Understanding Genitourinary Syndrome of Menopause (GSM)
Article written by Dr Emma Ginns, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025. This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
This guide explores Genitourinary syndrome of menopause, a common and often underdiagnosed symptom of perimenopause and menopause. This is often abbreviated to GSM for short.
What is GSM?
Genitourinary Syndrome of Menopause (GSM) refers to a group of symptoms caused by low oestrogen affecting the vulva, vagina, bladder and urinary tract. You may have heard this previously called vaginal atrophy.
GSM is very common, affecting up to 80% of women. Symptoms can begin during perimenopause or appear years after menopause, and without treatment they tend to persist and slowly progress.
The good news is that these symptoms are highly treatable and most women experience significant, and often complete relief, with the right care.
What are the Symptoms of GSM?
Women may notice one or several of the following changes:
Vaginal dryness, itching or burning
Vulval discomfort, tearing, bleeding or irritation
Pain, stinging or soreness during sex, which can impact sexual desire
Reduced sensation or difficulty reaching orgasm
Recurrent urinary tract infections (UTIs)
Urinary frequency, urgency, or waking overnight to pass urine
Leaking urine
Bladder pressure or discomfort
Light bleeding or irritation after intercourse
These symptoms can affect confidence, relationships, sexual wellbeing and sleep, and can significantly impact quality of life.
Everyday Self-Care for Vulval and Vaginal Comfort
Gentle care of the vulval skin can make a meaningful difference:
Wash only with water. Soaps, shower gels, bubble baths and fragranced wipes can irritate the area.
If you prefer to use a wash product, choose an unfragranced emollient such as Cetraben, Hydromol or aqueous cream.
These emollients can also be used as moisturisers on the external tissues after washing.
Vaginal moisturisers (e.g. YES VM) can be used externally and internally to improve comfort.
Everyday Self-Care for Bladder Health
Simple lifestyle steps can help support bladder function:
Drink regularly and empty your bladder after sexual activity.
Be aware of common bladder irritants such as caffeine and alcohol - some women notice improvement by reducing these.
Smoking can worsen bladder symptoms; support is available if you wish to stop.
Pelvic floor exercises can improve bladder control and circulation. The Squeezy app is a helpful reminder.
If you think you have a UTI, contact your GP surgery for assessment.
Vaginal Moisturisers and Lubricants
Regular moisturising keeps tissues comfortable and hydrated. Moisturisers such as YES VM, Sutil Luxe, Olive & Bee or YES COCO can be used daily or several times per week.
Everyone is different - you may prefer one product over another, so it is worth trying a few.
Lubricants reduce friction during sexual activity and can make intimacy more comfortable.
Options include:
Water-based: YES WB, Sutil Luxe
Silicone-based: Uberlube, Vielle
If sexual activity is comfortable, it can help maintain blood flow and elasticity in the area.
Medical Treatments for GSM
1. Vaginal Oestrogen (estradiol or estriol)
A highly effective treatment used long-term. Symptoms return when it is stopped.
Improvements are often seen within 1-3 months.
Available as pessaries, tablets, creams, a gel, or a vaginal ring.
Absorbed only locally with minimal effect on the rest of the body.
Safe for most women, including many with a history of breast cancer.
Helps restore moisture, elasticity and pH and often improves bladder symptoms.
Postmenopausal women can buy estradiol pessaries (Gina) or estriol cream (Oversee) over the counter in the UK.
2. Vaginal DHEA (Prasterone / Intrarosa)
A local hormone treatment that converts within the tissues to oestrogen and testosterone.
Improves vaginal dryness, elasticity and urinary symptoms.
3. Oral Ospemifene
A tablet licensed for vaginal dryness and discomfort.
4. Systemic HRT
For women with broader menopausal symptoms, systemic HRT can help improve GSM.
Many women benefit from using both systemic HRT and vaginal oestrogen together.
5. Vaginal Laser Therapy
Not available on the NHS.
Long-term safety and effectiveness data are still evolving.
May be considered in women who do not achieve relief with other options.
Useful external resources:
https://menopausesupport.co.uk/wp-content/uploads/2025/07/GSM-OF-MENOPAUSE-SYMPTOM-CHECKER.pdf
https://mref.uk/wp-content/uploads/2024/10/fast-facts-4-GSM.pdf
Recommended reading on GSM:
Me and My Menopausal Vagina: Living with Vaginal Atrophy, by Jane Lewis
The Vagina Bible: Dr Jen Gunter