What Is Genitourinary Syndrome of Menopause and how do you manage it?

Understanding the Hormonal Changes Behind Vaginal and Bladder Symptoms

Menopause is a natural part of life, but it often comes with changes that many women aren’t prepared for, especially when it comes to intimate health. One common yet under-recognised condition is Genitourinary Syndrome of Menopause (GSM). This includes a range of symptoms affecting the vagina, vulva, and urinary tract, most of which are caused by declining oestrogen levels.

Let’s break down what GSM is, why it happens, and what you can do about it.

Why Does GSM Happen?

During menopause, your body produces much less oestrogen the hormone that plays a crucial role in maintaining the health of the vaginal and urinary tissues.

Without enough oestrogen:

• The vaginal lining becomes thinner, drier, and less elastic

• Natural lubrication decreases

• The vaginal canal may shorten and narrow

• The vaginal pH becomes less acidic, making it easier for infections to develop

• The tissue becomes more fragile and prone to irritation

  
  

Oestrogen supports healthy blood flow, maintains collagen levels, and keeps the vaginal lining moist and resilient. It also promotes the natural renewal of vaginal cells, increasing glycogen levels, which feed healthy bacteria (lactobacilli) that produce lactic acid. This helps maintain a protective, acidic environment. When this system breaks down, the risk of vaginal discomfort and urinary issues increases.

Androgens Matter Too

While oestrogen gets most of the attention, androgens such as DHEA (dehydroepiandrosterone) are also important for vaginal and bladder health. The vaginal tissues contain androgen receptors that help:

• Reduce inflammation

• Maintain muscle tone and contractility

• Support tissue healing and resilience

  
  

After menopause, DHEA becomes one of the main sex steroids in the body. It’s made by the adrenal glands and is converted locally in the vagina into both oestrogen and androgen forms, helping to maintain tissue health. This discovery has led to newer, more holistic treatment options for GSM, including vaginal DHEA therapies.

GSM Isn’t Just Caused by Menopause

Although GSM is most common after menopause, other factors that lower oestrogen levels can also lead to symptoms, including:

• Breastfeeding

• Cancer treatments such as chemotherapy or radiation

• Oophorectomy (surgical removal of the ovaries)

• Certain medications, like tamoxifen or some birth control pills

• Smoking

• Immune system disorders

Even less frequent sexual activity can increase the risk of vaginal atrophy. Regular sexual stimulation, whether alone or with a partner, helps promote blood flow and elasticity in the vaginal tissues.

Common Symptoms of GSM

GSM can affect the vagina, vulva, and urinary tract. Symptoms may include:

Vaginal and Vulval Symptoms:

• Vaginal dryness, itching, or burning

• Pain during sex (dyspareunia)

• A feeling of tightness or shortened vaginal canal

• Loss of elasticity or stretch

• Minor cuts or lacerations near the vaginal opening

• Pale or whitish discolouration

• Thinning or shrinking of the labia

• Redness or inflammation

• Vulval skin changes or lesions

  
  

Urinary Symptoms:

• Urgency (a sudden need to wee)

• Frequency (needing to go more often)

• Pain or burning when urinating

• Recurrent urinary tract infections (UTIs)

  
  

How Is GSM Diagnosed?

If you’re experiencing any of these symptoms, it’s important to speak with a qualified healthcare provider. A diagnosis is usually based on:

• A detailed discussion about your symptoms

• A pelvic examination to check for signs like thinning, redness, or loss of stretch

• Checking for changes in the size or shape of the vaginal and vulval area

  
  

These are not just “part of ageing” you have to put up with there are treatments that can help

GSM is a medical condition, and it can be treated.

The Good News: Help Is Available

Treatments for GSM include:

• Local oestrogen therapies (creams, pessaries, rings)

• DHEA-based vaginal therapies

• Non-hormonal lubricants or moisturisers

• Lifestyle advice to improve blood flow and tissue health

  
  

Your individual treatment plan should be safe, evidence-based, and tailored to your needs—whether or not you can use hormones.

You Deserve to Feel Comfortable

Many women feel embarrassed or unsure about bringing up symptoms of GSM. But these changes are common, treatable, and nothing to be ashamed of.

At Amanda Prince health we offer compassionate, expert menopause care to help you feel like yourself again. We offer Vaginal HIFU and Laser Co2 treatments from a Wirral location which are non hormonal treatments that can be incredibly helpful in restoring the collagen and elasticity of the vagina, making life more comfortable

Book a consultation today and take the first step toward reclaiming your comfort, confidence, and well-being

Regards

Amanda