During our menopausal years, we can experience many symptoms such as brain fog, hot flashes, night sweats, insomnia, low libido, and emotional highs and lows- just to name a few. However, the symptoms of Genitourinary Syndrome of Menopause, better known as GSM can be particularly troublesome.
GSM is defined by the National Institute of Health (NIH) as the following:
“The genitourinary syndrome of menopause (GSM) is a relatively new term for the condition previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. The term was first introduced in 2014. GSM is a chronic, progressive, vulvovaginal, sexual, and lower urinary tract condition characterized by a broad spectrum of signs and symptoms. Most of these symptoms can be attributed to the lack of estrogen that characterizes menopause. Even though the condition mainly affects postmenopausal women, it is seen in many premenopausal women as well.”
Here are some of the symptoms of GSM:
- Vaginal dryness
- Vaginal burning
- Vaginal discharge
- Genital itching
- Burning with urination
- Urgency with urination
- Frequent urination
- Recurrent urinary tract infections
According to the 2020 Genitourinary Syndrome of Menopause (GSM) position statement of the North American Menopause Society,
“Genitourinary Syndrome of Menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life.”
Here are their 2020 recommendations for resolving some of these symptoms:
“Clinicians can resolve many distressing genitourinary symptoms and improve sexual health and the quality of life of postmenopausal women by educating women about, diagnosing, and appropriately managing GSM. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for the individual patient, and patient preference. Nonhormone therapies available without prescription provide sufficient relief for most women with mild symptoms. Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy, and ospemifene are effective treatments for moderate to severe GSM. When low-dose vaginal estrogen or DHEA or ospemifene is administered, a progestogen is not indicated; however, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data at present to confirm the safety of vaginal estrogen or DHEA or ospemifene in women with breast cancer; management of GSM should consider the woman’s needs and the recommendations of her oncologist.”
You can see from these recommendations that some women may be able to simply use moisturizers and lubricants to resolve these issues if they are minor. Local estrogen or DHEA therapy is best if you have more severe symptoms. However, there was a caveat for women who are breast cancer survivors.
The North American Menopause Society (NAMS) latest recommendations say, “For survivors of breast cancer with GSM, low-dose vaginal ET (estrogen therapy) or DHEA may be considered in consultation with their oncologists if bothersome symptoms persist after a trial on nonhormone therapy. There is increased concern with low-dose vaginal ET for women on AIs (Aromatase Inhibitors).”
As medicine and science evolve, recommendations change. I wanted to share this paper in the Journal of the National Cancer Institute reported in Medical Express, which states that “menopausal hormone therapy for breast cancer survivors is not associated with breast cancer reoccurrence.”
Here are some more key points:
“Hot flashes and night sweats, as well as vaginal dryness and urinary tract infections, plague breast cancer survivors frequently. These symptoms worsen the quality of life and can lead patients to discontinue therapy. These symptoms may be alleviated by vaginal estrogen therapy or menopausal hormone therapy. However, the safety of systemic and vaginal estrogen use among breast cancer survivors, particularly those with estrogen receptor-positive disease, has been unclear.
Many doctors caution breast cancer survivors against using menopausal hormone therapy following the demonstration of an increased risk of breast cancer recurrence in two trials in the 1990s. Though subsequent studies have not shown increased recurrence, such studies had serious limitations, including small sample sizes and short follow-up periods.
Researchers here investigated the association between hormonal treatment with the risk of breast cancer recurrence and mortality in a large cohort of Danish postmenopausal women treated for early-stage estrogen receptor-positive breast cancer.
The study included longitudinal data from a national cohort of postmenopausal women, diagnosed between 1997 and 2004 with early-stage breast cancer who received no treatment or five years of hormone therapy, as ascertained from Denmark’s national prescription registry.
Among 8461 women who had not received vaginal estrogen therapy or menopausal hormone therapy before a breast cancer diagnosis, 1957 and 133 used vaginal estrogen therapy or menopausal hormone therapy, respectively, after diagnosis. The researchers here found no increase in the risk of recurrence or mortality for those who received either vaginal estrogen therapy or menopausal hormone therapy.”
I think this cohort study will help crack open the conversation between doctors and breast cancer patients about the safety of vaginal estrogen therapy. I know it is hard to keep up with the changing philosophy. However, we must thank science for continuing to study and learn.
If you are experiencing some of the symptoms of GSM and have tried over-the-counter treatment to no avail, take this information in with you and have a conversation with your Oncologist and your Menopause Specialist. Your quality of life is very important.
Do not give up until you get the help you need and deserve!
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