What is the impact of GSM?
Genitourinary syndrome of menopause (GSM) describes a range of genital, sexual, and urinary symptoms arising due to reduced oestrogen levels during perimenopause and postmenopause. Symptoms include vaginal dryness, pain during sex, urinary frequency, and recurrent urinary tract infections (UTIs) that can disrupt daily living, intimacy, sleep, and self-esteem.1 Unlike vasomotor symptoms, GSM tends to be progressive and irreversible without appropriate treatment.2 Estimates of GSM prevalence vary between 13% and 87% for those aged >40 years.3
Moisturisers, lubricants, and local oestrogen preparations are cheap, safe, and effective treatments. Local (vaginal) oestrogen has been shown to improve vaginal dryness dysuria, frequency, urge, and stress incontinence, and reduce recurrent UTIs in menopausal patients.4 They are underutilised, with only 4%–35% of those affected using treatment.3 Individuals in the UK are less likely than their European counterparts to seek advice from a healthcare professional for their symptoms, despite similar reported prevalence.5 This highlights the need for practitioners to proactively ask about GSM symptoms in those presenting with an individual GSM symptom or other menopausal presentations.
How to diagnose GSM in primary care?
Diagnosis is clinical, based on a history of typical symptoms that may be accompanied by signs on examination. Clinicians should take note of pre-existing skin conditions, vulval skin products, previous birth trauma, and/or prolapse that may contribute to symptoms and make alternative diagnoses more likely.
Examination is always advised, in particular if patients report lumps, sores, and bleeding, which can be associated with vulval intraepithelial neoplasia, requiring urgent referral.
Examination findings in early disease can be subtle and difficult …
