Under Development: This website is actively being built. Some features and content may be incomplete.
Understanding vaginal and urinary symptoms of estrogen deficiency, and why they don't improve without treatment
Genitourinary Syndrome of Menopause (GSM) is the medical term for vulvovaginal and urinary symptoms caused by estrogen deficiency, typically occurring during and after menopause. GSM includes what was previously called "vulvovaginal atrophy," "vaginal atrophy," and "urogenital atrophy."
GSM affects 50-70% of postmenopausal women. Unlike hot flashes that often improve over time, GSM symptoms worsen without treatment and significantly impact quality of life and sexual function.
GSM significantly impacts:
Estrogen deficiency causes:
Key point: The pH change alters the vaginal microbiome, losing protective lactobacilli and increasing infection risk (UTIs, bacterial vaginosis).
GSM is diagnosed based on:
No blood tests required. Diagnosis is clinical based on symptoms and exam.
Rule out other causes of vaginal symptoms:
Treatment focuses on restoring vaginal health and estrogen levels. This is educational information only - treatment decisions should be made with your healthcare provider.
First-line treatment for GSM. Reverses atrophy, restores vaginal pH, and improves all symptoms.
Intrarosa: DHEA insert that converts locally to estrogen and testosterone. FDA-approved for dyspareunia. Alternative to estrogen for some women.
Osphena: Selective estrogen receptor modulator (SERM) taken orally. FDA-approved for moderate-to-severe dyspareunia. Estrogen-agonist effects on vaginal tissue. Alternative to vaginal estrogen.
Less effective than hormonal treatments but may provide some relief:
Unlike hot flashes, which often improve over time:
This educational content cannot and does not:
If you have vaginal dryness, painful intercourse, or recurrent UTIs, discuss these symptoms with your healthcare provider. GSM is highly treatable.
GSM develops during perimenopause and worsens after menopause
Women with POI can also develop GSM due to estrogen deficiency
Scripts for discussing vaginal and sexual health symptoms with providers
Another cause of vulvar pain and dyspareunia - important to distinguish from GSM