Genitourinary Syndrome of Menopause (GSM): A Clear Guide

Educational content only. This is not medical advice and is not product labeling. Talk with your clinician about your own symptoms. Medical disclaimer.

Genitourinary Syndrome of Menopause, or GSM, is the medical term for the group of vaginal, vulvar and urinary changes caused by lower estrogen during and after menopause. It used to be called vulvovaginal atrophy. The newer name reflects that it affects the bladder and urethra as well as the vagina.

Smiling woman in a gray cardigan after menopause

How common is GSM?

Very common. The Menopause Society estimates that GSM affects roughly 27% to 84% of postmenopausal women, yet it is frequently underdiagnosed and undertreated [1]. Unlike hot flashes, GSM tends to be progressive: without treatment, symptoms usually continue or worsen over time.

Symptoms of GSM

Vaginal: dryness, burning, irritation and reduced lubrication
Sexual: pain with intercourse, reduced arousal, and spotting after sex
Urinary: urgency, frequency, burning with urination and recurrent UTIs
Vulvar: itching, thinning skin and sensitivity

What changes in the tissue

Before menopause, estrogen keeps the vaginal lining thick and multi-layered, with a rich blood supply and natural moisture. After menopause the lining becomes thinner and flatter, blood flow drops and natural secretions decrease. That’s why dryness, irritation and discomfort become more common.

Illustration of premenopausal vaginal tissue with a thick epithelium, dense blood supply and natural moisture — Before menopause: thick lining, dense blood supply, natural moisture

Illustration of postmenopausal vaginal tissue with a thinner epithelium, reduced blood supply and less moisture — After menopause: thinner lining, reduced blood supply, less moisture

Perimenopause: it can start earlier than you think

Estrogen begins to fluctuate and decline years before your final period. Some women notice dryness or discomfort during sex in their 40s, even while they still have regular cycles. Read more in our guide to vaginal dryness in perimenopause.

Managing GSM

Treatment usually starts with non-hormonal moisturizers and lubricants and can move to local (vaginal) hormone therapy or other prescription options. Hormone-free serums with hyaluronic acid, peptides and growth factors are another option, especially for women who can’t or prefer not to use hormones. See the full rundown on our treatment options page.

Hormone-free intimate comfort

AIRS Advanced Intimate Renewal Serum is a hormone-free intimate serum that helps moisturize and comfort delicate intimate skin.

Learn about AIRS

Is GSM the same as vaginal atrophy?

GSM is the newer, broader term. It includes the vaginal changes once called atrophy plus related urinary and vulvar symptoms.

Can GSM be reversed?

Symptoms can often improve a lot with consistent care. Since the underlying hormone change continues, most women need ongoing maintenance.