Genitourinary Syndrome of Menopause (GSM)
Genitourinary Syndrome of Menopause (GSM) is primarily caused by decreased oestrogen levels in postmenopausal individuals, or those of any age who experience reduced oestrogenic stimulation of the urogenital tissues. The symptoms women can experience as a result of these changes have been labelled the Genitourinary Syndrome of Menopause (GSM), formally and more commonly known as vaginal atrophy.
GSM impacts 27% to 84% of postmenopausal women.1 Women vary in their experience of these changes, some barely notice changes, whilst others may suffer terribly from many of the symptoms. Below is a comprehensive list of the symptoms that can be attributed to the hormonal shifts associated with GSM:
Vaginal
- Dryness
- Burning
- Discharge
- Itching
- Shortening and tightening
Urinary
- Burning with urination
- Urgency with urination
- Frequent urination
- Recurrent Urinary Tract Infections (UTIs)
- Urinary incontinence
Intercourse
- Light bleeding after intercourse
- Discomfort
- Decreased vaginal lubrication
The presence of oestrogen encourages plump, moist, strong tissues; it also directly helps feed the good bacteria, lactobacillus, residing in the vagina and surrounding tissues. Unfortunately, as oestrogen slowly reduces in menopause or treatment induced menopause, its protective role in the genitourinary areas lessens.
Alongside the symptoms above, the vaginal microbiome composition can shift to a more diverse, less protective environment. This microbial shift is the reason women in menopause suffer more commonly from Urinary Tract Infections (UTIs) and vaginal imbalances such as Aerobic Vaginitis (AV).
Management of these symptoms is available. Medically, the primary support is topical vaginal oestrogen in the form of pessaries or creams. Other interventions that may help include vaginal moisturisers, use of lubrication during sexual intercourse, probiotics to repopulate protective lactobacillus species, dietary changes to include regular consumption of healthy fats and protein, and preventative measures against UTIs, e.g. D-Mannose.
Reference
- National Institutes of Health. Genitourinary Syndrome of Menopause (GSM). Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/ Last accessed March 13, 2025.
