Vaginal dryness, burning, painful sex and urinary symptoms can be part of genitourinary syndrome of menopause. Learn what GSM is and which options to discuss with a clinician.
A common problem with an unfamiliar name
Genitourinary syndrome of menopause, usually shortened to GSM, describes changes in the vulva, vagina, bladder and urethra that can occur as estrogen levels fall. Unlike hot flushes, GSM often does not simply fade away with time and can become more noticeable after menopause.
Symptoms can include dryness, burning, itching, irritation, discomfort with penetration or pelvic examinations, urinary frequency or urgency, and recurrent urinary symptoms. Some people assume these changes are an unavoidable part of ageing and never mention them. They are common, but they are also treatable.
Why does GSM happen?
Lower estrogen can make vulvovaginal tissues thinner, drier and less elastic and can reduce lubrication. Changes around the urethra and bladder may contribute to urinary symptoms. Other conditions can cause similar symptoms, including infections and dermatologic conditions, so persistent burning, discharge, bleeding or pain deserves assessment rather than assuming it is menopause.
Nonprescription options
Vaginal moisturizers are used regularly to help maintain moisture in the tissues, while lubricants are used around sexual activity to reduce friction. The Menopause Society also advises avoiding products that worsen irritation; for many people, gentle external washing with water is sufficient and fragranced products can be irritating.
If a product stings or makes symptoms worse, stop using it and discuss alternatives with a clinician or pharmacist.
Prescription options to discuss
Low-dose vaginal estrogen is an established treatment for moderate to severe vaginal dryness and atrophy and is available in several forms. Other prescription options may also be considered depending on symptoms and medical history. People with a history of hormone-sensitive cancer or other complex medical history should discuss local treatment decisions with the clinician involved in their care.
When to get checked
Book an appointment if symptoms are persistent, painful, affecting sex or daily life, or accompanied by bleeding, unusual discharge, recurrent urinary infections or new pelvic pain. Bleeding after menopause should always be medically assessed.
Learn the wider menopause picture
The free Menopause Starter Kit explains common symptoms and treatment options to discuss, while the full Menopause Guide & Meal Plan covers the menopause transition more broadly.
