What is it?
Genitourinary syndrome of menopause, or GSM, is the medical name for a group of symptoms affecting your vagina, vulva, and bladder area. It includes dryness, irritation, discomfort or pain during sex, and urinary symptoms like needing to wee urgently or getting repeat infections.
Why does it happen?
The tissue in this area is sensitive to oestrogen. As your oestrogen levels fall, it gets thinner, drier, and less stretchy. Unlike hot flushes, which tend to ease over time, GSM usually doesn’t get better on its own, and it tends to get worse the longer it’s left untreated.
GSM affects around half of women after menopause, and current NICE guidance treats these symptoms as a core part of menopause care, not something separate or minor.
Things that can help
- Vaginal moisturisers (used regularly, not just before sex) and lubricants (used during sex). NICE recommends these as a first step, especially if hormonal treatment isn’t right for you
- Avoiding scented soaps, douches, or harsh products in that area, which can make irritation worse
- Staying sexually active, with a partner or alone, which can help keep the tissue healthier, whenever that’s comfortable for you
Can anything medical help?
Vaginal oestrogen is NICE’s recommended first prescription option for GSM, including if you’re already using HRT, since standard HRT doesn’t always fully sort out local symptoms. It works directly where it’s needed with very little absorbed elsewhere in your body, which is why it’s often suitable even for some people who can’t take full-body HRT, though your clinician will always check this applies to you. You can have it on prescription or can buy it from a pharmacy over the counter
When to get more help
See a GP if:
- vaginal moisturisers or lubricants aren’t helping enough after a few weeks
- you have signs of a urinary infection (burning when you wee, needing to go urgently, cloudy or strong-smelling urine)
- you notice any unusual bleeding, lumps, or changes to the skin in that area. These need a separate check to rule anything else out and make sure you’re on the right treatment
The bottom line
GSM is common, doesn’t improve on its own if left untreated, and doesn’t get talked about enough. But it responds really well to treatment, from simple moisturisers right through to prescription options. You don’t need to just live with it.
If this is affecting you, book a menopause consultation — it’s one of the most treatable menopause symptoms there is.
References
- NICE NG23: Menopause — identification and management (updated November 2024)
- Genitourinary syndrome of menopause: Common problem, effective treatments — Phillips & Bachmann, Cleveland Clinic Journal of Medicine
