Genitourinary syndrome of menopause (GSM) is a collection of vaginal and urinary symptoms caused by declining estrogen. It can lead to discomfort and changes that affect daily life and intimacy.
*All images feature a model portrayal
(unless otherwise noted).
Genitourinary syndrome of menopause, sometimes called atrophic vaginitis or vulvovaginal atrophy, is a common but often overlooked women’s health condition that occurs during or after menopause.
According to The North American Menopause Society, GSM affects about 27 to 84 percent of postmenopausal women.
GSM can cause uncomfortable vaginal and urinary symptoms that disrupt intimacy and impact overall well-being. The good news is that effective treatments exist, and with the right care, you can find meaningful relief.
GSM can affect both your vagina and urinary tract, leading to a wide range of symptoms that can interfere with everyday comfort and overall quality of life. These symptoms often start gradually during or after menopause and tend to stick around, or worsen, if you don’t get treatment, but every woman is different.
Here are the types of genitourinary symptoms you might experience with GSM.
Vaginal and vulvar symptoms:
Vaginal dryness, burning, or irritation
Vulvar itching or discomfort that can make sitting, walking, or exercise uncomfortable
Thinning or tightening of vaginal tissues, which can make gynecological exams or sex painful
Pubic hair turning gray and/or thinning
Sexual symptoms:
Painful intercourse (called dyspareunia) due to reduced lubrication
Loss of libido (sex drive)
Sexual dysfunction, like the inability to achieve an orgasm
Urinary symptoms:
Frequent urination, both during the day and overnight
Urinary urgency or difficulty holding urine
Dysuria (painful urination)
Stress or urge urinary incontinence (leakage of urine with coughing, sneezing, or sudden urges)
Recurrent urinary tract infections (UTI)
Urethral caruncle (red noncancerous growth on the opening of your urethra)
Beyond general physical discomfort, GSM can make it harder to sleep comfortably, limit physical activity, make social gatherings less enjoyable, and put a strain on your intimate relationships. Many women also describe feeling embarrassed or frustrated by their symptoms.
Symptoms of GSM are common, but they’re also often underreported. If you’re dealing with any of these, it’s important to know that effective treatments are available and that you don’t have to accept GSM as a normal part of aging.
There’s evidence that, left untreated, GSM can cause urogenital tissue changes that can be difficult to reverse — another reason to bring up your symptoms with your healthcare provider.
The primary cause of genitourinary syndrome of menopause is the natural decline in estrogen levels that happens during and after menopause. Estrogen, a primary female reproductive hormone, plays a major role in maintaining your vaginal and urinary tissue health.
When estrogen levels drop, several changes take place:
Thinning of vaginal tissues. The lining of the vagina becomes thinner, less elastic, and more fragile, which can cause irritation, dryness, and discomfort.
Reduced natural lubrication. Lower estrogen means less vaginal moisture, leading to painful intercourse and increased friction.
Changes in vaginal pH. The loss of estrogen alters the balance of healthy bacteria, increasing your risk of irritation and urinary tract infections.
Weakening of urinary tissues. Estrogen supports the bladder and urethra. Without it, you might experience urinary urgency, frequency, incontinence, or recurrent infections.
While menopause is the most common trigger, GSM can also affect:
Women who have had their ovaries removed (a surgical procedure that causes menopause)
Those undergoing cancer treatments that reduce estrogen (such as chemotherapy, radiation, or hormone therapy for breast cancer)
Anyone with significant hormonal changes
Not every woman will experience GSM, but if you do, symptoms can continue after menopause.
While any perimenopausal or postmenopausal woman can develop GSM after estrogen levels decline, the following can increase your risk:
Natural menopause. This is the most common risk factor for developing GSM, as estrogen levels drop gradually during the transition of menopause, which usually begins between the ages of 45 and 56 years old.
Early or surgical menopause. Women who have their ovaries removed (a surgery called an oophorectomy) or who enter menopause earlier than average may experience GSM symptoms sooner and to a more significant degree.
Cancer treatments. Chemotherapy, pelvic radiation, and hormone-blocking therapies (often used in breast cancer treatment) can significantly lower estrogen and contribute to GSM symptoms.
Smoking. Smoking is known to have negative effects on the health of blood vessels and surrounding tissues, and can alter your vaginal microbiome (the community of microbes that influence your health). It can reduce blood flow to the vaginal tissues and further lower estrogen activity, worsening dryness and thinning in this area.
Lack of sexual activity. Without regular sexual activity or stimulation, your vaginal tissues are more likely to lose elasticity and lubrication, which can make certain GSM symptoms, like dryness and vaginal discomfort, worse.
It’s important to note that GSM isn’t a reflection of your personal hygiene or lifestyle choices. There’s no reason to feel guilty or ashamed if you’re experiencing these symptoms. It’s common for women to experience these symptoms as their estrogen levels decline.
Healthcare providers usually diagnose genitourinary syndrome of menopause through a combination of medical history and a simple gynecologic exam.
A healthcare provider will ask about your symptoms, such as vaginal dryness, burning, pain during intercourse, or urinary changes. They may also ask about your overall health, menstrual history, past surgeries, and whether you’re undergoing any cancer treatments.
