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.
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.
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.
GSM treatment: what works
GSM is very treatable. According to The Menopause Society and the 2025 AUA/SUFU/AUGS guideline, treatment follows a step-by-step approach based on how bothersome symptoms are [1].
- Hormone-free first steps: a vaginal moisturizer every 2–3 days and a lubricant during sex.
- Low-dose vaginal estrogen: cream, insert or ring. The most studied option for moderate to severe GSM, and it also helps prevent recurrent UTIs.
- Other prescriptions: vaginal DHEA (prasterone) or ospemifene, a daily pill.
- Pelvic floor physical therapy for painful sex or tight muscles.
Unlike hot flashes, GSM usually doesn’t go away on its own, so ongoing care is common. See the full rundown of every vaginal dryness treatment.
Hormone-free intimate comfort
AIRS Advanced Intimate Renewal Serum is a hormone-free intimate serum that helps moisturize and comfort delicate intimate skin.
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.
What are the symptoms of GSM?
Common symptoms include vaginal dryness, burning or itching, pain during sex, light bleeding after sex, urinary urgency or frequency, and repeated urinary tract infections. They can start in perimenopause and often get worse over time without treatment.
What is the treatment for GSM?
Treatment usually starts with vaginal moisturizers and lubricants. For moderate to severe symptoms, low-dose vaginal estrogen, vaginal DHEA or ospemifene are recommended. Pelvic floor physical therapy helps with painful sex.
Related reading
- Find a doctor, specialist or support
- Vaginal laser vs. at-home care
- Vaginal estrogen vs. hormone-free options
- Vaginal dryness after hysterectomy
- Vaginal dryness after menopause
- Painful sex after menopause
- Alternatives to vaginal estrogen
- Vaginal dryness after breast cancer
- Hyaluronic acid for vaginal dryness
- What is vaginal atrophy?
- Recurrent UTIs after menopause
- Low libido and vaginal dryness
- Can vaginal dryness cause bleeding?
Sources
- The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement. Menopause. 2020;27(9):976–992.
- The Menopause Society. MenoNote: Genitourinary Syndrome of Menopause.