What is Genitourinary Syndrome of Menopause (GSM)?

Over 80% of menopausal women experience changes in their genital and urinary health.

What is Genitourinary Syndrome of Menopause (GSM)?

Over 80% of menopausal women experience changes in their
genital and urinary health.

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Symptoms of GSM

Over 80% of menopausal women experience changes in their genital and urinary health, but less than 10% of these women seek treatment from a provider.

During perimenopause and menopause your levels of estrogen drop and this can affect many different parts of your body. There is one group of menopausal symptoms that is the least talked about despite issues being extremely common – GSM.
Because GSM symptoms happen as a result of falling estrogen levels at menopause, and because symptoms involve your genitals and urinary function, the collective term ‘Genitourinary Syndrome of Menopause’ or GSM for short is used by providers. GSM used to be called ‘vaginal atrophy’ but this term is quite outdated now.

GSM can commonly cause some of the following symptoms:

  • Reduced moisture and lubrication of the vulva and vagina, which can lead to discomfort, dryness, soreness, itching and/or pain when something is inserted into the vagina.
  • Genital tissue becomes more fragile and can tear easily.
  • Irritation or burning sensation in the vulva.
  • Less elasticity of the vagina which can mean it feels less ‘stretchy’.
  • Changes to the nerve endings in the clitoris. This can either reduce sensation or cause heightened sensitivity that is unpleasant.
  • Needing to use the bathroom more often, especially at night.
  • A thinning of the labia majora and labia minora which can leave the urethra more exposed and prone to infections in the urinary tract and bladder.
  • A weakening of the pelvic floor and neck of the bladder. This can cause leaks of urine especially when laughing, sneezing, coughing or jumping.
  • Increased urgency or feeling like you need to rush to use the bathroom.

While GSM can have a big impact on your wellbeing, there are very safe and effective treatments available so you don’t need to suffer in silence. Ensuring you are replacing the estrogen your body needs can help to reduce symptoms. Vaginal estrogen that is applied directly to the vulva and inside the vagina can help with tissue recovery and reduce other unwanted issues. Happy down there days!

Keep reading to find out more about these treatments and how to minimize the effects of menopause on your genital and urinary health.

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Further reading

Symptoms of Menopause

Staying Healthy Down Below

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1 in 5 women will need to add in vaginal estrogen because their HT isn’t reaching the genital area to provide relief that’s needed.

The impact of GSM

We’ve described a list of symptoms, but what does this really mean for how GSM could affect you day-to-day?
Here are just some of the ways GSM can interfere with women’s lives without treatment.

  • Feeling uncomfortable, sore or itchy down below.
  • Stinging when using your usual shower gel or soap.
  • Having recurrent urinary tract infections (UTI’s) or cystitis.
  • More episodes of thrush because there is less ‘good’ bacteria to fight off bugs.
  • Discomfort wearing certain kinds of underwear or trousers.
  • Difficulty taking part in activities like cycling, horse riding, spin classes, Peloton, or anything else where you sit astride a seat.
  • Discomfort with sexual play and intimacy due to feeling sore or experiencing vulvovaginal dryness and the vagina feeling less stretchy.
  • Reduction in your ability to orgasm due to the above changes and the increased sensitivity of the clitoris.

If you have a partner, the effects of GSM on your sex life can negatively impact your relationship. Some partners worry or feel that a lack of lubrication and arousal means you feel less attracted or turned on by them. In turn, it can leave you feeling upset as to why your body is not responding to your partner in the way it once did.

How can you manage genital and urinary changes?

Check out ways to keep your vulva and vagina happy here.
If you’re feeling sore, here are some extra tips to consider:

  • You don’t need to wash too often, once a day is enough.
  • Wash yourself with your hands rather than a flannel or sponge, which may feel abrasive and can transmit bacteria.
  • Gently pat rather than rubbing yourself dry.
  • After washing, use an intimate moisturizer that is kind to the skin. Brands to trust include Ah! Yes VM, or Tabu.
  • Always use plenty of skin-kind lubricant when taking part in sexual play including during solo adventures!

