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Many women experience changes in vaginal health during menopause, often due to declining estrogen levels. These changes can lead to symptoms collectively known as genitourinary syndrome of menopause (GSM) [1]. GSM can affect the vulva, vagina, and lower urinary tract, potentially causing dryness, irritation, pain during intercourse, and urinary symptoms [2].
Fortunately, various hormone therapy options are available to help manage these symptoms and improve vaginal health. This article will explore different approaches, including localized and systemic hormone therapies, and discuss their considerations based on current evidence.
What is Genitourinary Syndrome of Menopause (GSM)?
Genitourinary Syndrome of Menopause (GSM) is a common condition resulting from decreased estrogen and other sex steroid levels that occur with menopause [1]. These hormonal changes can lead to alterations in the tissues of the vulva, vagina, and lower urinary tract, which become thinner, less elastic, and have reduced blood flow and lubrication [2].
Symptoms of GSM can significantly impact quality of life, including vaginal dryness, burning, itching, discomfort or pain during sexual activity (dyspareunia), and urinary urgency, frequency, and recurrent urinary tract infections [2].
Localized Vaginal Estrogen Therapy
Localized vaginal estrogen therapy is a highly effective option for addressing GSM symptoms directly [3]. This approach delivers estrogen directly to the vaginal tissues, helping to restore their health and function without significant systemic absorption [2].
Available forms of localized vaginal estrogen include creams, rings, and tablets [2]. These methods can improve vaginal dryness, reduce pain during intercourse, and alleviate other symptoms of GSM [3]. For women with a history of breast cancer, vaginal estrogen therapy is generally considered safe, with minimal systemic absorption, and can be an important option for managing GSM symptoms [PMID 37535961, PMID 35316932].
Systemic Hormone Therapy
Systemic hormone therapy (HT), which includes estrogen taken orally, transdermally (e.g., patches, gels), or via other routes, can also improve vaginal health as part of its broader effects on menopausal symptoms [2]. When systemic HT is used for other menopausal symptoms like hot flashes, it often addresses vaginal symptoms as well.
However, for women whose primary or only menopausal symptom is related to vaginal health, localized vaginal estrogen therapy is generally preferred due to its targeted action and lower systemic exposure [2]. The decision to use systemic HT should involve a discussion with a healthcare provider to weigh potential benefits against individual health considerations.
Ospemifene: A Non-Estrogen Hormone Therapy Option
Ospemifene is an oral medication that acts as a selective estrogen receptor modulator (SERM) [4]. It is approved for the management of moderate to severe dyspareunia (painful intercourse) and vaginal dryness due to menopause [5]. Ospemifene works by stimulating estrogen receptors in the vaginal tissue, helping to improve the thickness and moisture of the vaginal lining [4].
Studies have shown ospemifene to be effective in improving symptoms of vulvovaginal atrophy, including reducing vaginal dryness and pain during intercourse [5]. It may be an option for women who cannot or prefer not to use localized estrogen therapy, including some breast cancer survivors, though specific considerations apply [6].
Considering Other Hormone Therapy Approaches
While not strictly estrogen, dehydroepiandrosterone (DHEA) is another hormone therapy option available as a vaginal insert for GSM [7]. DHEA is a steroid hormone that is converted into estrogens and androgens within the vaginal cells, helping to improve vaginal tissue health [8].
Vaginal DHEA has been shown to improve symptoms of vaginal dryness and painful intercourse associated with menopause [8]. Similar to localized estrogen, it offers a targeted approach to improving vaginal health with minimal systemic absorption [8].
References
- The genitourinary syndrome of menopause. Menopause (New York, N.Y.), 2021
- The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause (New York, N.Y.), 2020
- Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2022
- Ospemifene efficacy and safety data in women with vulvovaginal atrophy. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2020
- Ospemifene for the treatment of vulvar and vaginal atrophy: A meta-analysis of randomized trials. Part I: Evaluation of efficacy. Maturitas, 2019
- Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors: A Systematic Review and Update. Pharmaceuticals (Basel, Switzerland), 2023
- Medical Treatment of Female Sexual Dysfunction. The Urologic clinics of North America, 2022
- The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. The Journal of urology, 2025
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease. Content is for informational purposes only and is not medical advice; consult a qualified healthcare provider before starting any supplement. As an Amazon Associate we earn from qualifying purchases.
