Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause (GSM): Signs and Care

Genitourinary syndrome of menopause, or GSM, is a group of changes caused by low estrogen after menopause. It affects the vagina, the vulva and the bladder area. It can cause dryness, itching, pain during sex and urine problems. It used to be called vaginal atrophy. GSM is common, but many women do not talk about it. It can be treated.

Please note: This page shares general health information in simple words. It is not medical advice. Every body is different, so talk to a doctor or gynaecologist before you try any treatment.

Key Facts About GSM

GSM is caused by low estrogen during and after menopause.
About half of women after menopause have signs of GSM.
It affects the vagina, the vulva and the bladder area.
Unlike hot flashes, GSM often gets worse over time without treatment.
It used to be called vaginal atrophy or atrophic vaginitis.
Moisturisers, lubricants and low-dose vaginal estrogen can help.

What Is GSM?

"Genito" means the genital area. "Urinary" means the bladder and the tube that carries urine out of the body. A "syndrome" is a group of symptoms that happen together.

So GSM is a group of symptoms in the genital and urinary areas that start because of menopause. Estrogen helps keep these areas thick, moist and stretchy. When estrogen stays low, the skin becomes thinner, drier and more easily hurt.

Is GSM the Same as Vaginal Atrophy?

Yes. GSM is the newer name for vaginal atrophy. Doctors changed the name in 2014. The old name only talked about the vagina. The new name also includes the bladder and urine changes that often come with it. It also avoids the word "atrophy," which many women found upsetting.

You may also hear the term atrophic vaginitis. It means the same thing.

What Are the Symptoms of GSM?

Symptoms can be in three areas.

Vagina and Vulva

Vaginal dryness
Itching, burning or soreness
Discharge that is different from usual
Light bleeding or spotting, especially after sex

Sex

Pain or discomfort during sex
Less natural wetness during sex
Bleeding after sex

Read more about painful sex after menopause.

Urine

Needing to pass urine often
A sudden, strong need to pass urine
Burning when passing urine
Urine infections that keep coming back
Leaking urine

What Urinary Problems Can Happen After Menopause?

Low estrogen can also make the skin around the bladder and urine tube thinner. This can lead to:

Passing urine more often, including at night
A sudden urge to go
More urine infections
Leaking urine when you cough, laugh or rush

If leaking urine is your main problem, read about urinary incontinence after menopause.

Why Does GSM Get Worse Over Time?

Hot flashes often get better with time. GSM usually does not. As long as estrogen stays low, the skin in these areas keeps getting thinner. This is why it is important to get help early instead of waiting for it to pass.

How Is GSM Treated?

GSM can be treated, and most women feel much better with the right care.

First Steps You Can Take

Use a vaginal moisturiser regularly to keep the area moist.
Use a water-based lubricant before sex.
Wash the outside area with plain water or a mild, unperfumed wash.
Avoid perfumed soaps, wipes and douches.
Wear loose cotton underwear.
Regular sex or sexual activity can help keep blood flowing to the area.

Treatment From a Doctor

Low-dose vaginal estrogen is the main medical treatment for GSM. It comes as a cream, a small tablet, a gel or a ring that goes into the vagina. It helps the skin become thicker and moister again. It can also lower the chance of urine infections.

Vaginal estrogen is very low-dose. It does not carry the same risks as other hormone replacement therapy. So it can usually be used for a long time. Symptoms often come back if you stop.

Sirona Menopause Intimate Cream

The Sirona Menopause Intimate Cream is a hormone-free cream for the outside area, called the vulva. It is made for dryness, itching and irritation. It has Tasmanian berry, flaxseed and olive extracts, and is fragrance-free. It can help the outside skin feel more comfortable. It does not treat GSM or replace vaginal estrogen.

When Should You See a Doctor?

See a doctor or gynaecologist if:

Dryness, itching or pain does not get better with self-care.
Sex is painful.
You get urine infections again and again.
You leak urine.
You have any bleeding after menopause. This always needs to be checked.

Many women feel shy talking about these symptoms. Doctors see them every day. Telling your doctor is the first step to feeling better.

Related Terms

Shop menopause care: Sirona Menopause Collection

Sources

Genitourinary syndrome of menopause: Common problem, effective treatments. Cleveland Clinic Journal of Medicine, 2018. https://www.ccjm.org/content/85/5/390
Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Menopause, 2014. https://pubmed.ncbi.nlm.nih.gov/25160739/
NHS. Vaginal dryness. https://www.nhs.uk/conditions/vaginal-dryness/
NHS. When to take hormone replacement therapy (HRT). https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/
Sirona Menopause Intimate Cream product page. https://thesirona.com/products/intimate-cream

Disclaimer: This page is for general information only. It is not a substitute for advice, diagnosis or treatment from a qualified doctor. It was written by the Sirona Content Team using the trusted medical sources listed above. Always talk to your doctor or gynaecologist about your symptoms and before starting any medicine, supplement or product. If you have heavy bleeding, chest pain, trouble breathing or severe pain, get medical help right away.