Written by Dr. Sudarshan Cheral

Medically reviewed by Dr. Bhavya

Updated on February 12, 2025

Genitourinary Syndrome of Menopause: What Is It?

Menopause is one of the inevitable stages in every woman's life. Even though menopause occurs naturally, and there are many health problems that women experience due to hormonal changes, it is also a boon for women in some ways. The main thing is freedom from menstrual cycles.

Along with hot flashes, mood swings, sleep problems and others, vaginal dryness is another major problem that bothers you during menopause. Vaginal dryness and other related symptoms are collectively known as genitourinary syndrome. Although it may appear like a minor issue, it can cause a rift in your relationship with your partner.

If you are suffering from vaginal dryness, painful intercourse, and frequent urination, you might be suffering from the genitourinary syndrome of menopause (GSM). Genitourinary syndrome (vaginal atrophy or atrophic vaginitis) is a common problem that women experience during menopause. But it is not a terrible and untreatable health problem without any solutions. 
 

Changing your lifestyle and using simple remedies can control the symptoms and improve your quality of life.

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What Is Genitourinary Syndrome of Menopause (GSM)?

Genitourinary Syndrome of Menopause, previously known as vulvovaginal atrophy or atrophic vaginitis. Because this condition is not limited to vaginal dryness alone, this condition is also associated with many other symptoms like pain, burning sensation etc.

The genitourinary syndrome of menopause (vaginal atrophy or atrophic vaginitis) often affects you during menopause. In this condition, the lining of your vagina becomes dry and thin due to a lack of estrogen. Other associated symptoms of genitourinary syndrome are burning, itching, spotting and pain during sexual intercourse, also frequent urination and urinary tract infections.

During menopause or during the perimenopausal stage, vaginal atrophy occurs when your ovaries produce less oestrogen. It can also occur before these stages when oestrogen levels decrease due to cancer treatment or due to surgical removal of ovaries. You may experience many uncomfortable symptoms when hormone levels decrease. These symptoms can disrupt your quality of life.

Key Symptoms of GSM

The pathology of genitourinary syndrome of menopause involves the vulva, vagina, and lower urinary tract. Therefore, symptoms manifest in the part affected. The following symptoms characterize it:

Vaginal Symptoms

Symptoms of genitourinary syndrome of menopause-related to the vagina and sexual health include:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal itching
  • Vaginal burning
  • Vaginal discharge
  • Decreased lubrication during sex
  • Painful sexual intercourse
  • Spotting or bleeding, especially during sex
  • Decreased arousal/loss of libido

Urinary Symptoms

Symptoms of genitourinary syndrome of menopause related to urinary health include:

  • Urinary burning 
  • Urinary urgency 
  • Painful urination
  • Increased frequency of urination
  • Recurrent urinary tract infections
  • Urinary incontinence

Impact on Daily Life

 

The symptoms of menopausal genitourinary syndrome may be uncomfortable for you. Moreover, they can be debilitating.

Genitourinary Syndrome can cause various physical and psychological problems in you, affecting your quality of life and your relationship with your partner. In addition to these, the emotional side effects of GSM are also significant.

Pain, burning, itching, and menopausal urinary incontinence can interrupt all daily life activities. Increased frequency and urgency of urination can disrupt your daily schedule, and waking up frequently at night for urination can compromise the quality of your sleep.

The emotional side effects are as complex as the physical ones. Constant discomfort and mental turmoil can lead to anxiety and depression. It can cause vaginal dryness and pain during intercourse, which can reduce your sexual interest and interfere with intimacy with your partner.

GSM physical symptoms can affect your overall well-being in several ways. If left untreated, this condition can lower your overall self-confidence and slow down your personal and professional life.

Risk Factors and Contributing Factors

During menopause, your body naturally produces less estrogen, which can lead to vaginal atrophy. Not only menopause but also some other factors can reduce estrogen levels and lead to vaginal atrophy. Here are some factors that can contribute to GSM because of low oestrogen:

  • Smoking causes decreased flow of blood and oxygen to the vagina and nearby areas. It also reduces the effects of oestrogens on your body.
  • Women not having a vaginal childbirth are more likely to develop GSM symptoms than women who have given birth vaginally.
  • Absence of sexual activity. Sexual activity increases blood flow and makes your vaginal tissues more elastic.
  • Decreased ovarian functioning due to chemotherapy or radiation therapy.
  • Medications that contain anti-oestrogen properties.
  • Surgical removal of ovaries due to certain medical reasons.
  • Intake of some birth control pills can suppress oestrogen production.
  • Immune disorders can disrupt hormonal balance and lead to decreased oestrogen levels.
  • Breastfeeding, where high prolactin levels suppress ovarian function and reduce oestrogen production.

Diagnosis of GSM

Diagnosis of GSM requires symptomatic evaluation, pelvic examination and some laboratory tests. The pelvic examination includes an examination of the vagina and cervix. A detailed evaluation is usually sufficient for the diagnosis of GSM. But in some cases, physical examination is necessary, and even laboratory tests help confirm specific parameters in others.   

A pelvic examination helps in detecting narrowing or shortening of the vagina, dryness, swelling, loss of stretchiness and decrease in size of the labia. Also, it detects redness and whitish discolouration.  

Your doctor will usually rely on physical exams to diagnose atrophic changes. However, they may also perform the following tests to rule out other health problems:

  • Pap test (To detect abnormal cells in your cervix before they become cancerous)
  • Urinalysis (A set of tests on your urine) 
  • Ultrasound (To look at the organs in your pelvic area between your abdomen (belly) and legs)
  • Vaginal pH (acid test)
  • Vaginal infection testing

Non-Hormonal Treatments

Non-hormonal treatment for GSM is gaining recognition in managing symptoms of GSM. Non-hormonal treatment is an alternative to hormonal treatment when you are unable to take hormonal medications. Non-hormonal treatments not only target the symptoms of GSM but also focus on improving overall vaginal health and quality of life through noninvasive and natural approaches.

