Introduction
Genitourinary Syndrome of Menopause (GSM) impacts at least half of all women undergoing menopause, largely due to a decrease in ovarian hormones such as oestrogens and androgens. Some women may experience symptoms at perimenopause, at menopause or when post-menopausal. The common symptoms of GSM include vaginal dryness, itching, burning, urinary issues like recurrent UTIs, reduced genital skin sensation, sexual dysfunction, and painful intercourse.
The Persistent Nature of GSM Symptoms
Unlike transient menopausal symptoms such as hot flushes, GSM symptoms do not resolve on their own and often worsen with age. By the age of 70, up to 70% of women will experience these symptoms, yet only a small fraction, around 7%, receive treatment.
Traditional First-Line Hormonal Treatments
For addressing vaginal dryness and atrophy, topical treatments such as Oestriol cream and Oestrodiol pessaries are highly effective. These treatments provide significant relief with minimal systemic absorption, making them safe for widespread use among women.
Role of Androgens in Women's Health
Contrary to common belief, androgens, often considered male hormones, are also produced in small amounts by female ovaries and play a crucial role in vaginal health. These hormones help maintain collagen and mucous production, which are essential for alleviating GSM symptoms.
Innovative Treatment: Prasterone
Prasterone represents a breakthrough in GSM treatment. This topical vaginal pessary, containing DHEA, converts into both oestrogen and testosterone locally in the vulvovaginal tissues. Clinical trials have shown that Prasterone increases vaginal wall thickness, normalizes pH, enhances vaginal secretions, and significantly reduces painful intercourse. Reports indicate a 46% reduction in discomfort during sex, along with improvements in desire, arousal, lubrication, orgasm, and overall sexual satisfaction.
Conclusion
Hormonal treatments for Genitourinary Syndrome of Menopause offer effective relief for many of the uncomfortable and often debilitating symptoms experienced by menopausal women. With new treatments becoming available, women have more options than ever to manage their symptoms effectively.
Author:
Dr. Karen Osborne, BSc (Hons), MBBS, MRCGP, DRCOG, DFSRH, FRACGP, With a dedicated focus on reproductive and sexual health.
References:
Labrie F, Archer D, Koltun W, et al. Menopause 2018;25:1339-1353.
Labrie F, Archer D, Martel C, et al. Menopause 2017;24:1246-1256.
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