Genitourinary syndrome of menopause (GSM), sometimes called vaginal atrophy or atrophic vaginitis, describes genital, sexual and urinary symptoms that can develop as estrogen and other sex hormones decline during perimenopause and after menopause. Symptoms may include vaginal dryness, burning, itching, pain with sex, decreased lubrication, urinary urgency or frequency, and recurrent urinary tract infections.
GSM is common and treatable, but the symptoms can overlap with infection, dermatologic conditions, pelvic-floor disorders and other gynecologic problems. A medical evaluation is useful when symptoms are persistent, painful, recurrent or accompanied by bleeding.
Related symptom resources: vaginal dryness during menopause and our comprehensive hormone symptoms guide.
What Is Genitourinary Syndrome of Menopause?
GSM is a broader term than vaginal atrophy because menopause-related changes can involve the vulva, vagina, bladder and urethra. Reduced estrogen can make vaginal tissue thinner, drier and less elastic and may reduce natural lubrication. The urinary tract can also be affected.
ACOG describes GSM as a collection of symptoms related to lower estrogen and other sex hormones, including vaginal dryness, pain with sex, burning, itching, irritation, bladder symptoms and recurrent UTIs. The Menopause Society notes that, unlike hot flashes, GSM often does not simply disappear with time and may worsen without treatment.
Common Symptoms
- Vaginal dryness or reduced lubrication
- Burning, itching or irritation
- Pain or discomfort with sexual activity
- Bleeding or spotting after sex
- Urinary urgency or frequency
- Recurrent urinary tract infections
- Vulvar discomfort or sensitivity
How GSM and Vaginal Atrophy Are Evaluated
Evaluation starts with the symptom pattern, menstrual and menopause history, medications, cancer history, prior hormone therapy and other medical conditions. Depending on the presentation, a pelvic examination or testing for infection may be appropriate. Bleeding after menopause should not automatically be attributed to vaginal atrophy and requires appropriate medical evaluation.
If you are also experiencing hot flashes, sleep changes, irregular periods or other menopause-transition symptoms, see our menopause treatment in Los Angeles and perimenopause treatment pages.
Treatment Options for GSM
Treatment is individualized according to symptom severity, medical history, patient preferences and contraindications. Options can include nonhormonal and prescription therapies.
Lubricants and vaginal moisturizers
For mild symptoms, vaginal lubricants used during sexual activity and vaginal moisturizers used regularly may reduce dryness and discomfort.
Low-dose vaginal estrogen
Low-dose vaginal estrogen is an established treatment for many women with GSM and is available in several forms. Whether it is appropriate depends on the individual clinical situation, including relevant cancer history and other risk factors.
Other prescription options
Other options may include vaginal dehydroepiandrosterone (DHEA) or oral ospemifene for selected patients. Treatment should be matched to the dominant symptoms and the patient’s medical history.
Systemic menopause hormone therapy
Women who also have significant vasomotor symptoms such as hot flashes or night sweats may be candidates for systemic hormone therapy after an individualized benefit-risk discussion. Systemic therapy is not required solely to treat GSM when local treatment is sufficient.
When to Seek Medical Evaluation
Seek prompt medical evaluation for postmenopausal bleeding, unexplained pelvic pain, a new vulvar or vaginal lesion, persistent discharge, recurrent urinary symptoms, or symptoms that do not improve with initial measures. New bleeding after menopause should be evaluated rather than assumed to be caused by dryness.
Physician-Led Menopause Care in Los Angeles
David Nazarian, M.D., is Board Certified in Internal Medicine and provides comprehensive evaluation of menopause-related and hormonal concerns. Care is individualized and may include review of symptoms, medical history, medications, appropriate testing, treatment options, risks and follow-up.
For an individualized evaluation, schedule an appointment.
