What Is GSM? A Complete Guide to the Genitourinary Syndrome of Menopause

If you have noticed vaginal dryness, discomfort during sex, or urinary tract infections that never used to be a problem, there is a good chance you are experiencing GSM, and you are far from alone. Estimates vary depending on how it is measured, but research suggests GSM affects a large share of postmenopausal women, with some studies putting the figure at 80 percent or higher. Importantly, symptoms are not limited to women who are fully postmenopausal: they can begin during the perimenopausal years, when estrogen first starts to fluctuate and fall.

What GSM actually means

GSM stands for genitourinary syndrome of menopause. The term was introduced in 2014 by a consensus panel convened by the International Society for the Study of Women's Sexual Health and The North American Menopause Society (now The Menopause Society), replacing older labels such as 'vulvovaginal atrophy.' The change was meaningful. 'Atrophy' described only the vaginal tissue, while GSM captures the fuller picture: the effects of declining estrogen across the vulva, vagina, urethra, and bladder. In short, it acknowledges that these changes are not only vaginal but urinary too.

The cause

The explanation is straightforward. The tissues of the vulva, vagina, urethra, and bladder are rich in estrogen receptors and rely on estrogen to stay thick, elastic, and well lubricated. As the ovaries wind down estrogen production through perimenopause and into menopause, these tissues gradually thin, lose elasticity, and become drier. Because estrogen usually declines over a span of years rather than overnight, the process is typically gradual and tends to progress over time.

There is one important exception: surgical menopause. If both ovaries are removed (a procedure called an oophorectomy), estrogen can drop abruptly rather than gradually, so GSM symptoms may appear sooner and more suddenly than they would with natural menopause.

The symptoms to watch for

GSM symptoms fall into two broad groups. On the genital side, you may notice dryness, burning, itching or irritation, and pain or discomfort during sex. On the urinary side, you may experience urgency, needing to go more often, discomfort when urinating, waking at night to use the bathroom, and recurrent urinary tract infections. As the tissues change, the vagina produces less natural moisture, the canal becomes less elastic, blood flow decreases, and the lower urinary tract becomes more vulnerable to irritation and infection.

Why it so often goes untreated

Here is the frustrating part. GSM is both common and very treatable, yet a striking number of women never get help for it. Surveys consistently find that only about half of women with symptoms ever raise them with a clinician, and many assume the changes are simply an unavoidable part of aging. They are not. Awareness is part of the problem on both sides of the exam room: many women do not realize these symptoms are treatable, and healthcare providers do not always ask about them, so the topic never comes up. Too often, women quietly scale back activities or intimacy they used to enjoy instead of seeking a solution that genuinely exists.

The good news: GSM is treatable

Unlike a passing infection, GSM does not resolve on its own, and it tends to worsen when left unaddressed. The encouraging news is that it responds well to treatment, and treating the underlying cause is what relieves the symptoms that flow from it. One of the most effective options is low-dose vaginal estrogen, which restores estrogen directly to the affected tissues with minimal absorption into the bloodstream. By correcting the estrogen deficiency at the root, it eases the dryness, discomfort, and urinary symptoms that result from it. That local action is why it can be a suitable choice even for many women who do not want or cannot take systemic hormones. Over-the-counter moisturizers and lubricants can ease symptoms day to day, but they do not reverse the underlying tissue changes the way estrogen can.

At Antha, we offer two FDA-approved local estradiol options: estradiol vaginal cream 0.01% and estradiol vaginal tablet inserts 10 mcg, each prescribed after a clinician reviews your symptoms and history. Estradiol is the main and most potent form of estrogen the ovaries produce during the reproductive years, so applying it locally replaces the very hormone these tissues have lost.

If dryness, painful sex, or recurrent urinary symptoms are affecting your daily life, you have real options, and you do not have to just live with it.

Sources

This article is for educational purposes and is not a substitute for personalized medical advice.

Buy now More from the blog