Genitourinary syndrome of menopause (GSM)

Why the name changed

Terms like 'vaginal atrophy' described only part of the problem and many women found them off-putting. Estrogen receptors are found throughout the vulva, vagina, clitoris, urethra and bladder, so low estrogen can affect all of them. GSM captures the whole picture, including bladder and urinary symptoms, in neutral language.

Common symptoms

Symptoms vary from mildly irritating to life-limiting:

• Vaginal dryness, burning, itching or irritation.
• Pain, dryness or light bleeding with sex, and reduced arousal or lubrication.
• Urinary urgency, needing to go more often and burning when you urinate.
• More frequent urinary tract infections.
• Thin, pale or easily irritated vulvar and vaginal tissue.

How it differs from hot flashes

Hot flashes usually fade over the years after menopause. GSM generally does the opposite: without treatment it tends to persist or gradually worsen. Symptoms often appear a few years after the final period, so many women don't connect them to menopause. GSM can also follow breast cancer treatment, removal of the ovaries, pelvic radiation or some fertility and hormonal medicines, and dryness can occur while breastfeeding.

Treatment options

Effective treatments exist, and you don't need to wait until symptoms are severe. A clinician will usually rule out other causes, such as infections or skin conditions, first. Options include:

• Water- or silicone-based lubricants for sex and regular vaginal moisturizers. These help comfort but don't reverse tissue changes.
• Avoiding scented soaps, douches and other irritants.
• Low-dose vaginal estrogen as a cream, tablet or insert, or ring. Very little reaches the bloodstream, and it can also lower the risk of recurrent urinary tract infections.
• Vaginal prasterone (DHEA), an FDA-approved insert for painful sex caused by menopause.
• Pelvic floor physical therapy when muscle tension or pain is part of the problem.

Safety notes

If you've had breast or endometrial cancer, talk with your oncology team before using any vaginal hormone product; the decision depends on your cancer type and treatment and is made case by case. Any bleeding after menopause should be checked by a clinician, because it can signal problems unrelated to GSM, including cancer.

If you take systemic hormone therapy and still have vaginal symptoms, adding a vaginal product is common. At HealifyMD, estriol vaginal cream, which is compounded and not FDA-approved, is one option your clinician may discuss alongside FDA-approved alternatives.