Vulval and Vaginal Atrophy
This condition is now called the Genitourinary Syndrome of Menopause (GSM).
What is vulval and vaginal atrophy?
This is a group of symptoms all related to the reduced oestrogen levels associated with the menopause. Similar symptoms can be due to low oestrogen levels associated with breastfeeding, certain anti-oestrogen drugs or absent periods for reasons other than the menopause.
What are the symptoms of GSM ?
Symptoms of GSM include vaginal dryness and burning, discomfort with intercourse and urinary symptoms, especially urgency, dysuria and urinary tract infections.
Oestrogen is important in maintaining the elasticity and thickness of vaginal and inner labial skin. Oestrogen also maintains the vaginal moistness, protective normal vaginal flora (lactobacilli) and the normal acidic vaginal ph.
Thinning of the skin increases the risk of trauma, including skin ulceration and possible vaginal bleeding.
Many women put up with these symptoms and don’t discuss them with any health practitioner. This is a pity as simple treatment is very effective.
Are there more serious symptoms associated with this condition?
It is always important to consider other potentially more serious causes of symptoms that mimic GSM. Post-menopausal bleeding needs to be fully investigated and uterine malignancy excluded before blaming GSM. Similarly urinary tract symptoms such as urgency can be due to urinary tract infections or even bladder malignancies. Vulval skin trauma may be due to an intrinsic skin disorder such as lichen sclerosus.
Dr Kliman can simply elucidate a diagnosis especially with the use of vulvoscopy (examining the vulva and vaginal skin with a microscope).
What is the treatment for GSM?
GSM can be treated with the use of bland, simple moisturisers and/or bath oil. However, the most effective treatment is the use of local oestrogens as a cream or pessary. Treatment should be used nightly for two weeks and then two nights a week indefinitely. In most cases systemic treatment on top of local treatment does not further enhance cure. A number of studies have shown systemic absorption from cream and pessaries is minimal and even women who have had hormone dependent cancers such as breast cancer are not at an increased risk of cancer recurrence when they use local rather than systemic hormone therapy.
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