Lichen Sclerosus & Menopause: What’s the Difference?

Introduction

A common question we hear at Lichen Sclerosus Support Network is, “What is menopause/genitourinary syndrome of menopause (aka GSM), and how do I know if that is causing my symptoms or changes to my vulva or if it’s lichen sclerosus? And this is an important question. 

Unfortunately, most conditions that affect the vulva have overlapping symptoms.

For example, if you Google “symptoms of GSM,” “symptoms of lichen simplex chronicus,” “symptoms of yeast (candidiasis),” etc., they will all come back with itch and pain as primary symptoms.

In this post, I will discuss what menopause is, what GSM is, and the changes that can occur to the vulva from GSM. I will highlight some differences between GSM and lichen sclerosus 

*This post is evidence-based; I draw on the medical literature to share what you need to know about menopause, genitourinary syndrome of menopause, and lichen sclerosus. Importantly, what I share is my interpretation of the science and data. 

Always speak to your healthcare provider before making any changes to your health plan.

**Further, this post is an introductory/overview piece and doesn't capture the full complexity of menopause; stay tuned for more content in the future.

Why Isn’t This Discussed More?

Let’s start with the question, “What is menopause”?

This is an excellent question because many people cannot answer it.

I don’t know about you, but the word ‘menopause’ was never discussed in my school. Not once in sex education did I encounter a discussion about this topic – just a lot of fear-mongering about STIs and pregnancy.

It was also never something that was discussed in my home. The most information I had about menopause growing up – and, frankly, until recently – was I would go through it later, get hot flashes, and act ‘erratically.’

Yeah, I know, that’s a pretty poor education I grew up with. 

What is Menopause?

Firstly, some semantics. Menopause is not a disease. It is a normal, natural event that occurs later in life when you miss your period for 12 consecutive months (without any apparent reasons explaining the lack of menstruation). This period marks the end of fertility. This period is associated with a reduction in the functioning of the ovaries, which lowers estrogen levels (NAMS, 2023). 

For many folks, menopause occurs between the ages of 45 and 55, but for many, it can be earlier or later; everyone is different.

The menopause journey, however, is complex and has three main phases – perimenopause, menopause, and post-menopause. Folks may experience different symptoms in each of these phases. 

Symptoms of Menopause

According to the ‘Let’s Talk Menopause’ website, menopause symptoms fall into four categories.

1. Physical symptoms
2. Cognitive symptoms
3. Mood symptoms
4. Urinary/sexual symptoms (i.e., genitourinary syndrome of menopause)

Physical symptoms may include hot flashes, chills, night sweats, joint pain, thinning hair, dry skin, etc. Cognitive symptoms may include brain fog and memory issues. Mood symptoms may consist of anxiety, irritability, etc. Urinary and sexual symptoms may include chronic urinary tract infections, low libido, painful sex, vaginal dryness, etc.

These lists are incomplete. Check out this link for a menopause symptom sheet.

What is GSM?

Let’s build on the GSM symptoms, as they are the ones that share a lot in common with lichen sclerosus. 

What is GSM?

GSM is a relatively new term that was first introduced in 2014 at the International Society for the Study of Women’s Sexual Health (Angelou et al., 2020). GSM is a chronic, progressive condition that affects the vulva, vagina, and lower urinary tract (ibid). 

There are a variety of signs and symptoms that comprise GSM.

Signs and symptoms of GSM include but are not limited to:

• Vaginal dryness
• Vulvovaginal itching, burning, irritation
• Thinning/graying of the pubic hair
• Vaginal and/or pelvic pressure
• Pain with sex
• Bleeding after sex with insertion
• Loss of libido
• Decreased arousal
• Urinary urgency
• Stress/urge incontinence
• Recurrent urinary tract infections.

(Ibid).

Anatomical Changes

GSM can cause anatomical/architectural changes. These include but are not limited to:

• Thinning of labia minora
• Reduced/loss of labia minora
• Loss of volume in the labia majora (they may appear flatter and deflated)
• Decreased elasticity 
• Dry and thin skin
• Shortened and narrowed vagina
• Prolapse (vaginal, urethral, etc.)

