How can you distinguish lichen sclerosus from genitourinary syndrome of menopause (GSM)?
Lichen sclerosus and GSM can feel similar at first because both can cause itching and discomfort, but they’re actually quite different conditions. Here at Alloy, we see this come up a lot, especially because GSM is so common during perimenopause and menopause.
Lichen sclerosus is an inflammatory skin condition. It typically causes very persistent, often intense itching along with thin, pale, or white patches on the vulva. Cracks or small tears can appear, and some people notice the itching being worse at night. It needs a specific medication, usually a high potency steroid cream, to get better. Vaginal estrogen on its own won’t treat it, though it’s definitely safe to use alongside other treatments.
GSM, on the other hand, is caused by the drop in estrogen during menopause. Symptoms tend to include vaginal dryness, burning, itching, urinary frequency, and pain with sex. The tissues become thinner and less elastic. GSM responds really well to vaginal estrogen, which you can use both inside the vagina and directly on the vulva if that’s where the symptoms are.
One of the clearest ways to tell the two apart is that GSM should start improving within a few weeks to a few months of consistent vaginal estrogen. If you’re using it correctly and still have ongoing or worsening itching, it’s important to get a careful vulvar exam to check for lichen sclerosus. Dr. Corinne Menn talks about this in detail in one of our YouTube chapters, which you can watch here: Lichen sclerosus vs. GSM.
If GSM turns out to be the issue, vaginal estrogen cream is one of the most effective treatments. You can read more about it or start a plan at our estradiol vaginal cream page: estradiol vaginal cream.
Estradiol Vaginal Cream
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