Vaginal changes in menopause
Genitourinary Syndrome of Menopause (GSM): What it is, why it’s important and what you can do about it
Written by: Dr. Madeleine Clark, ND MSCP
A common response I get in clinic when I run through my typically perimenopause symptoms questions with patients is
“Vaginal dryness? - oh ya that has definitely been happening”
Vaginal dryness, discomfort during sex, or more frequent UTIs are common symptoms during the perimenopause and menopause transition. We call this collection of symptoms: Genitourinary Syndrome of Menopause (GSM).
What is GSM?
GSM refers to a collection of symptoms and physical changes related to the decline in estrogen during menopause. It affects the vulva, vagina, bladder, and urethra — and it’s incredibly common, with studies estimating prevalence between around 80% of postmenopausal women
Common Symptoms of GSM Include:
Vaginal dryness or irritation
Pain or discomfort during sexual activity
Decreased lubrication, arousal, and orgasm
Vulvar or vaginal burning
Painful urination or urinary urgency
Frequent or recurrent urinary tract infections
These symptoms can significantly impact your quality of life, intimacy, and confidence, yet they often go undiscussed and untreated.
How is GSM Diagnosed?
A proper diagnosis starts with a thorough assessment. This might include:
Detailed symptom history (how long has this been going on, what symptoms show up for you etc.)
Pelvic examination, checking for:
Paleness to the skin, atrophy (looking for a decrease in tissue size - yes your vulvar tissue can decrease in size and even narrow in the opening, redness (erythema), or tissue fragility (you might be experiencing more cuts or irritation, even with just wiping or being in jeans)
Vaginal pH testing, which typically rises as estrogen declines
This is actually one of the most reliable clues you may be in perimenopause - even over testing FSH!
It’s also essential to rule out other conditions with similar symptoms, such as infections, skins concerns
How is GSM Treated?
The most effective treatment is usually local vaginal estrogen therapy, which replenishes estrogen directly to the affected tissues with minimal systemic absorption. This can be a safe option for most patients but requires consistent use.
is there non-hormonal options?
Yes, non hormonal options are often used in conjunction or in place of hormonal therapies.
These might include:
Vaginal moisturizers and lubricants
Hyaluronic acid suppositories
Pelvic floor therapy
Lifestyle changes (e.g., avoiding harsh soaps, improving hydration, supporting tissue health through nutrition), download our vulvar care handout for more information.
Why is it important to treat GSM?
We want to treat GSM not only to eliminate the symptoms, but also to preserve the health of the vulvar tissue and prevent UTI or infections in the future. As the tissue changes in response to the decline in estrogen, the changes in tissue architecture occur - causing the actually skin, opening to the vagina and clitoris to change size. The pH changes to the vagina also alter the microbiome of this area leading to an increase in UTI infections. In our later decades, UTIs can be life threatening.
You Don’t Have to “Tough It Out”
One of the most frustrating parts of GSM is how often it’s overlooked, dismissed, frankly not addressed or asked about. But GSM is not just “part of getting older” it’s a treatable medical condition, and support is available.
As a naturopathic doctor and Menopause Society Certified Practitioner, I work with patients to:
Accurately assess symptoms
Provide individualized treatment options, including prescriptions when appropriate
Collaborate with pelvic health physiotherapists and other providers when needed
I’m here to help you feel more like yourself again - comfortably, confidently, and with evidence-based care that meets you where you are. I offer complimentary meet and greet appointments to chat about your case and see if we are the right fit!