Menopause genitourinary syndrome

Overview

Genitourinary syndrome of menopause (GSM) is a condition that happens when lower estrogen levels after menopause cause changes in the vagina, vulva, and lower urinary tract. This can lead to dryness, discomfort, and other symptoms. It is sometimes called vaginal atrophy or atrophic vaginitis.

Yes, it is very common. More than half of postmenopausal women experience some symptoms of GSM.

GSM affects women who have gone through menopause, either naturally or due to surgery (like removal of ovaries) or medical treatments. It can also occur during perimenopause (the transition to menopause).

Symptoms

Common symptoms

• Vaginal dryness
• Burning or irritation in the vagina or vulva
• Pain or discomfort during sexual intercourse
• Itching
• Thin, watery discharge
• Urinary symptoms like needing to urinate more often or urgently
• Recurrent urinary tract infections (UTIs)

Symptoms in older adults

• Symptoms may be more pronounced in older women, with greater vaginal thinning and increased risk of urinary tract infections.
• Older adults might also experience more difficulty with sexual activity due to discomfort.

Causes

Main causes

• The main cause is the drop in estrogen levels that happens during menopause. Estrogen helps keep vaginal tissues healthy, moist, and elastic.
• Without enough estrogen, the vaginal walls become thinner, drier, and less stretchy. Similar changes can occur in the bladder and urethra (the tube that carries urine out of the body).

Risk factors

• Natural menopause or early menopause
• Surgical removal of ovaries
• Radiation therapy or chemotherapy to the pelvic area
• Breast cancer treatments that lower estrogen levels
• Certain medications that affect hormones

When to see a doctor

See a doctor urgently if:

• If you have severe pain, bleeding, or signs of infection (fever, chills)
• If you cannot pass urine

Book a routine appointment if:

• If vaginal dryness, discomfort, or urinary symptoms bother you or affect your quality of life
• If you are having painful sex that is causing distress
• If you have recurrent urinary tract infections

Diagnosis

A doctor will diagnose GSM based on your symptoms and a pelvic exam. They may also ask about your medical history, especially about menopause.

Tests that may be done

• Pelvic exam: The doctor will examine the vagina and vulva for signs of thinning, dryness, or irritation.
• Vaginal pH test: A simple test to measure acidity; a higher pH can indicate GSM.
• Urine test: To check for a urinary tract infection if you have bladder symptoms.

What to expect at your appointment

The exam is usually quick and similar to a regular pelvic check. Some women feel a bit of pressure or discomfort, but the doctor will try to make you comfortable. No special preparation is needed.

Treatment

Treatment for GSM focuses on relieving symptoms and improving quality of life. Options range from simple self-care to prescription therapies. A combination often works best.

Self-care at home

• Use a water-based vaginal moisturiser two to three times a week to keep the vagina hydrated.
• Apply a vaginal lubricant before sexual activity to reduce discomfort.
• Avoid harsh soaps, douches, or scented products near the vaginal area.
• Consider pelvic floor exercises to strengthen muscles and improve urinary symptoms.

Medical treatments

If self-care is not enough, your doctor may recommend treatments that can be inserted directly into the vagina. These include low-dose estrogen creams, rings, or tablets that release estrogen locally. There are also non-hormonal options like certain vaginal moisturisers or a medication that works on nerve signals. Your doctor will discuss the options that are safest for you based on your health history.

When is surgery considered?

Surgery is rarely needed for GSM. It might be considered only if there is severe narrowing (stenosis) of the vagina that does not respond to other treatments.

Living with this condition

Living with GSM can be uncomfortable, but most women find that a combination of self-care and medical help eases symptoms. It helps to stay informed and communicate openly with your partner and doctor.

Lifestyle tips

• Stay sexually active, as regular sexual activity (with or without a partner) can help maintain vaginal elasticity.
• Use lubricants and moisturisers consistently.
• Wear cotton underwear and avoid tight clothing.
• Practice good hygiene without over-cleansing.

Diet and exercise

A balanced diet with plenty of fluids may help overall urinary health. Pelvic floor exercises (Kegels) can strengthen the muscles and help with bladder control. There is no specific diet that cures GSM, but eating foods rich in phytoestrogens (like soy) might offer mild benefit for some women.

Mental health and emotional wellbeing

GSM can affect your self-esteem, body image, and intimate relationships. Many women feel frustrated or embarrassed. If these feelings are strong, talk to your doctor or a counsellor. You are not alone, and treatments can restore comfort and confidence.

Prevention

GSM cannot be completely prevented because it is a natural part of menopause. However, early treatment of symptoms can prevent them from getting worse. Staying sexually active and using vaginal moisturisers may help maintain tissue health.

Screening programmes

There is no routine screening test for GSM. But if you are postmenopausal, it is a good idea to mention any symptoms to your doctor during your regular check-ups.

Complications

If left untreated

• Increased discomfort and pain during sex, potentially leading to avoidance of intimacy
• Recurrent urinary tract infections
• Urinary incontinence (leaking urine)
• Weakening of vaginal tissue, which can lead to tears or bleeding

Long-term outlook

The outlook is very good. Although GSM is a chronic condition, treatments are safe and effective. Most women get significant relief from symptoms and can enjoy a good quality of life. It is worth seeking help early.

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