Even though estrogen and DHEA therapy are considered to be the most effective, they may not be suitable for everyone. These are the different treatment options available that don't involve hormones.

1. Laser treatments: These are noninvasive and nonsurgical in nature. Laser treatments help regenerate vaginal tissue and improve its strength and elasticity. There is only limited long-term research on their use.

2. Lubricants and moisturizers: Lubricants and moisturizers improve comfort during sex by reducing vaginal dryness. Multiple brand names are available over the counter at your local grocery store. Vaginal lubricants are water, silicone or oil-based. And they are very short-acting, whereas vaginal moisturizers are longer-acting to help the cells maintain moisture.

3. Ospemifene: Ospemifene, known by the brand name Osphena, has benefits similar to those of estrogen, but it doesn't contain estrogen. It helps to reduce vaginal dryness and increases comfort during sexual intercourse. But even this is not free from side effects. It may increase hot flashes, but most people do not exhibit any symptoms. It can also increase the risk of blood clots. But it is not common.

4. Dilators: Dilators help to improve comfort during sexual intercourse by dilating your vagina. You can start with a small dilator and gradually shift to larger sizes over time.

Hormonal Treatments

GSM symptoms are effectively manageable with hormonal therapy. Oestrogen therapy and dehydroepiandrosterone (DHEA) are the only hormone therapies for vaginal atrophy. Hormone therapy for menopause is as follows:

1. Oestrogen therapy

Topical use of oestrogen or local estrogen therapy will not increase the oestrogen levels in your bloodstream. Oestrogen can be used in the form of cream, vaginal pill or ring. 

  • Oestrogen cream: The application of oestrogen cream locally into your vagina reduces dryness and discomfort. After using it for several weeks, the usage frequency can be reduced.
  • Vaginal ring: Placing a ring inside your vagina, which releases a low dose of estrogen, helps reduce vaginal discomfort.  This is placed for three months, after which it should be replaced.
  • Vaginal tablet: Placing a small tablet inside your vagina to overcome the vaginal symptoms of GSM. The tablet is placed using an applicator. 
  • Vaginal estrogen suppositories: Oestrogen suppositories are inserted about 2 inches into the vaginal canal. Initially, these low-dose rings are inserted daily for weeks. Then, the frequency can be reduced and only needs to be inserted two times per week.

2. Hormone replacement therapy

Apart from topical application of oestrogen, systemic estrogen therapy will help you to overcome symptoms of GSM along with menopausal symptoms such as hot flashes. This is taken in higher doses that go to other cells of your body, not just to your vagina. If you have other associated symptoms along with vaginal dryness, hormonal replacement therapy is a better option than topical oestrogen therapy. Hormone replacement improves vaginal health and sleep, reduces hot flashes and enhances your mood.

Managing GSM Symptoms Effectively

Managing Genitourinary Symptoms includes addressing many factors. Some changes in your lifestyle are essential to improve your quality of life and relieve GSM-related discomfort. Here are some tips to manage your GSm symptoms effectively:

  • Eat a healthy and nutritious diet to keep your body healthy. Drink plenty of water to stay hydrated.
  • Exercise can help with weight management and boost your mental health.
  • Practice stress-reduction techniques at home, like meditation, yoga, deep breathing, etc.
  • Get enough sleep and rest.
  • Excessive alcohol and caffeine disrupt sleep and have the potential to worsen GSM symptoms.
  • Similarly, smoking can also worsen your symptoms.
  • Regular sexual intercourse helps to maintain your vaginal health.
  • Practising proper personal hygiene helps reduce the symptoms.
  • Avoid using irritant soapstone douches, and use breathable cotton underwear.

When to See a Doctor

If you have any symptoms like vaginal dryness, pain, burning sensation, itching, urinary problems, unusual bleeding or discharge even before menopause, you need to seek proper treatment.

If you have had these symptoms for several weeks and the moisturizers you use for dryness are ineffective, meet your doctor immediately. Even if the symptoms have only been present for a few days and are unbearable, seeking medical advice is still necessary. Also, if you have any symptoms that negatively affect your daily life, seek your doctor's help for appropriate remedies.

Wrapping Up

More than 50% of women experience genito-urinary symptoms during menopause. Unfortunately, many women are unaware that this is a defined medical condition that has a proper treatment. This makes it very difficult for women to go through menopause without receiving any treatment despite the difficulties faced because of GSM.

There are several treatments available, each with their own benefits and limitations. Managing menopause symptoms also has a crucial role in managing GSM. However, many women are dissatisfied with their chosen treatment and are looking for other effective treatments. For this reason, you should discuss any issues related to your menopause openly with your doctor.

Nirva Health provides a platform for such open discussion of health issues. Our healthcare professionals are always ready to help you resolve any GSM-related or menopause-related issues. Why wait longer to get your problems resolved? Book your consultation today with Nirva!

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Dr. Sudarshan Cheral

Dr Sudarshan Cheral is an Ayurveda practitioner with over 9 years of rich clinical experience. Also, as an experienced Ayurveda medical writer with more than 4 years in the field, he has skillfully contributed to Ayurveda literature, assisting in writing 4 books and translating 2 essential texts. Dr. Sudarshan is deeply committed to the art of teaching and has guided numerous international students on their journey to mastering Ayurveda.