Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause

“The genitourinary syndrome of menopause (GSM)
includes bothersome vaginal, vulvar (lips of the vagina),
and urinary symptoms that can affect quality of life…”.1

Umbrella

What may the Genitourinary Syndrome of Menopause Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary/Genito-Urinary Syndrome of Menopause (GSM)
  • Menopause Vaginal Dryness
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy (VVA)

Definition

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Genitourinary Syndrome of Menopause, published May 2025, the (United States) Menopause Society’s (formerly the North American Menopause Society) definition is:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner. Unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment”.2

Symptoms

What may be symptoms of GSM?

In Vaginal Atrophy: Symptoms & Causes – Symptoms the (United States) Mayo Clinic include:

“Genitourinary syndrome of menopause symptoms can include:

  • Dryness, burning or itching in the vagina
  • Thin, watery, sticky, yellow or gray fluid that comes out of the vagina
  • Frequent or urgent need to urinate, or a burning feeling during urination
  • Losing control of the bladder, also called urinary incontinence
  • More-frequent infections of the urinary tract and vagina
  • Pain during sex due to less lubrication, or light bleeding after sex
  • Shortening and tightening of the vaginal canal”.3

Common or Not

How common is GSM?

In Menopause: Menopausal Symptoms – Bladder, Vaginal and Vulval Problems the (Australian) Jean Hailes for Women’s Health (JH) explain:

“Around 1 in 2 women are affected by ‘genitourinary syndrome of menopause’ (GSM). GSM affects the bladder, vagina and vulva.

Sometimes people will use the term ‘vulvovaginal atrophy’ to describe the changes in the vagina and vulva”.4

Cause

What causes GSM?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause happens when the body makes less estrogen. Lower estrogen causes the tissues in the vagina to become thinner, drier, less elastic and more fragile”.5

Treatment

What are some GSM treatments?

In The 2023 Practitioner’s Toolkit for Managing Menopause – Effectiveness: Local Treatment of Urogenital Atrophy, the authors explain:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.6

On page one and two in Genitourinary Syndrome of Menopause: Treatment Options the Menopause Society elaborate on:

“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. Therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be used in combination with prescription therapies for more severe symptoms.

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • An effective and safe treatment, low-dose local estrogen applied directly to the vagina…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA may be options for women with a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.7

Vaginal Estrogen

Is vaginal estrogen placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use, published February 2025, the Menopause Society clarify:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina”.8

On page one in Genitourinary Syndrome of Menopause (GSM), reviewed November 2025, the British Menopause Society note:

“Whilst vaginal estrogen (also referred to as local estrogen) therapy is the best known treatment, newer drugs and interventions are now available”.9

Painful Sex

How may painful sex (dyspareunia) be resolved?

The Mayo Clinic explain:

“… make an appointment if you have painful sex that doesn’t get better after you use a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others), water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others) or silicone-based lubricant (ID Millennium, Pink, Pjur, others)”.10

Regular Sex

May regular sex help prevent GSM?

In Vaginal Atrophy: Symptoms & Causes – Prevention the Mayo Clinic elaborate on:

“Regular sexual activity, either with or without a partner, may help prevent genitourinary syndrome of menopause. Sexual activity increases blood flow to the vagina, which helps keep tissues in the vagina healthy”.11

Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)

What is the Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025), published April 2025, endorsed by The International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS)?

In Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025) the authors elaborate on:

“This guideline provides information to clinicians regarding identification, diagnosis, counseling, and treatment for patients with GSM to optimize symptom control and quality of life while minimizing adverse events. The strategies defined in this document were derived from evidence-based and consensus-based processes; however, shared decision-making is the optimal strategy to individualize level of impact and ultimate interventions”.12

What is AUA, SUFU and AUGS?

In the context above, these abbreviations stand for the:

Health Care Provider

What if I think I have GSM?

If you think you have GSM it can be in your best interest to choose to discuss this with your health care provider. Why? Because in Menopause: Menopausal Symptoms – Bladder, Vaginal and Vulval Problems the JH note:

“While symptoms such as hot flushes usually disappear over time, bladder, vaginal and vulval problems can continue in postmenopause (and might even get worse)”.13

On page two in Genitourinary Syndrome of Menopause the Menopause Society also note:

“Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment.

