Genitourinary Syndrome of Menopause (GSM): Symptoms, Causes & Evidence-Based Treatment Options
If you’ve been experiencing vaginal dryness, burning, recurrent UTIs, bladder urgency, irritation, pain with intimacy, or a feeling that ‘something just isn’t right’ during perimenopause or menopause — you are not alone.
Many of these symptoms may relate to a recognised medical condition known as Genitourinary Syndrome of Menopause (GSM).
GSM is very common, with research suggesting it may affect approximately 40–60% of postmenopausal women, with prevalence increasing over time post-menopause.
The good news is that GSM is treatable, and support is available.
What Is GSM?
Genitourinary Syndrome of Menopause (GSM) describes a collection of symptoms affecting the vaginal tissues, vulva, bladder, and urinary tract associated with declining oestrogen levels.
GSM commonly develops during perimenopause and menopause, but can also occur after surgical menopause, during breastfeeding (sometimes referred to as Genitourinary Syndrome of Lactation or GSL), during treatment with anti-oestrogen medications, or in other low-oestrogen states.
Unlike hot flushes, which often resolve at some stage in postmenopause, GSM symptoms often persist or gradually worsen over time if left untreated.
Common Symptoms of GSM
Symptoms can include:
Vaginal dryness
Burning, irritation, itching
Pain with intercourse
Reduced lubrication
Recurrent UTIs
Urinary urgency or frequency
Bladder irritation
Painful urination despite negative urine tests
Tissue fragility or tearing
What Causes GSM?
Oestrogen plays an important role in maintaining the health of the vaginal and urinary tissues.
As oestrogen levels decline:
Vaginal tissues can become thinner, drier, and more fragile
Natural lubrication decreases
Blood flow to the tissues may reduce
Vaginal pH and microbiome balance can change
Lactobacillus levels may decline
Urinary tissues may become more sensitive and vulnerable to irritation & infection
These changes can contribute to both vaginal and urinary symptoms
Evidence-Based Treatment Options for GSM
Treatment approaches depend on symptom severity, individual preferences, medical history, and whether hormonal therapy is appropriate.
Vaginal Oestrogen Therapy
Low-dose vulvovaginal (topical) oestrogen is considered a gold-standard treatment for many symptoms of GSM and is a form of menopausal hormone therapy (MHT).
It may help:
Improve vaginal moisture and elasticity
Reduce burning and irritation
Support tissue integrity
Improve urinary symptoms
Support the vaginal microbiome
Reduce recurrent UTIs in some women
In Australia, local vaginal oestrogen is commonly prescribed as estriol creams, low-dose estradiol vaginal pessaries or cream. These topical treatments generally have an excellent safety profile with minimal/negligible systemic absorption.
These treatments require a prescription from your GP or specialist, who will consider your individual symptoms, medical history, medications, and whether local oestrogen therapy is appropriate for you.
Hyaluronic Acid Vaginal Moisturisers
There is growing evidence supporting the use of vaginal hyaluronic acid moisturisers and pessaries for GSM-related symptoms.
Many women also find vaginal moisturisers to be a helpful adjunct alongside other GSM treatments, or as an initial therapy for milder symptom presentations, particularly for improving comfort, dryness, and tissue hydration. They may also offer supportive non-hormonal options for women who are unable to use hormone therapies.
Complementary & Integrative Support
Many complementary approaches can be safely used alongside MHT and may help to provide additional support for tissue health, microbiome balance, and symptom relief.
Depending on the individual, supportive strategies may include:
Hyaluronic acid moisturisers/pessaries
Sea buckthorn oil
Practitioner-guided topical fennel preparations (not essential oil)
Nourishing barrier-supportive preparations
Pelvic floor physiotherapy
Stress and nervous system support
Nutritional support
Phytoestrogen-rich foods such as flaxseed
When Should You Seek Support?
It’s important that persistent vulvovaginal or urinary symptoms are properly medically assessed initially, as symptoms can overlap with infections, dermatological conditions, pelvic pain conditions, and other gynaecological or urinary tract conditions. Proper diagnosis is the first step in establishing an effective treatment approach.
Consider seeking support if you are experiencing:
Recurrent UTIs
Unexpected vaginal bleeding or bleeding during/after intercourse
Persistent dryness, burning, or irritation
Pain with intimacy
Bladder urgency or discomfort
Any genitourinary symptoms affecting sleep, confidence, relationships, or quality of life
Symptoms that keep returning despite treatment
Integrative care alongside prescribed therapies such as vaginal oestrogen or MHT
Final Thoughts
Genitourinary Syndrome of Menopause is common, real, and treatable.
If you’ve been experiencing recurrent urinary symptoms, vaginal discomfort, dryness, irritation, or other changes during perimenopause or menopause, you are not alone — and there are evidence-based, effective treatment options available. Seeking assessment and treatment early may may also help prevent symptoms from progressing over time.
With the right support, many women experience significant improvement in comfort, confidence, and quality of life.