Understanding Genitourinary Syndrome of Menopause (GSM)

Vaginal Hormones.... everyone is starting to talk about them! (YAY!)

People say that vaginal or pelvic symptoms affect more than half of all postmenopausal women. I suspect this is horribly inaccurate - its got to be closer to 100%.... especially if you consider symptoms throughout the lifespan.

Vulva Costumes made in Brooklyn - Luna loves body positive art! . Read more here: https://www.refinery29.com/en-us/2016/05/112038/conceived-in-brooklyn-vagina-costumes

Fluctuations of estradiol due to nursing, birth control use, cancer treatments, and natural estrogen loss with aging and menopause can cause all kinds of overwhelming symptoms which we collectively call Genitourinary Syndrome of Menopause, or "GSM" for short.

GSM causes chronic pain, causes the loss of vaginal and vulvar tissue health, increases the risks of urinary tract infections (which can be very serious and even life threatening!) and erodes quality of life.

Most women never hear the name "GSM" from a doctor, and many suffer in silence for years, assuming discomfort is simply an inevitable cost of aging.

Please remember..... GSM is TREATABLE and you do not have to suffer with these symptoms!

What Causes Genitourinary Syndrome of Menopause (GSM)

?

GSM is a direct consequence of the hormonal shifts that result in a loss or low level of estradiol. What causes that? Well, menopause is probably the most common and recognized among most folks.

But wait! There are other causes! Breastfeeding, cancer treatments, sugrical removal of the ovaries for any reason, and birth control pills are all on that list as well!

As estrogen levels fall, the tissues of the vulva, vagina, and lower urinary tract undergo significant changes. Estrogen is not merely a reproductive hormone — it is a tissue maintenance hormone. It keeps vaginal walls thick, elastic, and well-lubricated. It supports the healthy bacterial environment of the vagina. It maintains the sensitivity and integrity of surrounding urinary structures. And it helps to promote blood flow and health to pelvic tissues and muscles.

When estrogen declines, all of this changes. Vaginal walls thin and lose elasticity. Natural lubrication decreases substantially. The vaginal pH rises, disrupting the protective microbiome. The urethra and bladder, share the same estrogen-dependent tissues, and are also affected.

What happens next? A constellation of symptoms begin and can worsen progressively if left untreated — unlike hot flashes, which typically fade over time, GSM does not resolve without treatment and can have serious consequences!

Recognizing the Symptoms

GSM presents across two overlapping domains: vaginal and urinary.

Vaginal symptoms include dryness, burning, and irritation at baseline — symptoms that intensify dramatically during sexual activity. Penetration may become painful or impossible. Women often report tearing, bleeding, or prolonged soreness after sex. Some withdraw from intimacy entirely, not realizing a medical explanation — and a solution — exists.

Urinary symptoms are equally disruptive but less frequently connected to menopause by patients or providers. These include urinary urgency, increased frequency, recurrent urinary tract infections, and discomfort with urination. For many women, these symptoms are investigated repeatedly without the underlying hormonal cause ever being addressed.

Vaginal Hormones Work — Kitchen Supplies Do Not

Low-dose vaginal estrogen therapy is the gold-standard treatment for GSM, and its safety and efficacy profile is exceptional. It is safer than tylenol and viagra, and will improve your quality of life way more than "just dealing with it".

Unlike systemic hormone therapy — which raises estrogen levels throughout the body — vaginal estrogen is applied locally in low doses. It is available as a cream, suppository insert, or a slow-release ring.

Because absorption into the bloodstream is near zero, the systemic estrogen exposure is negligible. Large studies and decades of clinical use have consistently confirmed that vaginal estrogen does not meaningfully raise blood estrogen levels. Period. End of story.

The efficacy data is compelling. Most women report significant improvement in vaginal dryness, pain with sex, and urinary symptoms within weeks to months. Tissue changes — thickening, improved elasticity, restored moisture — are measurable.

Quality of life improvements are profound and well-documented.

Importantly, major medical organizations — including the North American Menopause Society and the American College of Obstetricians and Gynecologists — affirm that vaginal estrogen is safe for the vast majority of postmenopausal women, including most women with a history of breast cancer, when used under medical supervision.

The Bottom Line

GSM is not an inevitable, untreatable consequence of aging. It is a hormone-deficiency condition with a safe, effective, localized treatment. If you are experiencing vaginal dryness, pain with sex, or unexplained urinary symptoms after menopause, speak with your provider — and ask specifically about vaginal estrogen.

You will be offered vaginal estrogen at Luna Hormone Health and you should be offered vaginal estrogen with your own providers too!