New Hope for Women Suffering from Genitourinary Syndrome of Menopause (GSM)

Despite affecting up to 85% of post-menopausal women, GSM continues to fly under the radar. A 2024 survey commissioned by New Zealand company Myregyna found 40% of women had never discussed their GSM symptoms with anyone, including their partner or doctor. Although there are numerous treatments available, it seems many are suffering in silence. “The loss of oestrogen in the genito-urinary area is a more slowly progressive problem, so it takes a while to appear,” says Christchurch endocrinologist Anna Fenton. “Many women are embarrassed to bring it up with their doctors and doctors are embarrassed to bring it up with them.” Even if a woman is on HRT treatment, she may still need to use a topical vaginal oestrogen. The funded product in New Zealand is commonly known as Ovestin although it has now been rebranded as 0.1% Estriol Cream. It contains a low dose of a weaker form of oestrogen and has minimal absorption into the bloodstream. A long-established and effective treatment, it is inserted using an applicator or finger but the downside is that the cream can be messy, melting and leaking out afterwards. Another issue is that vaginal oestrogen cream has always come with the same sort of medical warnings as systemic HRT treatment, despite it being considered safe to use. “The limited research we’ve got would suggest that for most women it’s fine,” says Fenton. “One group we are very cautious about are those who are on aromatase inhibitors, such as Letrozole or Anastrozole, to block oestrogen following breast cancer treatment. We also don’t have a lot of information with regard to endometrial or ovarian cancers. Most oncologists are reasonably comfortable with using it but generally we’ll try other options first.” As an alternative, non-hormonal vaginal moisturisers are widely available. Most are plant-based and compatible with the normal vaginal PH balance. “They can be really useful for a lot of women,” says Fenton. New Zealand-made, 100% natural products include Myregyna, a hydrating cream/dietary supplement combination. A recent independent clinical trial sponsored by Myregyna found that when the cream was applied daily for 56 days by women with moderate-to-severe GSM it led to a significant reduction of symptoms, including vaginal discomfort, dryness, sexual function and bladder function. There are also newer but unfunded hormonal treatments available that Fenton is prescribing more frequently. Intrarosa is a vaginal pessary which contains a form of DHEA, a natural hormone. Costs vary but it can be up to $108 a month. “The body metabolises DHEA into oestrogen and testosterone,” says Fenton. “It has been shown to have very significant effects on GSM symptoms like pain and burning and it prevents UTIs. But the other big advantage is that it improves sexual function.” Other user-friendly forms of vaginal oestrogens include a water-based gel, Blissel, a film-coated tablet called Vagifem and a silicone vaginal ring, Estring, that delivers a three-month supply of the hormone. All are available on prescription in New Zealand, but none are funded at this point. Overseas, a non-hormonal oral pill called Ospemifene is used to treat vaginal dryness and painful sexual intercourse. Fenton says clinicians realise post-menopausal women here need alternatives. “We’re limited, with Ovestin being the only funded option,” she says. “There are some women who get burning and stinging and can’t tolerate it, and we’ve repeatedly brought that up with Pharmac.” If left untreated, GSM is likely to worsen over time, leading to an increase in unpleasant symptoms and a higher risk of recurrent infections.