Aside from hot flashes and their associated issues, The genitourinary syndrome of menopause and its' symptoms are some of the most forgotten, least asked or spoken about, embaressing and distressing, problems related to midlife hormonal changes that most women experience at some point, if not treated.
The Genitourinary Syndrome of Menopause (GSM)—previously known as vulvovaginal atrophy—is a common medical condition affecting many women during perimenopause and menopause. As estrogen levels decline, the tissues of the vagina, vulva, bladder, and urethra undergo changes that lead to thinning of tissues, vaginal dryness, and loss of elasticity. Unlike hot flashes, which generally abate 4-7 years postmenopausally, GSM is a chronic condition that typically does not improve without treatment. Fortunately, effective and safe treatments are available, and addressing GSM can significantly improve comfort, sexual health, and overall quality of life.
One of the most common concerns related to GSM is vaginal dryness and painful sex (dyspareunia). Women may also experience burning, itching, irritation, or ongoing vaginal discomfort, even outside of sexual activity. These symptoms can negatively affect intimacy, self-confidence, daily comfort and emotional well-being. It is important to know that painful intercourse and vaginal discomfort are not an inevitable part of aging, and women deserve relief and evidence-based care for these symptoms.
GSM also has a significant impact on urinary and bladder health. Symptoms may include urinary urgency, frequency, painful urination, stress or urge incontinence, and difficulty fully emptying the bladder. Low estrogen levels weaken the tissues that protect the urinary tract, increasing the risk of recurrent urinary tract infections (UTIs). If left untreated, repeated infections can lead to serious complications, including kidney infections and in rare cases, urinary sepsis. Treating GSM is an important preventive step in supporting long-term urinary health peri and post menopausally.
One of the most effective treatments for GSM is local vaginal bioidentical estrogen therapy. Vaginal estrogen works directly at the source to thicken and restore tissue strength, hydration, blood flow, and natural protective mechanisms—often with minimal systemic absorption. Research shows that local estrogen therapy can improve vaginal dryness, reduce painful sex, improve bladder symptoms, and lower the risk of recurrent UTIs. Treatment should always be individualized, taking into account a woman’s personal medical history, symptoms, and health goals. Women in Philadelphia, Roxborough, The Main Line and Surrounding Suburbs, can receive expert, personalized menopause care at Women Wise Holistic Healthcare and Wellness is by Eve Jacobs, Board Certified Women’s Health Nurse Practitioner and active Menopause Society Member ensuring thoughtful, nuanced treatment plans designed to help women feel heard, understood, reassured, comfortable, healthy, and empowered.
FAQ’S:
What is Genitourinary Syndrome of Menopause (GSM)?
Genitourinary Syndrome of Menopause (GSM) is a chronic medical condition caused by declining estrogen levels during perimenopause and menopause. It affects the vagina, vulva, bladder, and urethra, leading to symptoms such as vaginal dryness, painful sex, urinary urgency, frequency, incontinence, and recurrent urinary tract infections. GSM does not usually improve without treatment but is very treatable with appropriate care.
What are common symptoms of GSM?
Common symptoms of GSM include vaginal dryness, burning, itching, irritation, painful intercourse (dyspareunia), and general genital discomfort. Urinary symptoms may include urgency, frequency, leakage, discomfort with urination, and recurrent UTIs. Symptoms may worsen over time if left untreated.
Is painful sex after menopause normal?
Painful sex is common during menopause, but it is not normal and NOT something women should have to live with. Pain during intercourse is often caused by GSM and low estrogen levels affecting vaginal tissues. Effective treatments are available and can significantly improve comfort and sexual health.
How does GSM affect bladder and urinary health?
Low estrogen levels weaken the tissues of the bladder and urethra, increasing the risk of urinary urgency, frequency, incontinence, and recurrent urinary tract infections. Untreated GSM can infections or urinary sepsis.
What is vaginal bioidentical estrogen therapy? (BIET)
Vaginal "bioidentical" estrogen therapy is estrogen that is biochemically, molecularly and structurally exactly like the estrogen our bodies make naturally which is 17-beta estradiol. These hormones made in laboratories are derived from natural plant sources like yams and soy. It is a localized treatment that delivers estrogen directly to vaginal and urinary tissues. It helps restore moisture, elasticity, blood flow, and natural protective mechanisms. Because it is applied locally, systemic absorption is typically minimal for most women.
Is vaginal estrogen safe?
For most women, local vaginal estrogen is considered very safe and well tolerated. It has been extensively studied and is recommended by major menopause and women’s health organizations. Treatment decisions are always individualized based on personal medical history and risk factors.
Do I need systemic hormone therapy to treat GSM?
No. GSM can often be effectively treated with local vaginal estrogen alone, without systemic hormone therapy. Many women who cannot or choose not to use systemic hormones can still safely treat GSM.
How long does treatment take to work?
Many women notice improvement within several weeks of starting treatment, with continued improvement over time. GSM is a chronic condition, so ongoing treatment is often recommended to maintain benefits.
Do you offer GSM treatment in Philadelphia, The Main Line and Suburbs?
Yes. Women Wise Holistic Healthcare and Wellness, LLC provides personalized GSM care for women in Philadelphia, Roxborough, the Main Line, and surrounding suburbs.
Is your practice insurance-based?
Women Wise Holistic Healthcare and Wellness, LLC is a fee-for-service practice. Payment is collected electronically at the time of service and credit card information is required to make an appointment. This model allows for longer visits, personalized care, and individualized treatment planning without insurance limitations. Our visits are generally an hour, or sometimes longer. Follow-up visits are typically 30 minutes.
Please call to find out more about our amazing peri and menopausal care we offer. You’ll be so happy you did.!!! We are here for you and want to know your thoughts about your experience with us to create the best women’s healthcare possible. We think women are special and believe our practice, clinicians and staff are too and so is our approach to in-person healthcare.(we also offer telemedicine). Our mission is to provide the most outstanding, compassionate, reaffirming, empowering, women’s health experience possible with your help and input always. You and your thoughts and experience about and with us, matter greatly!!
Please see the link below regarding a great article on this topic