Genitourinary Syndrome of Menopause (GSM)
(Sometimes called vulvo-vaginal atrophy)
GSM refers to changes in the vagina, vulva, and urinary system that happen when estrogen levels are low. This can occur naturally around menopause or suddenly after removal of the ovaries, chemotherapy, or medications that block hormones (such as some breast cancer treatments).
Common Symptoms
Why does GSM happen?
What can be done?
Common Symptoms
Vaginal or vulvar dryness, burning, or itching
Pain or tightness with sexual activity
More frequent or painful urinartion
Recurrent urinary tract infections
Urine leakage with coughing, laughing, or exercise
Unusual discharge or light bleeding, especially with sex
These symptoms can range from mild to very bothersome and may affect comfort, mood, and intimacy.
Why does genitourinary syndrome of menopause happen?
Estrogen helps keep vaginal and urinary tissues healthy. When estrogen levels drop:
• The vaginal lining becomes thinner, drier, and less stretchy.
• Natural lubrication decreases.
• The urethra (where urine exits) becomes more exposed and prone to irritation or infection.
These changes can cause discomfort and increase the risk of urinary issues.
What can be done?
Treatment focuses on comfort and restoring tissue health. We focus on the 3 Rs.
Reduce Friction
Retain Vaginal Moisture
Restore vaginal & urinary tissue
1
2
3
#1 Reduce Friction:
Using a lubricant during sexual activity to make things more comfortable.
Look for:
Water or silicone-based lubricants
Avoid:
Products with parabens, glycerin, fragrances, or spermicides (can irritate tissues).
Tip:
Silicone-based lubricants last longer but shouldn’t be used with silicone sex toys.
Water-based Lubricants:
Sliquid H2O - Amazon Link
AH! YES WB - Amazon Link
Silicone-based Lubricants:
Oil-based Lubricants:
Olive Oil
#2 Retain Vaginal Moisture:
Use a vaginal moisturizer regularly - like lotion for dry skin. This keeps tissue hydrated and comfortable.
Apply 2-3 times per week (for aromatase inhibitor users, evidence supports 5 times per week), or daily if symptoms are more severe
Hyaluronic acid products tend to give deeper, more long-lasting moisture
Consistency matters more than brand; find what feels best for you
Hyaluronic Acid-based Moisturizers:
Gels
Suppositories
Raveree Bonafide (more expensive, subscription model)
Other types of vaginal moisturizers:
Replens, Luvena, K-Y Silk-E, Femineae, Silken Secret, Me Again, Coconut oil!
#3 Restore Vaginal & Urinary Tissue:
Improve blood flow, restore elasticity and thickness, improve natural moisture, decrease bladder leakage, normal vaginal pH
For people treated with breast or gynecologic cancers, nonhormonal options (lubricants and moisturizers) are recommended to try first
If symptoms do not improve, or are severe local vaginal estrogen therapy is very effective and is safe
Low dose treatment, works mostly in the vaginal and urogenital (bladder, urethra) tissues - very little estrogen is absorbed into the bloodstream
Many cancer specialists and gynecologists (including national and international organizations that write treatment guidelines) support their use when nonhormonal treatments aren't effective
Many different kinds of vaginal estrogen: vaginal rings that are placed for 90 days at a time, creams, tablets, suppositories. (Learn more)
Improvement takes 6-8 weeks of regular use to see full effects.