Genitourinary Syndrome of Menopause

This article, titled “Systematic Review of Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM): Clinical and Physiologic Outcomes,” was published in Obstetrics & Gynecology (Green Journal), April 2024 issue. You can access the full article here: Green Journal - GSM & Vaginal Estrogen Review.

The authors conducted a systematic review of 17 randomized controlled trials involving 3,753 menopausal women, primarily in the U.S., Canada, and Europe. The goal? To evaluate both subjective symptom relief and objective tissue or physiologic changes after treatment with vaginal estrogen, a frontline therapy for GSM.

GSM includes symptoms many of you are all too familiar with: vaginal dryness, burning, itching, painful intercourse, urinary urgency, and recurrent UTIs. Despite how common these symptoms are, GSM is underdiagnosed, under-treated, and—frankly—under-discussed.

💡 Why Does It Matter?
Let’s get into the good stuff—the takeaways you can use:

• ✅ Vaginal estrogen significantly improves symptoms: Across nearly all trials, women reported meaningful relief from dryness, burning, itching, and dyspareunia (pain with sex). These improvements were often clinically significant and lasted up to 12 months.
  
• ❗️However, the objective data is mixed: Measures like vaginal pH, epithelial thickness, or cell maturation index did not always correlate with symptom relief. In simpler terms—how your tissues “look” doesn’t always match how you feel.
  
• 📈 Some biomarkers, like vaginal maturation index and vaginal pH, improved in some studies—but not consistently across the board. This challenges older assumptions that symptom relief must be tied to cellular or hormonal metrics.
  
• 🔬 The review also noted a lack of long-term safety data for women with breast cancer, or for estrogen-sensitive conditions. This highlights a critical area for future research and the need for personalized, cautious treatment plans.

🌟 What This Means for You (and Me)

This study is a clinical game-changer in how we talk about and treat GSM.

Here’s what I want you to take away:

• Symptom relief is real and measurable, even if your vaginal tissue doesn’t “look” different under a microscope. That means your comfort and quality of life should drive treatment—not just lab markers.
  

• Objective findings can lag behind symptom improvement. Just because a vaginal swab doesn’t show increased cell turnover doesn’t mean estrogen isn’t working. In fact, this disconnect validates what so many of my patients report: “I feel better—even if no one else can see it.”

• We need to stop dismissing GSM symptoms. Too many women are told their concerns are “normal” or “just part of aging.” This study reminds us: GSM is a clinical syndrome with real pathophysiology—and real treatment options.

• For women who’ve had breast cancer or can’t use systemic estrogen, this review reinforces the urgent need for more targeted studies. Right now, we don’t have long-term safety data in these populations, which means careful, individualized plans—and shared decision-making—are critical.

• Consistency matters. Vaginal estrogen isn’t a “one-and-done” fix. The benefits come with consistent, ongoing use—usually 2–3 times per week. Think of it as hormone moisturization: you wouldn’t hydrate your face once and expect lasting results, right?
  
  

This isn’t about vanity. It’s about dignity, comfort, and autonomy. Whether you're struggling with vaginal dryness, pain during intimacy, or urinary urgency—there are evidence-backed treatments that can help. You deserve to feel well.

If you’ve been told “this is just what happens,” I’m here to tell you: we can do better.