Women’s Hormone Care • Board-Certified Internal Medicine
GSM & Vaginal Atrophy Treatment in Los Angeles
Genitourinary syndrome of menopause (GSM) is the modern term for a group of menopause-related changes that can affect the vulva, vagina, urethra and bladder. Symptoms may include vaginal dryness, burning or irritation, discomfort with intercourse, changes in lubrication and urinary symptoms.
David Nazarian, M.D., Board Certified in Internal Medicine, provides individualized evaluation for women in Los Angeles and Beverly Hills. Treatment is selected according to symptoms, medical history, examination findings when indicated, prior treatments and personal preferences.
What Is Genitourinary Syndrome of Menopause?
GSM describes genital, sexual and lower urinary-tract symptoms associated with the hormonal changes of menopause and, for some women, perimenopause. The older term vaginal atrophy focuses mainly on thinning and dryness of vaginal tissues, while GSM is broader because symptoms can also involve the vulva, urethra and bladder.
Unlike hot flashes, GSM symptoms do not necessarily improve with time and may become more noticeable without effective treatment. Symptoms can also overlap with infections, dermatologic conditions, pelvic-floor problems and other gynecologic or urinary disorders, which is why persistent or new symptoms deserve appropriate evaluation.
Common GSM and Vaginal Atrophy Symptoms
Dryness, Burning & Irritation
Vaginal or vulvar dryness, itching, burning, irritation, tenderness or a sensation of tissue fragility.
Pain With Sexual Activity
Reduced lubrication, discomfort with penetration, painful intercourse or soreness after sexual activity.
Urinary Symptoms
Urinary urgency, frequency, burning with urination or recurrent urinary symptoms may occur and should be evaluated to distinguish GSM from infection or other urinary conditions.
A Focused Medical Evaluation
History & Symptom Review
Menstrual and menopause status, symptom pattern, sexual and urinary symptoms, medications, prior treatments, cancer history, gynecologic history and treatment goals are reviewed.
Examination or Testing When Needed
A pelvic examination, urinalysis, infection testing or other evaluation may be appropriate when symptoms are new, persistent, atypical or not responding as expected. Not every patient needs the same tests.
Treatment Options Are Individualized
Moisturizers & Lubricants
Regular vaginal moisturizers and lubricants used with sexual activity can be useful first-line options for dryness and friction-related discomfort, particularly when symptoms are mild.
Low-Dose Vaginal Estrogen
Prescription low-dose vaginal estrogen is a local therapy commonly used for moderate to severe GSM symptoms. Available formulations can include creams, tablets or inserts, and rings. Selection depends on symptoms, preferences and medical history.
Other Prescription Options
Depending on the clinical situation, other options may include vaginal prasterone (DHEA), ospemifene or treatment directed at pelvic-floor dysfunction or another contributing condition.
Local Therapy vs. Systemic Hormone Therapy
When vaginal, vulvar or urinary GSM symptoms are the main concern, local treatment may be considered without using systemic hormone therapy. Systemic menopausal hormone therapy may be appropriate for selected women who also have bothersome hot flashes, night sweats or other indications, but the decision involves a different benefit-and-risk discussion.
Women with a personal history of breast cancer or another hormone-sensitive cancer need an individualized discussion. Nonhormonal options are often considered first, and decisions about local hormone treatment may involve coordination with the patient’s oncology team.
Why Symptoms Should Not Be Self-Diagnosed
Dryness, burning, pain and urinary symptoms are common in GSM, but they are not specific to menopause. Yeast or bacterial infections, urinary tract infections, vulvar skin conditions, medication effects, pelvic-floor dysfunction and other gynecologic or urologic conditions may produce similar symptoms.
A focused evaluation helps identify the likely cause and avoids treating every symptom as a hormone problem.
Frequently Asked Questions About GSM
Is vaginal atrophy the same as GSM?
Vaginal atrophy is an older, narrower term describing thinning, dryness and loss of elasticity of vaginal tissues related to lower estrogen levels. GSM is broader and includes vulvar, vaginal, sexual and lower urinary-tract symptoms.
Can GSM cause painful sex?
Yes. Reduced lubrication and changes in vulvovaginal tissues can contribute to discomfort or pain with penetration. Other causes of pain should also be considered when symptoms are persistent or atypical.
Do I need systemic HRT for vaginal dryness?
Not necessarily. If GSM symptoms are the main concern, local or nonhormonal treatment may be appropriate. Systemic hormone therapy is considered separately based on the patient’s overall menopause symptoms, health history and risk factors.
What treatments are available besides vaginal estrogen?
Options can include vaginal moisturizers, lubricants, vaginal prasterone, ospemifene, pelvic-floor therapy when appropriate and treatment of other contributing conditions.
Should urinary burning always be treated as GSM?
No. Urinary burning can also result from infection or other urinary conditions. New or persistent urinary symptoms may need urinalysis or other evaluation before treatment is selected.
Can women with a history of breast cancer receive treatment?
Management is individualized. Nonhormonal options are often considered first. Depending on symptom severity, cancer history and prior treatment, local therapies may be discussed with appropriate shared decision-making and oncology coordination.
Related women’s hormone care: Perimenopause · Menopause · Progesterone Therapy · Hormone Testing
Schedule a GSM & Vaginal Atrophy Consultation
Discuss vaginal dryness, painful intercourse, urinary symptoms or other menopause-related concerns with David Nazarian, M.D., in Beverly Hills.
