What is GSM or Vulvovaginal Atrophy in Menopause?

Key Takeaways
  • GSM is More Than Just Vaginal Health: Genitourinary Syndrome of Menopause (GSM) encompasses a range of symptoms affecting not only the vulvovaginal area but also the urinary system, due to decreased estrogen levels.
  • Treatment is Varied and Accessible: From topical hormonal to non-hormonal options, treatments are tailored to individual needs, ensuring comfort and improved quality of life.
  • Knowledge is Power: Understanding GSM and vulvovaginal atrophy demystifies menopausal symptoms, supporting individuals to seek treatment and enjoy life, including a healthy sex life, during and after the menopause transition.

What Is Genitourinary Syndrome of Menopause (GSM)?

Genitourinary Syndrome of Menopause, or GSM, might sound complex, but it's something many encounter as they go through the menopause transition. GSM is a condition that affects your sexual health, genital area, and urinary system. The root of the condition stems from a decrease in estrogen levels, which are crucial for maintaining the health of the vulvovaginal area and the lower urinary tract. When estrogen levels drop, it can lead to noticeable changes and discomfort in these areas.

What is the difference between GSM and Vulvovaginal Atrophy?

GSM is an umbrella term that covers a range of menopause symptoms related to the genital and urinary organs. GSM isn’t just about one specific issue or symptom, it refers to the broader spectrum of changes that can occur. This includes problems with the urinary system—like feeling the need to go to the bathroom more often or getting urinary tract infections (UTIs) more frequently.

Vulvovaginal Atrophy focuses on one specific aspect of GSM. It refers to the thinning, drying, and inflammation of the vaginal walls, which happens because of the drop in estrogen during menopause. This can be uncomfortable, especially during sex, and might lead to itching or burning sensations.

What are the symptoms of GSM?

Genitourinary Syndrome of Menopause (GSM) can cause a variety of symptoms that can affect both genital and urinary health. These symptoms include:

  • Vaginal Dryness: This extends beyond sexual activity, affecting overall daily comfort due to a lack of moisture.
  • Vulvar Atrophy: Thinning and drying of the vaginal and vulvar tissues can make daily activities like peeing, sitting down, and walking uncomfortable and painful.
  • Pain During Sexual Activity (Dyspareunia): Less lubrication can result in painful sex, which can lead to a desire to avoid it altogether.
  • Urinary Issues: An urgent need to pee, painful urination, and frequent UTIs can disrupt sleep and sometimes feel embarrassing in social situations.
  • Vaginal Bleeding: Although less common, this is a sign that you should see your healthcare practitioner to rule out any issues related to the lining of your uterus.

How is GSM treated?

Treatment for GSM can vary depending on what symptoms you're experiencing and what's causing them. Some common treatment options include:

  • Topical Treatments: Creams, tablets, and rings that replenish estrogen directly to affected tissues, helping restore thickness, elasticity, and natural lubrication of the vaginal walls.
  • Non-Hormonal Moisturizers and Lubricants: If hormones aren't right for you, or you need extra relief, moisturizers and lubricants can help keep things comfortable, reducing dryness and irritation.
  • Pelvic Floor Physical Therapy: This can help strengthen the pelvic floor muscles and alleviate some symptoms of GSM.

All of these treatment options are best discussed with a healthcare practitioner to understand which may be right for you, as well as the various benefits and risks. 

How Do Vaginal Topical Treatments Work?

Vaginal topical treatments  can help to restore the health of vaginal and urinary tissues. It can reduce symptoms of dryness, itching, and discomfort during intercourse and can improve urinary tract health, benefitting your quality of life and potentially reducing the risk of UTIs.

How Safe are Vaginal Topical Treatments?

Vaginal topical treatments are a common GSM treatment and works by replenishing estrogen in the tissues directly affected. These treatments are usually considered low-risk, with minimal systemic absorption, and are not associated with significant risk of heart disease, blood clots, or breast cancer. You can usually safely start these treatments at any point and continue to use it as long as you wish, allowing you to manage your symptoms effectively throughout your menopause journey.

Talk To Your Healthcare Practitioner

It's important to always have a thorough conversation with your healthcare practitioner before considering available treatments. If you’ve had estrogen-receptive cancer, this is particularly crucial if you are considering estrogen-based treatments. While there are concerns, many people can still safely use vaginal estrogen after a detailed discussion about the pros and cons of treatment. The decision to pursue treatment is one made together, ensuring it's the best choice for your lifestyle and health.

Menopause can sometimes bring uncomfortable changes, but they don't have to dictate your quality of life. Talk to a Felix healthcare practitioner—we’re more than happy to help guide you through your treatment options. With knowledge, treatment, and support, you can navigate this transition with confidence and celebrate this new chapter of life.

Medically reviewed by


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