madman
Super Moderator
In this interview, Dr. Amy Pearlman explains genitourinary syndrome of menopause in a clear and practical way. Genitourinary syndrome of menopause is a chronic condition driven by estrogen deficiency after menopause and can present with vaginal dryness, burning, irritation, pain with sex, urinary urgency, frequency, and recurrent urinary tract infections. It is extremely common, yet often underdiagnosed and undertreated.
Dr. Pearlman also reviews non hormonal treatment options, including lubricants, moisturizers, and pelvic floor physical therapy, which can provide meaningful improvement, especially in milder cases.
The conversation addresses one of the most common areas of confusion, the difference between vaginal hormone therapy and systemic hormone therapy. Prescription topical options include low dose vaginal estrogen, vaginal dehydroepiandrosterone, and vaginal testosterone, all of which target the underlying issue of reduced local estrogen and testosterone in the genital tissues. Vaginal hormone therapy works locally with minimal systemic absorption and is considered the gold standard for treating these symptoms.
In contrast, systemic hormone therapy affects the entire body and is used to treat symptoms such as hot flashes. Formulations such as transdermal estradiol, oral micronized progesterone, and transdermal testosterone are often favored when appropriate due to their safety profiles. Importantly, many women on systemic therapy still benefit from adding vaginal hormone therapy for persistent symptom
