Genitourinary Syndrome of Menopause (GSM)

Genitourinary Syndrome of Menopause (GSM) is a newer term for the symptoms commonly associated with the histologic/physiologic changes associated with vaginal atrophy and genital estrogen loss. These symptoms generally start at menopause and then progressively worsen. Effective hormonal treatments include vaginal estrogens (Estrace, Premarin, Estradiol, Intrarosa). Unfortunately, many women either don’t want to, or can’t, use hormonal treatments.

Common Symptoms:

  • Vaginal Dryness, burning, irritation
  • Loss of vaginal lubrication
  • Discomfort/dryness during intercourse
  • Urinary urgency and mild stress incontinence
  • External dysuria (pain/irritation at urethral opening while urinating)
  • Recurrent urinary tract infections (UTI)

Between 45-63% of postmenopausal women report experiencing symptoms of GSM. The REVIVE study reported that vaginal symptoms negatively affected enjoyment of sexual activity (59%), sleep (24%), and overall enjoyment of life (23%)

Unlike hot flashes, which generally improve with time, GSM symptoms get progressively worse after menopause – this will not just go away and generally requires treatment.

Breast Cancer survivors
Gynecologic Cancer survivors
Women with recent history of:

  • Myocardial Infarct (heart attack)
  • Cerebrovascular Accident (stroke)
  • Bleeding/Clotting disorders
  • Chronic Liver Disease

Fractional CO2 Vaginal Laser Therapy is a safe and effective non-hormonal treatment for GSM. This treatment is safe for women who can’t use estrogen/hormone therapy options.

Fractional CO2 Vaginal Laser Therapy

Fractional CO2 vaginal laser therapy is an effective treatment option for women who either don’t want to, or can’t, use hormone therapies. It is completely non-hormonal and is safe for women who can’t use Estrogen such as breast cancer survivors, gynecologic cancer survivors, stroke/heart attack survivors, etc…. It is a safe and precise therapy for vaginal tissue and only acts on the most superficial layers of vaginal skin to cause change.

Several years of studies have demonstrated persistent benefit for women using fractional CO2 vaginal laser therapy. Over 90% of women remained satisfied or extremely satisfied 1 year after treatment. Breast cancer survivors who were treated with fractional CO2 vaginal laser therapy showed significant improvement in vaginal dryness, itching/stinging, pain with intercourse, and dysuria. These benefits have been demonstrated with several different C02 laser machines over a prolonged time period and are based on improvement in validated questionnaires, examination, and microscopic evaluation of tissue specimens.

A special type of CO2 laser delivers pulses of focused laser energy to the vaginal epithelium in order to stimulate collagen + elastin neogenesis, increase blood flow, and create a thickened and normalized epithelium. Essentially, the fractional CO2 laser creates microscopic pinholes in the vaginal epithelium and heats surrounding tissue on a superficial microscopic level to induce tissue change, growth, and release of growth factors.

Fractional CO2 vaginal laser therapy is painless and uses a small probe a little wider then a quarter which easily passes into the vagina. This probe uses a sterile probe cover that is only used for that specific patient (this prevents contamination between patients and is different from other similar devices). The treatment itself is done in our office and takes approximately 5-10 minutes from start to finish with no anesthesia necessary. A total of 3 of these treatments (each a month apart) is required to compete therapy. A women can go back to work, life, etc… right after treatment and there are very few immediate post treatment restrictions other than a few days of vaginal rest.

No, TermiVa uses low frequency/long wavelength radiofrequency energy to heat tissue and cause tissue shrinkage/tightening. While it is still unclear if this therapy causes enough temperature change to cause remodeling, it should be understood that even in the best case scenarios this type of treatment is aimed at improving vaginal laxity complaints rather than treating genitourinary syndrome of menopause (GSM). This is an important difference to understand.

Unfortunately, it is not covered by insurance companies at this time. At First Coast Urogynecology we help subsidize the cost of treatment for women with a history of Breast Cancer, Gynecologic Cancer, or other medical reason which prevents them from using Estrogen. It’s not their fault they can’t use Estrogen and we want to do what we can to help. Ask our staff about this program if applicable.

Tissue Changes After CO2 Laser Therapy

Premenopausal Vaginal Tissue

This is a slide of typical premenopausal tissue. Things to notice are thickness of epidermis (top lighter part) and rete pegs (the areas that project into lower tissue)

Postmenopausal Vaginal Tissue

Notice the thin epidermis (top darker layer) and loss of rete pegs (loss of those extensions down into tissue) that comes with menopause.

After CO2 Laser Therapy

Notice how after fractional CO2 laser therapy there is a return to thicker epidermis (top part) and return of rete pegs (the extensions down into tissue from epidermis).

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At First Coast Urogynecology we are committed to improving the lives of our patient’s every day. We understand improving our patient’s quality of life comes not only from treating disease but also increasing pelvic floor wellness through education, therapy, and encouragement.

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Dr. Epstein and his staff have been focused on helping women with pelvic floor disorders for over a decade. Let us help you achieve your goals.

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