Genitourinary Syndrome of Menopause: What You Need to Know
When most people think about menopause, they picture hot flashes, mood swings, and maybe some trouble sleeping. But there’s another condition that affects the majority of women during and after menopause, yet it doesn’t get nearly as much attention.
It’s called Genitourinary Syndrome of Menopause (GSM).
What is Genitourinary Syndrome of Menopause?
Genitourinary Syndrome of Menopause (GSM) is a collection of changes that happen in the vaginal and urinary tissues due to declining estrogen levels during and after menopause. You may have also heard it called atrophic vaginitis or vulvovaginal atrophy in the past.
Menopause typically happens around age 51 (although it can occur anytime between 45–55 years). It’s defined as going 12 consecutive months without a menstrual period, vaginal bleeding, or spotting. It occurs because the ovaries stop releasing eggs for potential fertilization, and estrogen declines.
The significant hormonal changes from menopause, particularly the estrogen decline, will lead to a variety of changes body-wide, such as osteoporosis, increased risk for cardiovascular disease, mood and sleep disturbances, brain fog, hot flashes, night sweats, and fatigue.
Genitourinary Syndrome of Menopause has its own additional set of symptoms, including:
Vaginal dryness
Friable (easy to tear or bleed) vulvar and vaginal tissue
Decreased vaginal elasticity and increased stiffness
Inflammation, itching, and burning at the vaginal opening
Painful sex
Urinary urgency, frequency, and/or incontinence
Recurrent UTIs and other vaginal infections
Increased prolapse symptoms such as heaviness or pressure
Decreased libido
“Common” Does Not Mean “Normal”
GSM is very common and often goes untreated because it’s considered to be a ‘normal’ part of aging. One of our favorite sayings at Pelvic Health and Wellness is, “It is common, but it is not normal.”
Just because something is common does not mean you should have to suffer. GSM can drastically impact your quality of life. The discomfort and lack of bladder control may lead to reduced participation in social activities. It can strain intimate relationships for those who are sexually active. GSM symptoms are also a significant barrier to working out, deterring individuals from being physically active.
And here’s why that matters: staying active during menopause is hugely important. Strength training, in particular, can improve bone density, improve muscle mass, reduce the risk of fractures and falls, improve mood and sleep, decrease weight gain, improve brain function, decrease hot flashes, reduce risk of tendon injuries, and boost anti-inflammatory factors in our bodies.
So, if GSM is keeping you from the activities you love, that’s a big problem.
GSM is Very Treatable!
The good news? The majority of GSM symptoms are very treatable. The most effective approach usually combines hormonal therapy (like vaginal estrogen cream) and pelvic floor physical therapy.
In fact, in 2025, the American Urological Association released updated guidelines to help providers recommend the best education and treatment for GSM. One highlight? There is strong evidence supporting low-dose vaginal estrogen as a safe and effective option for managing the symptoms of GSM.
Low-dose Vaginal Estrogen Cream
Low-dose vaginal estrogen cream is considered the first-line hormonal treatment for GSM. It helps with:
Vaginal dryness and irritation
Atrophy
Tissue sensitivity
Painful sex
Recurrent UTIs or vaginal infections
Some urinary urgency and frequency symptoms
Two other hormonal options include vaginal DHEA (a precursor to estrogen) and ospemifene (which acts like estrogen in vaginal tissue).
And here’s something reassuring: research shows no evidence linking vaginal estrogen to breast cancer or the development of uterine cancer, and it may be an option for those with a personal history of breast cancer.
If you think vaginal estrogen cream might help you, talk with your primary care provider, OBGYN, or urologist about whether it is right for you.
Pelvic Floor Physical Therapy
As pelvic floor physical therapists, what can we do to help you with GSM? We can make a big difference!
We treat many of the issues that occur with GSM, such as urinary incontinence, urgency and frequency of urination, pelvic organ prolapse, and painful intercourse. We have a multitude of manual treatment techniques and recommendations to improve blood flow and circulation to these tissues, help restore elasticity and strength of the muscles, and help you establish new routines to maintain the health of your pelvic floor. Just like how our skincare routine changes as we age, so does the care for our pelvic health.
You Don’t Have to “Live With It”
Yes, menopause brings changes. But, you do not have to settle for dealing with the symptoms of menopause or genitourinary syndrome of menopause simply because it is common.
If you’re experiencing these symptoms, reach out to us at Pelvic Health and Wellness. Together, we’ll create a plan to keep you active, independent, and comfortable—so you can move through menopause with confidence.
About Pelvic Health & Wellness
Pelvic Health & Wellness was built with you in mind. We practice whole-person, individualized pelvic floor physical therapy in a caring and safe environment. Our physical therapists specialize in treating pelvic health concerns such as pelvic floor dysfunction, bowel and gut health, pelvic pain, pelvic organ prolapse, constipation, incontinence, fertility, and various pregnancy and postpartum-related conditions.
We understand that being ready to talk about and address your pelvic floor wellness concerns comes from a place of strength. We are here to support and encourage you on your journey back to health so you can return to doing what you love! If you are ready to take the first step in reclaiming your pelvic health and wellness, don't hesitate to get in touch with us today.