Compounded vaginal estrogen and testosterone are not government regulated or recommended for treatment of GSM in most cases”.14

Health Topics A-Z

Where may I find Health Topics A-Z related to Genitourinary Syndrome of Menopause?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. A Man’s Guide To Menopause
  2. ACOG Explains: Managing Menopause Symptoms [American College of Obstetricians and Gynecologists]
  3. BMS TV: Urogenital Atrophy
  4. Bladder Control: Lifestyle Strategies Ease Problems
  5. Bladder Diary
  6. Bladder Health
  7. Bladder Leakage: How To Talk To Your Doctor
  8. Breast Cancer Survivors Find Relief for Debilitating Menopause Symptom
  9. Complementary & Alternative Therapies: Non-Hormonal Treatments for Menopause Symptoms
  10. Complementary Medicines and Therapies: Options for Menopausal Symptoms
  11. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause: An Evidence Map
  12. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  13. Deciding About Hormone Therapy Use
  14. “Doctor, is it normal?” [Genitourinary Syndrome of Menopause (GSM)
  15. Douching
  16. Dyspareunia – Vaginal Atrophy and Beyond [Webinar] [ Sign In To Confirm Your Age]
  17. EMAS On-Demand Webinars [European Menopause and Andropause Society] [Multiply Languages]: Genitourinary Syndrome of Menopause (GSM): Diagnosis and Evidence-Based Management
  18. EMAS On-Demand Webinars [European Menopause and Andropause Society] [Multiply Languages]: Genitourinary Syndrome of Menopause (GSM): Unmet Needs, Treatment Gaps, and Opportunities for Better Care
  19. Estradiol (Vaginal Route)
  20. Experiencing Vaginal Dryness? Here’s What You Need To Know
  21. FAQs: Vulvovaginal Health
  22. FDA Direct: Removing Black Box Warnings for HRT (Part 1/2)
  23. FDA Direct: Removing Black Box Warnings for HRT (Part 2/2)
  24. Find A Menopause Practitioner [United States and Other]
  25. Find A Practitioner [Australasian Menopause Society i.e. Australia and New Zealand]
  26. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  27. Gaslighting of Genitourinary Symptoms of the Menopause
  28. Genitourinary Syndrome of Menopause
  29. Genitourinary Syndrome of Menopause (GSM)
  30. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)
  31. HRT Questions Answered
  32. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
  33. Hormone Therapy: Is It Right for You?
  34. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  35. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  36. Hormones and Urinary Symptoms In Women | Dr Louise Newson
  37. How To Manage Menopausal Symptoms: Managing Bladder, Vaginal and Vulval Problems
  38. How To Talk To Your Doctor About Menopause
  39. How Vaginal Hormones Can Transform the Health of Women
  40. International Menopause Society (IMS) Recommendations and Key Messages on Women’s Midlife Health and Menopause
  41. International Society for the Study of Women’s Sexual Health: Find A Provider
  42. Is It Too Late To Start HRT?
  43. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  44. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life]
  45. Living With Untreated Urinary Symptoms Penny Pijnenburg
  46. Lubricant Alternatives: What To Use and What To Avoid
  47. Managing Incontinence During In Perimenopause & Menopause
  48. Managing Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  49. Mayo Clinic Minute: Menopause and Sexual Health [+ Video Courtesy: Mayo Clinic News Network]
  50. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
  51. Menopause
  52. Menopause
  53. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Genitourinary Syndrome of Menopause
  54. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
    Genitourinary Syndrome of Menopause
  55. Menopause: Identification and Management [NICE Guideline]
  56. Menopause: Identification and Management [NICE Guideline]
    Genitourinary Syndrome of Menopause
  57. Navigating Menopause Together: How Partners Can Help
  58. Navigating Menopause: Honest Answers To All Your Questions [+ Video: What To Expect in Menopause]
  59. Navigating Menopause Care Resource Guide
  60. New AUA Guideline Offers Clinicians A Practical Toolbox for GSM Management [American Urological Association]
  61. Non-Hormonal Treatments Offer Relief for Genitourinary Syndrome of Menopause
  62. Painful Vaginal Sex (Dyspareunia)
  63. Online Events [International Menopause Society]: CAMS Menopause Hour Webinars – Genitourinary Wellness In Women
  64. Online Events [International Menopause Society]: IMS Partnership Symposia Series – It Is Not Just Incontinence – Common Bladder Problems Around Menopause
  65. Online Events [International Menopause Society]: Past Webinars – 2025: The Burn, the Itch, the Pain, the Urge: GSM In Women
  66. Painful Sex (Dyspareunia)
  67. Perimenopause
    Genitourinary Syndrome of Menopause
  68. Perimenopause and Menopause Symptom Checklist
    Genitourinary Syndrome of Menopause
  69. Preventing Urinary Tract Infections After Menopause: What Every Woman Should Know
  70. Struggling With UTIs After Menopause? Experts Say This Can Make A Difference
  71. Surprising Menopause Symptoms Q&A | Dr Louise Newson
  72. Talk About Painful Sex
  73. The 2023 Practitioner’s Toolkit for Managing Menopause
  74. The Menopause Society Show: Menopause and Sexual Desire
  75. UTI: This Common Infection Can Be Serious
  76. Urinary Incontinence In Women
  77. Urinary Tract Infections (UTIs)
  78. Urogenital Problems
  79. Use of OTC Products and Persistent Vulvovaginal Irritation In Postmenopausal Women, With Caroline Mitchell, MD, MPH [+ Video]
  80. Vaginal Atrophy
  81. Vaginal Atrophy
  82. Vaginal Dryness
  83. Vaginal Dryness
  84. Vaginal Dryness
  85. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  86. Vaginal Dryness: Alternative Treatments
  87. Vaginal Laser Therapy
    Genitourinary Syndrome of Menopause
  88. Videos & Podcasts: Videos – Menopause and Hormone Therapy: Current Perspectives and Controversies
  89. Vulva and Vagina
  90. Vulva and Vagina [Multiply Languages]
  91. Vulval Irritation and Treatment
  92. Vulval and Vaginal Conditions
  93. Vulval and Vaginal Pain
  94. What Is the Difference Between Vagifem and Estring?
  95. What Types of Vaginal Oestrogens Are There?
  96. Which Vaginal Moisturiser Should You Use?
  97. Why You Get An Itch or Thrush on Vaginal Estrogen and What To Do About It
  98. Your Daily Dose: Perimenopause, Don’t Suffer In Silence

