Genitourinary Syndrome of Menopause (GSM): More Than Just Dryness

Menopause brings many changes, and one of the most overlooked yet impactful is Genitourinary Syndrome of Menopause (GSM). While it’s often reduced to “vaginal dryness,” GSM is so much more than that—it affects vaginal, bladder, and urinary health, leading to persistent discomfort that doesn’t always improve on its own and has a significant impact on your quality of life.

If you’re experiencing vaginal irritation, painful intercourse, frequent UTIs, or bladder urgency, you’re not alone. GSM affects more than 50% of postmenopausal women, yet it remains under-discussed, leaving many struggling in silence.

The good news? There are solutions—both hormonal and non-hormonal—that can help restore comfort and improve vaginal health. This guide explores what GSM is, why it happens, and what you can do about it.

What is Genitourinary Syndrome of Menopause (GSM)?

GSM refers to a collection of symptoms affecting the vaginal and urinary tissues due to declining oestrogen levels during or leading up to menopause. Unlike symptoms like hot flushes, which often improve over time, GSM tends to persist and worsen if left untreated.

Common symptoms of GSM include:

• Vaginal dryness, irritation, and discomfort

• Painful intercourse (dyspareunia) due to thinning vaginal walls

• Frequent UTIs due to changes in the urinary tract

• Urinary urgency and leakage caused by weakened tissues

• Loss of vaginal elasticity leading to irritation and a “tight” sensation

These symptoms occur because oestrogen plays a key role in keeping the vaginal and urinary tissues strong, elastic, and well-lubricated. As oestrogen declines, these tissues become thinner, drier, and more fragile, leading to increased discomfort.

Why Does GSM Happen?

Oestrogen isn’t just a reproductive hormone—it also supports vaginal and urinary tissue health by:

• Maintaining vaginal moisture by stimulating natural lubrication

• Keeping the vaginal walls thick and elastic to prevent irritation

• Supporting beneficial Lactobacillus bacteria in the vaginal microbiome

• Strengthening the urethral lining to help prevent UTIs

As oestrogen levels drop, these protective functions decline, making GSM symptoms more likely. However, other factors can also contribute, including recurrent infections, gut imbalances, and changes in sexual activity.

HRT is One Option, But Not the Only One

Hormone Replacement Therapy (HRT) and topical vaginal oestrogen are highly effective for GSM, but they’re not the only solutions. Some women cannot or prefer not to use hormonal therapies, and there are several evidence-based, non-hormonal approaches that can help.

Non-Hormonal Strategies for Managing GSM

If HRT isn’t for you, or if you’re looking for additional support, there are several non-hormonal options backed by research.

1. Vaginal Moisturisers & Lubricants

Vaginal moisturisers hydrate and nourish the vaginal tissues, helping to restore comfort over time. These are different from lubricants, which provide temporary relief during intercourse.

• Hyaluronic acid-based moisturisers help improve vaginal hydration and tissue integrity.

• Water-based or silicone-based lubricants can ease discomfort during sex without disrupting vaginal pH.

2. Phytoestrogen-Based Vaginal Treatments

Certain plant-based compounds, such as fennel extract, soy isoflavones, and pomegranate extract, contain phytoestrogens, which can help support vaginal tissue health.

• Research on fennel extract suggests it can improve epithelial integrity, helping to strengthen and hydrate vaginal walls.

• Soy and red clover isoflavones have shown promise in reducing GSM symptoms by interacting with oestrogen receptors.

3. Omega-3s & Anti-Inflammatory Diet

Omega-3 fatty acids support tissue hydration and inflammation reduction, helping to improve vaginal and bladder health. A diet rich in wild-caught fish, flaxseeds, walnuts, and olive oil can provide natural support.

Additionally, an anti-inflammatory, whole-foods diet that includes antioxidant-rich fruits and vegetables can help reduce GSM-related discomfort.

4. Pelvic Floor Therapy

Pelvic floor physiotherapy can:

• Improve blood flow to the vaginal and urinary tissues

• Strengthen muscles that support the bladder

• Reduce symptoms of urinary urgency, incontinence, and discomfort

A trained pelvic floor physiotherapist can guide you through exercises tailored to your needs.

5. Supporting the Vaginal Microbiome

A healthy vaginal microbiome plays a key role in preventing infections and maintaining vaginal pH. Supporting beneficial Lactobacillus bacteria can help protect against BV, thrush, and UTIs, which often worsen with GSM.

• Lactobacillus-rich probiotics can help restore beneficial bacteria.

• Prebiotic foods like garlic, onions, and flaxseeds nourish good bacteria.

• Minimise antibiotic use unless absolutely necessary, as it can disrupt the microbiome.

You Don’t Have to Put Up With Discomfort

GSM is common but treatable, and you don’t have to suffer in silence. Whether you choose hormonal or non-hormonal options, there are many ways to improve vaginal and urinary health and restore comfort.

What You Can Do Today:

• Start with vaginal moisturisers if dryness is your primary concern.

• Consider probiotic and prebiotic support to protect the vaginal microbiome.

• Increase omega-3 intake to help hydrate and strengthen tissues.

• Explore pelvic floor therapy if urinary urgency or discomfort is an issue.

If you need support with GSM or any other symptoms of menopause or perimenopause you can book a personalised consultation here.