Understanding Genitourinary Syndrome of Menopause (GSM)

GSM, also called menopause premature ovarian failure, is a complex syndrome of symptoms due to the lack of hormone production by ovaries during menopause.

This disorder can cause significant adverse effects on a woman’s quality of life and is associated with an increased risk of systemic and local cancer, cardiovascular disease and early mortality. This article discusses GSM: what it is, the most common symptoms, risk factors for developing this condition and potential treatments.

What is Genitourinary Syndrome of Menopause?

Genitourinary syndrome of menopause is a complex syndrome of symptoms that occur due to the ovaries’ lack of hormone production during menopause. The common symptoms experienced by women that have this syndrome are fatigue, hot flashes, osteoporosis, vaginal dryness and bothersome bleeding.

The International Menopause Society defines it as a disruption in female hormonal function with onset before 45 and less than three years after menopause.

Causes of GSM

There are two types of causes for GSM: primary and secondary.

• Primary cause results from an absence or deficiency of functioning ovarian hormones. Primary ovarian insufficiency (POI) results from a lack of functional estrogen hormone production.
• Secondary cause results from another underlying disease that interferes with the ovary’s function. For example, chronic inflammation and autoimmune diseases can interfere with ovarian function, causing hypoestrogenism.

Symptoms of GSM

Fatigue is the main symptom of genitourinary syndrome of menopause. The fatigue can be very severe and cause exhaustion, but it can be milder than this as well. In many women with this syndrome, the fatigue becomes so debilitating that they are hospitalized.

Menopausal hot flashes are the most common symptoms of GSM. There are two types of hot flashes, those that occur during the day, known as premenstrual or lunar hot flashes, and those that occur at night, called nocturnal or central sleep onset. It is also essential to distinguish between the mild and moderate hot flashes that occur naturally with menopause.
In some women, there is also bleeding from the vagina or cervix. Some women report bleeding from the ears, nose or eyes.

Treatments for GSM

There are no known cures for genitourinary syndrome of menopause, but some treatments have alleviated some of the symptoms, such as exercise and estrogen therapy. Exercise is beneficial in treating fatigue.

Estrogen therapy has also been shown to help with fatigue. In some women, estrogen therapy can cause vaginal bleeding or headaches that can be managed with nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen or acetaminophen.

Topical lubricants and moisturizers are used in treating vaginal dryness. These are applied to the vagina every few hours to help moisturize the tissue and maintain an average moisture balance.

Risk factors for GSM

Several factors increase the risk of developing GSM. The most common risk factor is aging. As women age, their hormone levels decline, and they are at increased risk for developing GSM. Women over 45 have a greater chance of developing this syndrome than those younger than this.
Cigarette smoking is associated with an increased risk for menopause before age 40 and changes the hormones in vaginal tissue, which can cause it to dry up earlier.

Obesity can also contribute to early menopause because it affects estrogen levels by increasing insulin resistance in tissues that respond to estrogen-like breast tissue and the liver. Chronic inflammation associated with a high-fat diet can interfere with the liver’s ability to produce estrogen.

Prevention of GSM

There is no way to prevent this syndrome. However, there are some steps that you can take to reduce your risk of developing GSM. One way to prevent premature menopause is to avoid cigarettes and other harmful substances that adversely affect your body. These substances can damage DNA and cause it to malfunction, which may make you prone to premature menopause.
If you are overweight or obese, losing weight can help prevent or delay menopause by reducing the amount of insulin resistance in your body and lowering estrogen levels.

Conclusion

Genitourinary syndrome of menopause is a syndrome of symptoms, the most common of which are fatigue and hot flashes. Menopausal hot flashes are more severe and can be debilitating to some women. Although there are no known cures for GSM, there are some methods that can reduce the severity of the symptoms, such as estrogen therapy, exercise and topical lubricants.