Show your bladder some support!

  1. Drink lots of water. You should use the bathroom every 3-4 hours and your pee should be a pale yellow colour.
  2. Reduce caffeine and alcohol as they can make existing bladder problems worse.
  3. Do what you can to avoid constipation as it can put undue pressure on your bladder and pelvic floor. Drinking plenty of water can be a big help here.
  4. Reduce or if possible, stop smoking. Bladder problems are more common in people who smokers.
  5. Pee after sex to help flush bacteria away.
  6. Wipe yourself from front to back to avoid transferring fecal bacteria from your anus through to your vulva and vagina.
  7. Empty your bladder completely when you pee. It helps to be fully relaxed to do this.
  8. Regular exercise and managing body weight can also help your bladder stay healthy.

If you’re already across all of these and you still experience recurrent or persistent urinary symptoms, head over to Live UTI Free for more information about UTI testing and UTI treatment.

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Any warnings about vaginal estrogen?

Vaginal estrogen is not the same as hormone therapy (HT) as it is not absorbed into your bloodstream. This means it’s safe to use long term, including among women who have had breast cancer. Vaginal estrogen is something you will need to use long term to manage GSM. Your symptoms may return if you stop using the medication.

You can use both HT and vaginal estrogen together. In fact, 1 in 5 women taking HT will need to add in vaginal estrogen because their HT isn’t reaching the genital area to provide the relief that’s needed.

A note about cervical screening: If pain or embarrassment because of GSM symptoms is putting you off from getting a PAP smear, don’t worry. Using any of these vaginal estrogen treatments as described for 6 weeks before your smear test will make the exam a lot more comfortable for you.

When GSM is not getting better…

If you have used a vaginal estrogen treatment for at least 3 months as directed, and things are still not improving, go back and talk to your doctor. You may need to try a different product (as the type of estrogen varies between them and one may suit you better than another).

Equally, your symptoms may not (only) be caused by GSM. There are some other gynaecological conditions that overlap or present similarly to GSM, so it is important to make sure your symptoms have been diagnosed correctly. Remember, any unexpected vaginal bleeding, especially after menopause, should always be checked out too.

Hormone treatments for GSM

The best treatment to help to support with GSM symptoms is estrogen. It should be applied right back to the area where it’s needed most!

This treatment is called vaginal (or local) estrogen and it can be given in a few different ways. Each method of treatment involves the direct application of estrogen into the vagina. This process usually takes place at nighttime, so it can stay in place and is able to do its thing, while you sleep!

Here’s some advice on the different options available with the good, the bad…no uglies!

Tablet

Using an applicator insert the tablet high into the vagina. Do this daily for the first 2 weeks then 2x a week after that.

The tablet is easy to use and pretty ‘mess’ free! Check out if the applicator is reusable as some are daily use only and not very environmentally friendly.

Pessary

Insert the pessary into your vagina using your fingers. Do this daily for the first 3 weeks and then 2x a week after that.

Using a pessary means no plastic waste which is good for the environment. Pessaries can however produce a slight waxy discharge and may also damage latex condoms.

Cream

Fill an applicator with cream and insert it into your vagina. Do this daily for 2 weeks then 2x a week after that. You can also spread the cream on the vulva and urethral opening if needed.

The cream can disperse and get a bit messy. Some people find the transfer to clothing or bedding a little annoying. Others like the ability to apply the cream to other parts of the vulva!

Gel

Fill an applicator with gel and insert into your vagina. Do this daily for 3 weeks and then 2x a week after that.

The gel absorbs quickly. There may be some itching or irritation when you first start using the gel. As with the cream this application method can be a bit messy.

Ring

A small silicon flexible ring is inserted into the vagina. It releases a low and steady dose of estrogen. A healthcare professional can insert the ring or you can insert it yourself too. It stays in place for 90 days before you need to get a new one.

Once the ring is in place, there’s no daily/weekly application required nor any discharge. If you prefer, you can remove and replace the ring before or after you have sex.