer.
- Premarin has been formulated to deliver lower estrogen doses than oral HRT. As a result, women can achieve direct relief from vaginal discomforts without high hormone exposure, which reduces the risk of side effects.
- When applied, Premarin provides moisture and lubrication directly to the vaginal tissues, thereby combatting dryness and improving elasticity and comfort during intercourse.
- Premarin Vaginal Cream is easy to use and can be applied by the patient. This provides greater control and particularly benefits women who may find it harder to adhere to a daily oral medication regimen.
With targeted delivery, reduced systemic levels, lower doses, enhanced local effects, and greater convenience, vaginal creams can be a preferred alternative to other HRTs for treating vaginal discomforts during menopause. A woman must discuss her symptoms and medical history with a healthcare professional to determine the most suitable treatment approach for her case.
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The average retail price of a Premarin Vaginal Cream 30g tube in the US is over $500. From IsraelPharm, for the identical medicine also manufactured by Pfizer, you will pay just $68. That’s more than 80% savings.
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The role of estrogen in maintaining normal vaginal health.
Estrogen and progesterone are hormones that play several essential roles in maintaining normal vaginal health in premenopausal women. Throughout the reproductive years, both hormone levels fluctuate during the menstrual cycle, and their presence in the proper proportion is essential for the correct physical and biological functions of all parts of the female reproductive system, including the vagina.
When there is proper and coordinated fluctuation in estrogen and progesterone levels during the menstrual cycle, it will influence the vaginal environment, producing lubrication, pH levels, and cervical mucus consistency, all of which are necessary to support fertility, create an optimal environment for conception and pregnancy and ensure ongoing reproductive health.
The menstrual cycle involves four main phases:
- The follicular phase starts on the first day of menstruation, when follicle-stimulating hormone (FSH) is secreted by the pituitary gland, stimulating the growth of follicles in the ovaries containing immature eggs. As the follicles develop, they produce estrogen, primarily in the form of estradiol.
- Ovulation occurs when estrogen levels peak, releasing a mature egg from one of the follicles, usually around the middle of the menstrual cycle.
- After ovulation, the empty follicle transforms into the corpus luteum (the luteal phase), producing progesterone, which prepares the uterine lining (endometrium) for embryo implantation if there is fertilization.
- Menstruation follows if the egg is not fertilized, leading to a decline in both estrogen and progesterone and the start of another cycle.
Frequently Asked Questions
What are the symptoms of genitourinary syndrome in menopause?
The main signs and symptoms of genitourinary syndrome of menopause (GSM) may include vaginal dryness, burning or discharge; genital itching; burning during urination; need to urinate urgently and frequently; recurrent urinary tract infections (UTI).
How do you test for postmenopausal syndrome?
Doctors will usually ask for blood tests to check hormone levels. They will be checking for follicle-stimulating hormone (FSH) and estrogen (estradiol), which are the hormones that decrease with menopause.
What is the best test to confirm menopause?
Usually, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.
What is the gold standard treatment for menopause?
Estrogen therapy is considered the gold standard treatment, effective in 90% of women with symptoms of menopause, such as hot flashes.