Menopause is an inevitable stage in every woman's life. Many women anticipate certain symptoms associated with menopause, but how do you know when your experience might be something more? 

If you are experiencing symptoms that include vaginal dryness, painful intercourse and/or a frequent “urge to go,” Dr. Wen Shen, Co-Director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins says, it may be something called Genitourinary Syndrome of Menopause (GSM).

What is Genitourinary Syndrome of Menopause (GSM)?

GSM presents in women who are menopausal and includes vaginal dryness, not just with intercourse but in daily life.

Vulvar atrophy can make it painful just to sit, walk or urinate. The frequent 'urge to go' or incontinence disturbs sleep and can cause social embarrassment. Painful intercourse (dyspareunia) often leads to avoidance and can cause stress in relationships.

Treatment Options for GSM

There is help. Treatment options that are safe and effective are available to many patients, including Breast Cancer Survivors. Treatment options can include:

• Over the counter ointments and creams
• Hyaluronic acid creams
• Vaginal laser ablation
• Local ultra-low dose estrogen

Ultra-low dose estrogen is delivered topically. Clinical trials to date indicate there is minimal to no systemic absorption resulting in no increased risk of breast cancer recurrence. This locally applied, ultra-low dose estrogen comes in several forms: cream, vaginal tablet or ring.

While not currently FDA approved, Vaginal Laser Ablation (VLA), a procedure that was adapted from Dermatology, can offer some relief. VLA uses lasers to make micro-abrasions or tiny scratches in the vaginal wall, which stimulate the growth of new blood vessels causing a “remodeling” of vaginal mucosa so the body regrows a healthy new layer, but this is only temporary, because the lack of estrogen will make it atrophy again. The procedure requires annual maintenance treatments. This is not presently FDA approved and therefore not covered by insurance.

Talk to Your Doctor

If you are experiencing some or all of the symptoms of GSM, Dr. Shen encourages you to speak with your Gynecologist about which of the many safe and effective options might be right for you to restore function and improve quality of life. If your symptoms cannot be managed by your GYN, she/he may refer you to an Urogynocologist for additional care.

"It’s important to ask your Gynecologist whether she/he is comfortable managing menopausal issues," Dr. Shen says. "Until recently, menopause symptom management has not been a part of the medical school or residency curriculum so there are many doctors who are unfamiliar or uncomfortable with it.