Genitourinary Syndrome of Menopause (GSM): What You Need to Know

TL;DR

Genitourinary syndrome of menopause (GSM) is a common set of vaginal and urinary symptoms caused largely by declining estrogen. It can include vaginal dryness, burning/itching, pain with sex, and urinary symptoms like urgency, frequency, recurrent UTIs, and urinary incontinence. GSM is common—this article cites estimates up to ~45% of postmenopausal women. GSM usually does not go away on its own, but symptoms are highly treatable with options like vaginal moisturizers/lubricants, topical vaginal estrogen, pelvic floor physical therapy, and other clinician-guided therapies.

Key Terms

·       GSM (Genitourinary Syndrome of Menopause): a cluster of genital + urinary symptoms linked to low estrogen in menopause.

·       Vaginal atrophy / atrophic vaginitis: older terms sometimes used for GSM-related vaginal tissue changes; “GSM” is now preferred.

·       Nocturia: waking at night to urinate.

·       Urgency: sudden strong need to urinate.

·       Urinary incontinence: involuntary urine leakage.

What Is GSM?

GSM is a syndrome that affects the vulva, vagina, urethra, and bladder. It’s associated with the hormonal changes of menopause—especially reduced estrogen—and can begin during perimenopause or after menopause. GSM can significantly affect comfort, sleep, sexual health, and daily activities.

How common is GSM?

This article cites estimates that GSM affects up to ~45% of postmenopausal women.

Why GSM Happens

Declining estrogen changes blood flow, collagen, and tissue thickness/elasticity in the vaginal and urinary tracts. Typical physiologic effects include:

·       thinner, less elastic vaginal tissue

·       reduced natural lubrication

·       changes in urinary tract tissues that may contribute to urgency, frequency, UTIs, and leakage

Common GSM Symptoms

Vaginal and vulvar symptoms

·       vaginal dryness

·       burning or itching

·       irritation/discomfort

·       pain with sex (often reported with GSM)

Why: lower estrogen can reduce lubrication and thin vaginal tissues.

Urinary symptoms

·       burning with urination

·       urinary urgency (strong sudden need to urinate)

·       urinary frequency (needing to go often)

·       pain with urination

·       recurrent urinary tract infections (UTIs)

·       urinary incontinence

·       nocturia (waking at night to urinate)

Why: menopause-related tissue changes can affect bladder tone and pelvic floor support.

GSM and Urinary Incontinence

GSM can contribute to urinary leakage through:

·       reduced tissue support around the urethra and bladder

·       pelvic floor weakness

·       bladder and urethral tissue changes linked to low estrogen

The original article states that a substantial portion of menopausal women experience incontinence (presented as “up to 40–50%”). (If you plan to publish that exact range, consider linking it to a specific source.)

Treatment Options for GSM

GSM treatment should be individualized with a healthcare provider. Common options include:

1) Non-hormonal moisturizers and lubricants

·       Moisturizers: for regular symptom relief (baseline dryness/irritation)

·       Lubricants: for sex-related discomfort

2) Topical vaginal estrogen therapy

Often used when symptoms are moderate-to-severe or not relieved by non-hormonal options. Vaginal estrogen can improve tissue health and may improve some urinary symptoms in selected patients. (Ref: 1)

3) Pelvic floor physical therapy

Useful when symptoms include urinary leakage, pelvic floor weakness, pelvic pain, or sexual discomfort.

4) Other clinician-guided options

The original article mentions vaginal laser therapy (intended to stimulate collagen) and surgical interventions in severe cases. These should be discussed with a clinician because suitability and evidence vary by individual case.

Practical Daily Management

These aren’t “cures,” but they help reduce disruption while you treat underlying GSM:

·       keep a symptom diary (sleep, urgency triggers, dryness severity)

·       protect sleep by minimizing nighttime trips where possible

·       use discreet protection for leaks if needed (pads/absorbent underwear)

·       prioritize gentle hygiene and avoid harsh irritants

Nighttime urination (nocturia) support

If you’re getting up frequently at night, reducing fall risk is important.

How to Talk to Your Doctor About GSM (Conversation Toolkit)

Prepare before your appointment

Bring:

·       a list of symptoms (what, when started, frequency, severity)

·       what worsens/improves symptoms (sex, soaps, caffeine, stress, hydration)

·       how symptoms affect quality of life (sleep, intimacy, mood)

Simple opener scripts

·       “I think I’m having genitourinary symptoms related to menopause—dryness and urinary urgency. Can we discuss GSM and treatment options?”

·       “These symptoms are affecting my sleep and comfort. I’d like a plan for both vaginal and urinary symptoms.”

Ask about the full range of options

·       non-hormonal measures

·       topical hormonal therapy (if appropriate)

·       pelvic floor PT

·       follow-up timeline and what improvement should look like

Key Takeaways

·       GSM is common and linked to declining estrogen in menopause. (Ref: 1)

·       Symptoms can involve both vaginal and urinary systems.

·       GSM usually does not resolve without treatment, but it is highly manageable.

·       A clinician can help tailor treatment (non-hormonal, topical estrogen, pelvic floor PT, and other options).

FAQs

Does vaginal atrophy (GSM) go away on its own?

Generally, no. GSM symptoms usually persist without treatment. Many people improve with moisturizers/lubricants and/or topical estrogen under clinician guidance. (Ref: 1)

Can estrogen help with bladder control during menopause?

It can for some people. Estrogen supports the health of vaginal and urinary tissues, and low estrogen can contribute to urinary symptoms. Vaginal estrogen is one option clinicians may use for GSM-related symptoms. (Ref: 1)

Does vitamin D help vaginal symptoms in menopause?

A systematic review cited in this article suggests vitamin D may help vaginal health in some studies, but evidence is not definitive and more research is needed. (Ref: 2)

Why might a bedside urinal help during GSM?

For people with frequent nighttime urination, bedside toileting can reduce sleep disruption and may reduce fall risk from walking to the bathroom repeatedly at night.

References

1.         Goldstein I, et al. “Multidisciplinary Overview of Vaginal Atrophy and Associated Genitourinary Symptoms in Postmenopausal Women.” Sexual Medicine (2013).

2.         Riazi H, et al. “Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review.” J Menopausal Med (2019).