Name two local therapies for GSM.

• A. Oral calcium and vitamin D
• B. Systemic hormone therapy
• C. Topical corticosteroids
• D. Vaginal estrogen and moisturizers

Answer: (D)

GSM affects the vaginal and vulvar tissues because estrogen levels have fallen, so the goal is to restore the health of the mucosa right where symptoms live. Local therapies deliver treatment to the vaginal area with minimal systemic absorption, addressing the thinning, dryness, and irritation directly.

Vaginal estrogen is a local therapy because it places estrogen right in contact with the vaginal epithelium. This stimulates the lining to thicken, improves elasticity, increases moisture, and lowers the pH to a healthier level. The result is relief from dryness, irritation, and painful intercourse, with low systemic exposure.

Moisturizers are another local, non-hormonal option. They hydrate and maintain vaginal moisture on a daily basis, helping with ongoing comfort and reducing friction during activities. They don’t introduce hormones, so they’re suitable for people who prefer or require non-hormonal management.

The other choices don’t fit as local therapies for GSM. Oral calcium and vitamin D support bone health, not vaginal tissue. Systemic hormone therapy provides hormones throughout the body, not just the vaginal area. Topical corticosteroids target inflammation and are not standard first-line treatments for GSM itself, and long-term use can thin skin or cause other issues.