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Genitourinary Syndrome of Menopause. April 2025:1. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 29 April 2026
  2. Genitourinary Syndrome of Menopause. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 29 April 2026
  3. Vaginal Atrophy: Symptoms & Causes – Symptoms. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 29 April 2026
  4. Menopause: Menopausal Symptoms – Bladder, Vaginal and Vulval Problems. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/#section-menopausal-symptoms Accessed: 29 April 2026
  5. Genitourinary Syndrome of Menopause: Key Points. 15 July 2024. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/genitourinary-syndrome-of-menopause Accessed: 29 April 2026
  6. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam12 September 2024, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: The 2023 Practitioner’s Toolkit for Managing the Menopause Supporting Notes – Effectiveness: Local Treatment of Urogenital Atrophy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 29 April 2026
  7. Genitourinary Syndrome of Menopause: Treatment Options. 2025:1-2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 29 April 2026
  8. Deciding About Hormone Therapy Use. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/default-document-library/MenoNote-Deciding-About-HT-2025.pdf Accessed: 29 April 2026
  9. Genitourinary Syndrome of Menopause (GSM). Reviewed November 2025:1. British Menopause Society https://thebms.org.uk/wp-content/uploads/2025/11/09-NEW-BMS-ConsensusStatement-Genitourinary-Syndrome-of-Menopause-GSM-NOV2025-B.pdf Accessed: 29 April 2026
  10. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 29 April 2026
  11. Vaginal Atrophy: Symptoms & Causes – Prevention. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 29 April 2026
  12. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025). April 2025. American Urological Association https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause Accessed: 29 April 2026
  13. Menopause: Menopausal Symptoms – Bladder, Vaginal and Vulval Problems. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/#section-menopausal-symptoms Accessed: 29 April 2026
  14. Genitourinary Syndrome of Menopause. 2025:2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 29 April 2026
Topic Last Updated: 12 May 2026 – Topic Last Reviewed: 29 April 2026

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