(Ibid)

Overlap of GSM signs and symptoms with Lichen Sclerosus Signs and Symptoms

Now, if you’re sitting here thinking, “Hold up, a lot of this sounds like lichen sclerosus,” you are correct. There are many overlapping signs and symptoms of lichen sclerosus and GSM.

For example, GSM and lichen sclerosus can cause symptoms like itch, burning, and discomfort. Further, both GSM can cause architectural changes to the vulva. Both are chronic conditions that will continue to progress without treatment.

Misdiagnosis: Is it Menopause or Lichen Sclerosus?

Folks are commonly misdiagnosed with yeast or menopause when they actually have lichen sclerosus. This is likely because many of the symptoms and signs overlap. This is why finding a healthcare provider specializing in genitopelvic conditions is critical. These specialists can tease apart overlapping symptoms and make an accurate diagnosis – and, by the way, there may be multiple diagnoses to be made.

Conversely, I know some folks diagnosed with lichen sclerosus, only to find out later this diagnosis was inaccurate and their symptoms were due to GSM.

What To Do If You Aren’t Sure if Your Signs/Symptoms are Due to GSM or Lichen Sclerosus

Suppose you were diagnosed with lichen sclerosus and are moving through perimenopause/menopause and start experiencing new vulvovaginal, sexual health, and urinary symptoms. In that case, bringing this up with a doctor is critical. Ideally, this discussion would take place with a doctor specializing in genitopelvic conditions and who is NAMS – the North American Menopause Society – certified. You can find more information on NAMS and finding a NAMS provider here.

GSM is not treated with topical corticosteroids like lichen sclerosus. Therefore, if you assume any/all sexual/urinary/vulvovaginal symptoms are lichen sclerosus when they are, in fact, GSM, the steroids will not improve your condition. Conversely, treatments for GSM will not help lichen sclerosus. This is why it’s fundamental to know if your symptoms are due to lichen sclerosus, GSM, or both. 

Treatments for GSM typically involve vaginal estrogen. More recently, vaginal DHEA (e.g., Intrarosa) and Ospemifne, a selective estrogen receptor modulator (aka a SERM), are being prescribed (Suckling et al., 2006, Angelou et al., 2020). 

For folks with lichen sclerosus and GSM, the two are treated separately. Many folks use steroids for lichen sclerosus and vaginal estrogen, vaginal DHEA, and/or SERMS for GSM.

Menopause Resources

Organizations

NAMS website

Let’s Talk Menopause Website

Provider Directory

NAMS provider directory

Podcasts

You are Not Broken Podcast by Kelly Casperson

Blogs

Dr. Jen Gunter’s the Vajenda Blog

Conclusion on Menopause and Lichen Sclerosus

In sum, it is not easy having a vulva or vagina. There are so many vulvovaginal conditions that have overlapping symptoms and signs. This makes it hard for us to realize when our symptoms are from LS, menopause, or something else. If you suspect your symptoms may be caused by GSM, be sure to book an appointment with a NAMS certified doctor or doctor who specializes in genitopelvic conditions.

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Reach Out to Me

Whether you are debating booking a support call with me, have a quick question, or want to share something related to my content, I can be reached via:

Email: Jaclyn@lostlabia.com

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Sources Cited & Consulted

Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020 Apr 8;12(4):e7586. doi: 10.7759/cureus.7586. PMID: 32399320; PMCID: PMC7212735.

James H. Pickar, “Emerging therapies for postmenopausal vaginal atrophy,” Maturitas, Volume 75, Issue 1, 2013, Pages 3-6, ISSN 0378-5122,https://doi.org/10.1016/j.maturitas.2013.01.020.

Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015 Aug;21(2):65-71. doi: 10.6118/jmm.2015.21.2.65. Epub 2015 Aug 28. PMID: 26357643; PMCID: PMC4561742.

Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001500. doi: 10.1002/14651858.CD001500.pub2. Update in: Cochrane Database Syst Rev. 2016;8:CD001500. PMID: 17054136.

NAMS – site accessed May 2nd, 2023

Let’s Talk menopause – site accessed May 2nd, 2023