Dr Gillian with a patient

Genitourinary Syndrome of Menopause (GSM): Just When You Thought It Was Over…

So, you made it through the hot flushes, the mood swings, and the sleepless nights. You thought the worst of menopause was behind you. Then, out of nowhere, you start noticing new, uninvited guests in your postmenopausal life—vaginal dryness, discomfort, and bladder issues. Welcome to the lesser-known but all-too-common phase of menopause: Genitourinary Syndrome of Menopause (GSM).

What Is GSM, and Why Is It Sneaky?

GSM is the umbrella term for the changes that happen to your vaginal and urinary health due to long-term oestrogen depletion. Unlike the rollercoaster of perimenopause symptoms, which eventually settle, GSM tends to creep in slowly and—here’s the kicker—it doesn’t get better on its own. We’re talking about symptoms like:

  • Vaginal dryness and irritation – everyday discomfort, not just during sex.
  • Painful sex (dyspareunia) – because nobody asked for sandpaper-like friction.
  • Recurrent UTIs – suddenly, you feel like you’re on first-name terms with your pharmacist.
  • Urinary urgency, frequency, leakage or a constant feeling of “I need to go” even when you just went. Urinary leakage can lead to irritation of the vulval skin along with wearing pads or panty liners as a result- creating a ‘dermatitis’ and even more of a problem!
  • Night time bladder stops – waking up frequenctly throughout the night to empty your bladder is another symptom your ‘down there’

Why Does GSM Happen Now?

You might think, “But I got through menopause—why is this happening now?” The answer lies in oestrogen, or rather, the lack of it. Once menopause settles in for the long haul, oestrogen levels stay consistently low, causing the vaginal walls and urinary tract tissues to become thinner, drier, and less elastic. The result? Less natural lubrication, increased risk of irritation and inflammation or ‘dermatitis’, and a ‘weak’ bladder.

Managing GSM: You Don’t Have to Just Put Up With It

The good news? There are effective treatments, and you don’t need to suffer in silence.

1. Oestrogen Therapy (Local or Systemic)

  • Vaginal oestrogen creams, pessaries, or rings can directly treat dryness and irritation with minimal systemic absorption.
  • HRT (Hormone Replacement Therapy) can help if you have other ongoing menopausal symptoms, but it’s not essential for GSM treatment.

2. Hydration and Bladder Care

  • Drinking plenty of water keeps tissues hydrated and reduces UTI risk.
  • Avoiding bladder irritants (caffeine, alcohol, spicy foods) can prevent unnecessary irritation.

3. Pelvic Floor Support

  • pelvic floor exercises can help strengthen muscles and improve bladder control.
  • If bladder leaks or discomfort persist, a women’s health physiotherapist can work wonders.

4. Lubricants and Vaginal Moisturisers

  • Water-based lubricants can make intimacy more comfortable.
  • Vaginal moisturisers (different from lubricants) provide long-term hydration for everyday comfort.
  • Barrier ointments can also really help, especially if you are experiencing urinary leakage as not only do they provide much needed moisturisation for irritated skin, they also act as a barrier to any irritants. If you swim, ride a bike or horse regularly you may find this an essential part of your daily routine to protect those now-more-delicate areas. 

The Takeaway

Just when you thought menopause was behind you, GSM makes an entrance. But here’s the thing—you don’t have to accept it as your new normal. Whether it’s vaginal discomfort, recurrent UTIs, or bladder control issues, there are solutions available, and they actually work.

So, if any of this sounds familiar, don’t suffer in silence. Have a chat with your GP, a menopause specialist, or a women’s health physio. Menopause may be inevitable, but ongoing discomfort doesn’t have to be!