Some of the most distressing symptoms of perimenopause and menopause include vaginal dryness and bladder leaks. Together, vaginal, urinary, and sexual symptoms are called genitourinary syndrome of menopause (GSM).

To learn more about genitourinary syndrome of menopause, ThisIsMenopause spoke with Cindi Rauert Lanners, a board-certified clinical specialist in women’s health and pelvic health and a doctor of physical therapy.

As a physical therapist, Lanners focuses on pelvic floor exercises that can help strengthen muscles that affect vaginal and urinary health in menopause. But she urges women in perimenopause to also seek medical care. “I want them to talk to their primary care, their OB- GYN, the individuals who they can ask, ‘Hey, how can you support me with the symptoms that I’m having?’ Because it does have a long-term impact.”

What Exactly Is Genitourinary Syndrome of Menopause?

Genitourinary syndrome refers to symptoms that affect the vagina, vulva, and lower urinary tract. The condition used to be called vaginal atrophy or atrophic vaginitis. GSM can start when estrogen levels decline during perimenopause, but it often occurs after menopause, when a woman’s menstrual periods stop permanently.

Declining estrogen levels can affect vaginal tissue and tissue in the vulva, urethra (a tube that carries urine out of the body), and bladder. This can affect the structure of these organs and how they function. For instance, the inner lining of the vagina can become thinner with GSM.

Symptoms of Genitourinary Syndrome of Menopause

GSM can cause a range of vaginal and urinary symptoms. “With loss of hormones, the tissue can be dry and sensitive,” Lanners said, explaining how GSM affects the genitals and urinary tract. “You might have painful external skin and tissue. Because that skin is painful, [you might] have guarded muscles.”

These symptoms can affect daily life and intimate relationships. Having a leaky bladder can be embarrassing and inconvenient. Sexual problems can cause difficulties in relationships and lead to self-esteem issues.

One woman surveyed by ThisIsMenopause described her experience with GSM. “I had no sex drive, and when I did it hurt too bad to be penetrated,” she said.

Another wrote, “Sleepy, hot flashes, urgency to pee.”

Getting Help for Genitourinary Syndrome of Menopause

Left untreated, symptoms of GSM often get worse and can lead to recurrent UTIs. However, around 70 percent of women who experience GSM don’t discuss their symptoms with their doctor. Less than 25 percent of women with GSM get treatment, which can relieve symptoms and significantly improve quality of life.

One woman surveyed by ThisIsMenopause shared that she wished she’d known sooner about “dryness and how to have a better sex life.”

It’s important to find a healthcare provider who has expertise in women’s health and menopause who you can talk to about GSM treatment options. Open communication with a healthcare provider about symptoms of menopause that may be affecting your vaginal, sexual, or urinary health, can help you find a treatment plan that’s appropriate for your particular symptoms.

Treatments for GSM

Fortunately a number of effective treatment options are available for GSM. Treatment of GSM includes the following options:

• Over-the-counter vaginal lubricants and vaginal moisturizers to help with vaginal dryness and sexual function
• Prescription low-dose vaginal estrogen therapy for the vulva and vagina
• Prescription systemic hormone therapy
• Exercise or physical therapy

“There are hormonal options and there are nonhormonal options. So as a physical therapist, I often get to help people with the nonhormonal options, meaning are the muscles moving well? Is that tissue not as sensitive?” said Lanners. She emphasized that physical therapy can work well with medical treatment.

“I encourage them to work with their medical provider. If they’re interested in hormonal support, it can help us as we treat the muscles,” Lanners said. “And if they’re not interested in hormonal support, there are also lubricants or different things on the market that can help that tissue be not as dry. And then in physical therapy, we look at, can those muscles contract?”

It’s important to note that lubricants and moisturizers can provide temporary relief from GSM symptoms, while vaginal estrogen can help thicken the lining of the vagina and promote natural lubrication. Vaginal estrogen hormone therapy also reduces the risk of UTIs. According to the Urology Care Foundation, vaginal estrogen should be the first-line treatment for GSM.

How Physical Therapy Can Help With GSM

Physical therapy for GSM is geared toward strengthening and rehabilitating muscles that are important for vaginal, urinary, and bowel function. “In the perimenopause, menopause transition, due to change in hormones that decrease in estrogen, the pelvic floor muscles start to atrophy,” explained Lanners. These muscles also weaken as we age.

In a study of 103 women, published in the Archives of Gynecology and Obstetrics, pelvic floor muscle training was found to significantly reduce symptoms such as vaginal dryness.

“Everyone is a little different and we can give you a specific program for the way your muscles are responding to get your specific symptoms better,” Lanners said. “Say you are an individual and you’re like, ‘Gosh, I have an overactive bladder. I’m going to the bathroom all the time. I have frequent urination.’ Your pelvic floor muscles might be a little tight, a little overactive.”

Lanners stressed that symptoms such as painful sex may be caused by other problems that a physical therapist can sometimes assess. “We’re going to look to see, OK, what’s going on in the low back? What’s going on in the hips? What’s going on in the abdomen? And then what’s going on directly in the pelvic floor?” she said.

Lifestyle Changes

Healthy lifestyle choices can also help relieve symptoms of GSM. Some steps you can take to protect your urinary and vaginal health include:

• Having regular sexual activity and taking time for arousal, with or without a partner, to preserve sexual health
• Quitting smoking, which lowers estrogen levels
• Avoiding cleansers and hygiene products that can irritate the vulva and vagina
• Maintaining a healthy weight because high weight is linked to poor pelvic floor muscle strength

Lanners also urges perimenopausal and postmenopausal women to become informed about GSM and treatment options that they discuss with their doctors. “I think receiving the education really can decrease anxiety levels and it can help a person know, ‘Oh, this is treatable,’” she said.