Genitourinary Syndrome of Menopause (GSM): What Every Woman Should Know

Genitourinary Syndrome of Menopause (GSM) is a term used to describe a collection of symptoms and physical changes associated with the natural decline of estrogen and other sex hormones during menopause. Affecting 
approximately 50–70% of postmenopausal women, GSM can significantly impact quality of life—yet it remains widely underdiagnosed and undertreated.

Understanding the Cause 

GSM occurs as a result of reduced estrogen levels, which play a key role in maintaining the health and integrity of the vaginal and urinary tissues. With the hormonal shift of menopause, the tissues of the vulva, vagina, bladder, and lower urinary tract become thinner, drier, and less elastic. Blood flow to these areas diminishes, leading to reduced natural lubrication and a slower healing response. In addition, the vaginal microbiome is altered, and vaginal pH often rises, increasing the risk of irritation and infection.
Several other factors can exacerbate GSM symptoms, including smoking, lack of sexual activity, use of anti-estrogen medications (such as those used in breast cancer treatment), and exposure to pelvic radiation or chemotherapy. 

Recognizing the Symptoms

GSM manifests in a range of vaginal and urinary symptoms. Vaginal symptoms may include dryness, itching, burning, irritation, reduced lubrication, vaginal tightness or laxity, and pain during intercourse (dyspareunia). Urinary symptoms often involve increased urgency or frequency, burning during urination (dysuria), recurrent urinary tract infections (UTIs), and urinary incontinence (either stress or urge-related).
Because GSM affects multiple systems and can present differently in each individual, the condition is often overlooked or misattributed to aging or unrelated concerns. 

Diagnosis

Diagnosis of GSM is typically based on a combination of a patient’s symptoms, medical history, and physical examination. During a pelvic exam, a healthcare provider may observe signs such as pale, thin vaginal tissue, decreased elasticity, and reduced moisture. A vaginal pH test may be performed, and if infections are suspected, urinalysis or additional testing may be recommended. Importantly, many women hesitate to bring up these symptoms—making open communication essential.

Treatment Options

Non-Hormonal Treatments:
▪ Vaginal moisturizers used regularly can help hydrate the vaginal tissues.
▪ Lubricants (water or silicone-based) are helpful for reducing discomfort during intercourse.
▪ Pelvic floor physical therapy is another supportive option, especially for urinary symptoms or discomfort associated with pelvic floor dysfunction

Hormonal Treatments:
The gold standard for GSM treatment is low-dose vaginal estrogen therapy. This treatment is safe and effective for most women and is available in several forms including:
▪ Creams: Premarin, Estragyn
▪ Tablets: Vagifem
▪ Vaginal rings: Estring
Other hormonal therapies include DHEA vaginal suppositories that boost local estrogen and androgen activity. In some cases, systemic hormone therapy (such as oral or transdermal estrogen) may be used, particularly if GSM coexists with other menopausal symptoms.

Lifestyle Tips & Preventive Measures

Simple lifestyle adjustments can help support vaginal and urinary health:
▪ Maintain regular sexual activity, which helps preserve blood flow and tissue elasticity.
▪ Perform pelvic floor exercises (Kegels) to strengthen muscles and improve urinary control.
▪ Avoid irritants such as scented soaps, douches, and synthetic underwear.
Additional self-care tips:
▪ Wear breathable cotton underwear and use cotton menstrual products.
▪ Clean the vulva with lukewarm water only—no soap required.
▪ After urination, rinse with cool water and pat dry gently.
▪ Apply a simple, fragrance-free emollient (like vegetable oil or Vaseline) to lock in moisture and protect the skin.

In Conclusion

While hot flashes may fade, GSM symptoms typically persist—and often worsen—without treatment. 
The good news is that GSM is both diagnosable and highly treatable. With the right care plan, many women find relief from discomfort and regain confidence in their sexual and urinary health.
The most important step is starting the conversation. If you’re experiencing any symptoms related to GSM, don’t hesitate to speak with your healthcare provider. With awareness, compassionate care, and effective treatment options, women can feel empowered to reclaim their comfort and well-being at every stage of life.

Article written by:

Wendy Hildebrand, Nurse Practitioner

Wendy Hildebrand is a Nurse Practitioner based in Victoria, BC, with over two decades of diverse nursing experience spanning medical-surgical, palliative, maternal-child health, and public health. Her passion lies in supporting and empowering women through the complex transitions of midlife with evidence-based education and compassionate care. Wendy brings a warm, collaborative approach to her work with sanoMidLife, where she is proud to partner with women on their journey toward renewed health, confidence, and well-being.