Genitourinary Syndrome of Menopause - It's Not Just Vaginal Dryness.

Following on from Edition 1 in this Volume 2 of Menopause Monthly - beyond the clinical language, Genitourinary Syndrome of Menopause shows up in very ordinary and often very disruptive ways. Women commonly describe:

• Sex becoming painful or simply unappealing when it used to be enjoyable, which can strain relationships and self-esteem

• A persistent dryness or rawness that makes sitting for long periods, exercising, or wearing certain clothing uncomfortable

• Itching or burning that gets mistaken for a yeast infection, sometimes repeatedly, before GSM is correctly identified

• Recurrent urinary tract infections that seem to come out of nowhere in a woman's fifties or sixties after years of having none

• A sense of grief or frustration -  many women say they assumed this was just something they'd have to live with, or felt embarrassed to bring it up even with their gynaecologist

  
  

That last point is important. Research consistently finds that women under-report these symptoms out of embarrassment, or because they've been led to believe it's simply an unavoidable part of aging. It isn't something you have to just endure - and it's also very treatable.

What Actually Helps

The encouraging news is that treatment options for GSM are well established and most are simple, low-risk and effective. What works best often depends on symptom severity and how much a woman is prepared to address the underlying factors (discussed further down).

For mild dryness:

• Vaginal moisturisers (used regularly, not just before sex) help restore moisture to vaginal tissue over time

• Lubricants used during intimacy reduce friction-related pain - water- or silicone-based options are generally recommended over glycerin-heavy or scented products, which can irritate sensitive tissue

  
  

For moderate to more significant symptoms:

• Low-dose vaginal estrogen (creams) are considered the gold-standard treatment for GSM. Because it's applied locally, very little reaches the bloodstream, making it a different risk profile than systemic hormone therapy - and it's generally considered safe even for many women who can't use systemic oestrogen. It's also one of the more underused options: studies show only about 5–35% of symptomatic women actually use it.

• Vaginal DHEA (prasterone / Intrarosa), a non-estrogen hormonal option, converts to estrogen and testosterone locally within vaginal tissue.

  
  

Other approaches:

• Pelvic floor physical therapy can help with both pain and urinary symptoms

• Staying sexually active (with a partner or otherwise) helps maintain blood flow and tissue elasticity - a case of "use it or lose it" that many clinicians mention

• Some women explore laser or radiofrequency therapies, though evidence and regulatory guidance on these is still evolving, and they're generally more expensive and less established than hormonal options. But have worked well for many women.

  
  

Overall, research on treatment usage shows lubricants and moisturisers remain the most commonly tried option (used by roughly a quarter to over 80% of symptomatic women across various studies), largely because they're accessible over the counter - but they don't address the underlying tissue changes the way local oestrogen therapy can.

An Important & (maybe) Surprising Point

It is no secret for women in menopause that their body becomes more sensitive and delicate – from the skin on our face, to the hair on our head, to the tissue of all of our organs and our vulva and vagina. This is actually a very beautiful thing – whilst what we experience can be challenging, the refinement in our bodies and the intricate adjustments taking place, are seriously incredible – constant communication from our bodies.

How attentive have we been with this part of our body up until now? How honouring have we been of the delicacy of the vulva and vagina area – a very sacred part of every woman’s body. How have we nurtured this area, loved this area, respected this, cared for this area? Have we allowed unwanted imposition or loveless interactions?

Perhaps all of this is worth considering when/if we arrive at menopause with symptoms that are challenging. Yes, the hormones are changing – but how have we lived to support their natural transition? This is not an opportunity to be hard on ourselves, but to simply reflect and listen to the body and embrace the communication. Adjust our movements now – in our very next step, we can be honouring, loving, tender, respectful and deeply nurturing of our body.

So, keep this in mind – and yes of course, part of the care and attentiveness is finding the right treatment and support for you.

If you're noticing dryness, discomfort, itching, or changes in sensation during or after menopause, you are not alone and you are not imagining it. It is one of the most common and most under-discussed aspects of the menopause transition, affecting a substantial share of postmenopausal women. It's also genuinely treatable, often with simple, low-risk options – and it’s well worth looking at the underlying factors just mentioned above to really address the issues that arise.

It is important to be vocal with your doctor or your gynaecologist or anyone you trust in your care team. Given that many clinicians won't bring it up first, the conversation often has to start with you. It's a completely reasonable, medically valid thing to ask about, and there's a good chance it can make a real difference in how you feel day to day. And, with the right support, with underlying factors also addressed, can make a difference to how you feel about yourself as a woman, overall.

This article is for general informational purposes and isn't a substitute for personalised medical advice. If you're experiencing symptoms, talk to a healthcare provider about what's right for you.