What is genitourinary syndrome of menopause (GSM)?
Genitourinary syndrome of menopause (GSM) is the umbrella term for vulvo-vaginal and urinary changes linked to lower oestrogen in peri- and post-menopause. It can include vaginal dryness (atrophy), irritation, burning, soreness, dyspareunia, and urinary urgency or recurrent UTIs. Symptoms vary in intensity and may fluctuate. Many find relief with regular vaginal moisturisers and lubricants, local oestrogen or DHEA, and supportive lifestyle steps. Educational only. Results vary. Not a cure.
Detailed Medical Explanation
What is GSM? Genitourinary syndrome of menopause (GSM) describes a cluster of symptoms and exam findings affecting the vulva, vagina, urethra and bladder due to declining oestrogen and other sex steroids during peri- and post-menopause. You may also see older terms such as “vaginal atrophy” or “atrophic vaginitis”; today, GSM is preferred because it recognises vaginal dryness alongside urinary symptoms and their impact on comfort, sex, and quality of life.
Why does it happen? With lower oestrogen, the vaginal epithelium becomes thinner and less elastic, blood flow reduces, and natural lubrication falls. The vaginal pH rises and protective lactobacilli decline, which can increase irritation and susceptibility to inflammation or infection. Similar hormonal effects can influence the urethra and bladder trigone, contributing to urgency, frequency, or recurrent urinary tract infections (UTIs).
How might it feel? Common features include vaginal dryness (sometimes called genitourinary atrophy), itching, burning, micro-tears, soreness after exercise or intercourse, and dyspareunia (pain with sex). Some notice stinging with urine on the vulval skin, post-coital spotting, or a feeling of tightness. Urinary symptoms can occur with or without vaginal symptoms. It’s important to distinguish GSM from infections, dermatological conditions (for example, lichen sclerosus), or other causes of vulvo-vaginal pain.
Is vaginal dryness the same as GSM? Vaginal dryness is one core component of GSM but not the whole picture. GSM spans both vaginal and urinary domains. Two people with the same diagnosis may have very different symptom mixes—from primarily dryness to mainly urinary issues—so management is individualised.
What helps? First-line self-care typically involves regular vaginal moisturisers (used several times per week to rehydrate the lining) and personal lubricants (used right before sexual activity). Options include water-based, silicone-based, or oil-based products; each has pros and cons for feel, longevity, and condom/sex-toy compatibility. For persistent dryness and dyspareunia, local vaginal oestrogen (cream, tablet, pessary, or ring) or vaginal DHEA can restore the tissue environment and improve lubrication and comfort. Some consider pelvic floor physiotherapy, dilators, or psychosexual therapy if pain or anxiety around intimacy has developed.
Professional care and next steps. A clinician can assess for GSM, rule out infections or skin conditions, and guide a step-wise plan. If you are exploring device-based or regenerative options alongside core care, see our overview of how treatment pathways work and check typical pricing and what’s included. Not every option suits everyone, and some have limited evidence or specific risks; a shared decision-making conversation helps match benefits, risks and preferences.
Learn more. Trusted resources explain GSM in detail, including symptom lists, practical self-care, and guideline-based treatments. See the NHS overview of vaginal dryness, the menopause management guideline from NICE, a Cochrane review summarising evidence for local oestrogen therapies, and a clinical review of GSM on PubMed.
Clinical Context
GSM is common and under-reported; symptoms can begin in late perimenopause and persist for years without treatment. Those more likely to experience bothersome dryness include individuals with earlier menopause, bilateral oophorectomy, or prolonged breastfeeding, and anyone who cannot or chooses not to use systemic HRT. Vaginal symptoms may be exacerbated by fragranced washes, tight or abrasive clothing, low arousal, or inadequate lubrication. Conversely, persistent irritation, fissures, or pain may signal co-existing conditions such as lichen sclerosus, vestibulodynia, dermatitis, or candidiasis—these need targeted management.
Who may not be suited to certain options? People with active genital infections, recent surgery, unhealed tears, or undiagnosed bleeding usually need assessment before starting new products or procedures. Those with a history of hormone-sensitive cancers should discuss local vaginal oestrogen or DHEA with their oncology and menopause teams; shared, personalised decisions are standard, guided by symptom burden and risk tolerance. Alternatives include consistent use of non-hormonal moisturisers/lubricants, pelvic floor physiotherapy, psychosexual support, and, in selected cases, device-based or regenerative treatments where evidence and safety are acceptable.
Practical next steps: adopt gentle vulval care (lukewarm water only, fragrance-free emollients as a soap substitute), schedule regular moisturiser use, choose suitable lubricants for intimacy, and plan follow-up to review response in 6–12 weeks. If urinary symptoms dominate or UTIs recur, assessment for atrophic changes and consideration of local oestrogen may reduce frequency; see NHS guidance on vaginal dryness and related care.
Evidence-Based Approaches
Guidelines recommend step-wise management. The NICE Menopause Guideline (NG23) advises offering information on vaginal moisturisers and lubricants, and considering local vaginal oestrogen for GSM when symptoms affect quality of life. Local oestrogen can be delivered as estradiol or estriol creams, pessaries/tablets, or an estradiol-releasing ring; choice reflects preference, dexterity, and symptom pattern. Systemic HRT may help some, but local therapy is often required even when systemic symptoms (e.g., hot flushes) improve.
Cochrane reviews consistently find that low-dose vaginal oestrogens improve dryness, soreness, and dyspareunia compared with placebo, with broadly similar efficacy across formulations, and minimal systemic absorption at recommended doses. See the Cochrane Library synthesis on local oestrogen for postmenopausal vaginal symptoms for methodology and pooled estimates.
For individuals who cannot or prefer not to use oestrogen, non-hormonal moisturisers (some containing hyaluronic acid) offer symptom relief, though effects may be smaller or require regular, ongoing use. A clinical narrative review on genitourinary syndrome of menopause summarises comparative options, including vaginal DHEA (prasterone) and indications for pelvic floor and psychosexual interventions. Prescribers should also consult the British National Formulary for practical product guidance and contraindications; see BNF for up-to-date UK prescribing information.
Safety considerations: topical oestrogens are generally well tolerated; transient irritation or discharge may occur. Systemic absorption is low at licensed doses, but shared decision-making is essential in hormone-sensitive cancer survivors. Monitor response and adjust formulation or frequency to the lowest effective regimen. Evidence for energy-based devices or regenerative injectables in GSM is still evolving and not first-line; decisions should weigh uncertainties, costs, and regulatory status against symptom burden and preferences.