A pelvic exam lets your provider check for signs of tissue thinning, dryness, inflammation, or narrowing of the vaginal opening. They may look at your vulva, vagina, and urinary structures to check for signs of low estrogen.
If it’s still unclear whether you’re experiencing GSM or something else, your provider may use other diagnostic tools, such as:
Vaginal pH testing. Since low estrogen often changes vaginal pH, this test measures acidity levels in the vagina to help confirm whether symptoms are related to GSM rather or an infection.
Urine tests. Rarely ordered for GSM diagnosis, but may provide more insight if urinary symptoms are severe.
Imaging. Also rarely needed, but your doctor might suggest imaging if they suspect you have an underlying condition.
Vulvar biopsy. A simple procedure to help with diagnosis if there’s a concern for skin conditions that can affect the vulva (e.g., lichen sclerosis).
Because some symptoms of GSM can mimic other conditions, like urinary tract or vaginal infections, lichen sclerosus (a chronic inflammatory skin condition that most often affects the vulva), or other skin-related issues, a careful exam ensures you get an accurate diagnosis and appropriate treatment plan.
You can effectively manage GSM with a variety of safe and proven treatments. The goal of therapy is to help you feel comfortable, improve vaginal and urinary health, and address symptoms bringing down your quality of life.
Here are some of the most common genitourinary syndrome treatment options.
These options are available without a prescription:
Vaginal lubricants. You use these during sexual activity to reduce friction and discomfort.
Vaginal moisturizers. You apply these regularly, usually several times per week, to help maintain hydration and reduce dryness.
Hyaluronic acid creams. These may improve vaginal moisture and elasticity by increasing water absorption in your tissues.
Vaginal estrogen therapy (creams, tablets, or vaginal rings) is the gold standard treatment for GSM and often uses estradiol.
These intravaginal therapies deliver low-dose vaginal estrogen directly to the vaginal tissues, improving thickness, elasticity, lubrication, and pH balance.
Because absorption into the bloodstream is minimal (unlike options using systemic absorption), the risks of localized hormonal treatments like these are much lower compared to systemic hormone therapy.
If you’re also experiencing vasomotor symptoms (e.g., hot flashes and night sweats), systemic hormone therapies may be a better option.
Women who can’t use use estrogen — such as those with a history of breast cancer or gynecologic cancers — may benefit from non-hormonal treatments options, such as:
Selective estrogen receptor modulators (SERM, like ospemifene). An oral medication that acts on estrogen receptors to improve vaginal tissue health without delivering estrogen directly.
Mucosal lidocaine. A topical numbing agent that can reduce burning or pain, especially during sex.
Additionally, pelvic floor physical therapy is a specialized type of physical therapy focused on the pelvic floor muscles, tissues, and nerves that support the bladder, uterus, vagina, and rectum.
It can be helpful for GSM because these muscles play a vital role in urinary control, sexual function, and overall pelvic comfort.
Laser and radiofrequency vaginal therapies have been studied as potential treatments for GSM. Some women report improvements in dryness and elasticity.
However, these treatments aren’t approved by the Food and Drug Administration (FDA) and can be expensive, often requiring repeat sessions.
A recent paper published in the Journal of the American Medical Association found no significant difference in vaginal symptoms between laser therapy and placebo after one year. This treatment also comes with potential side effects, like vaginal bleeding, pain, and urinary tract infections.
More research is needed to determine the long-term safety and effectiveness of laser therapy for GSM.
Your daily habits can significantly affect GSM. Adjusting certain routines may help manage symptoms and support your vaginal health.
Sexual activity. For those in a healthy, safe relationship, regular sexual activity can help maintain blood flow and tissue elasticity.
Hygiene. Use gentle, fragrance-free cleansers. Avoid irritants such as douches or harsh soaps to reduce the risk of irritation.
General wellness. Engage in regular exercise, manage stress, and stay well-hydrated to support overall and pelvic floor health.
Because GSM treatment varies for each person, consult a gynecologist to discuss symptoms and appropriate treatment options. With the right approach, most people can achieve symptom relief and better quality of life.
If you’re living with genitourinary syndrome of menopause, know that you’re not alone. GSM is a common condition, and while it can cause significant symptoms for some women, it’s also very treatable.
It’s important to have open conversations with a trusted healthcare provider about what you’re experiencing so that, together, you can create a personalized plan to restore comfort, intimacy, and confidence in your daily life.
It’s natural to have questions about GSM. Here are some answers to common concerns around the condition.
The most common symptoms of GSM include vaginal dryness, irritation, burning, painful intercourse, and vulvar discomfort. Many women also experience urinary changes, such as urgency, frequency, leakage, or recurrent urinary tract infections.
Treatment depends on your symptoms and health history. Options include lubricants, vaginal moisturizers, and hyaluronic acid creams for dryness. Local vaginal estrogen (in the form of creams, tablets, or a vaginal ring) is the most effective treatment. Non-hormonal prescription options and pelvic floor therapy may also help.
GSM is a long-term condition because it’s linked to the natural decline of estrogen after menopause. However, with ongoing treatment, you can manage symptoms and experience lasting relief. If you stop therapy, your symptoms may return, which is why it’s important to stay consistent with treatment.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at blog@forhims.com!