What Genitourinary Syndrome Is and Why It Matters

Genitourinary syndrome of menopause, or vaginal atrophy, is a condition in which the vaginal walls become thin, dry, and inflamed due to menopause. Menopause is when a person who menstruates no longer has a menstrual cycle. It is reached after 12 months without a period.

Perimenopause is the time leading up to menopause, when hormone levels begin to fluctuate. This stage of menopause usually lasts about four years, but the time frame varies from person to person. People may start experiencing the symptoms of vaginal atrophy at any stage of menopause.

Keep reading to learn about the symptoms, risk factors, diagnosis, and treatment of genitourinary syndrome of menopause. 

What Is Vaginal Atrophy?

"Vaginal atrophy," "atrophic vaginitis," and "urogenital atrophy" are terms that have been used to describe the condition that’s now called "genitourinary syndrome of menopause" (GSM). GSM is a progressive condition affecting the genital area and urinary tract that develops after menopause. 

GSM affects about 15% of people in perimenopause. After menopause, the percentage of people experiencing some GSM symptoms is 50%–70%. 

It develops from a lack of estrogen in the body after menopause. The low estrogen levels lead to symptoms like:

• Vaginal dryness
• Vaginal burning
• Discomfort and pain during sex
• Genital itching
• Burning while peeing
• Urgency (immediate need) to urinate
• Frequent urinary tract infections (UTIs)
• Urinary incontinence (lack of control)
• Light bleeding or spotting after sexual intercourse
• Decreased vaginal lubrication during sexual intercourse
• Shortening and tightening of the vagina

Some people may experience the symptoms of GSM in early menopause, while other people could develop GSM several years after reaching menopause. 

Risk Factors and Causes

Genitourinary syndrome of menopause is caused by a drop in estrogen production. Lower estrogen levels lead to thinning of the vaginal walls, fewer blood vessels in the genital area, changes in pH (a measure of acidity and alkalinity) and vaginal flora (the microbes normally present), and an increased risk of tearing tissue.

Menopause is the main risk factor for GSM. Other risk factors include:

• No history of vaginal deliveries
• Alcohol abuse
• Cigarette smoking
• Lack of exercise
• Abstinence or no sexual activity
• Premature ovarian failure
• Cancer treatments, such as chemotherapy and radiation
• Hysterectomy and bilateral oophorectomy (removal of uterus and ovaries)
• History of diseases of the genitals or urinary tract

Diagnosis

GSM is often underdiagnosed because many people are embarrassed to talk about their symptoms with their healthcare provider. Typically, GSM is diagnosed simply through a review of medical history and a physical exam of the pelvis. 

Treatment

Since GSM is caused by the natural changes in estrogen levels that happen after menopause, there isn’t a cure. Still, the symptoms can be managed to help maintain your quality of life and prevent discomfort. 

The types of treatment will depend on the symptoms you’re experiencing. Your healthcare provider may recommend treatments like:

• Vaginal lubricants
• Vaginal moisturizers
• Low-dose vaginal estrogen therapy, like creams, tablets, and rings
• Systemic hormonal therapy, like oral estrogen pills
• Selective estrogen receptor (ER) modulators
• Duavee (bazedoxifene and conjugated estrogen)

Complications

GSM can increase the risk for several complications, such as:

• Frequent vaginal infections: Changes to pH balance and vaginal flora increase the risk for yeast and bacterial infections.
• Urinary tract problems: The changes to flora and pH also increase the risk for urinary tract infections (UTIs). You may also experience urinary leakage and increased urgency and frequency of urinating.

When to See a Healthcare Provider

Many postmenopausal people experience the symptoms of GSM. But often, people feel embarrassed to discuss their symptoms and don’t receive treatment to help them feel better. Talk with your healthcare provider if you’re experiencing pain during sex, unexpected spotting, burning sensation, soreness, or frequent infections.

You can get help with your symptoms so you can experience less pain and maintain a high quality of life. It can be uncomfortable to talk about these symptoms with a healthcare provider, but the discussion can be worthwhile to help you feel better.

Summary

Genitourinary syndrome of menopause (GSM), previously called vaginal atrophy, is a condition that develops as estrogen levels drop during the menopausal transition. It’s a common condition that affects about 50%–70% of people after menopause.

After menopause, vaginal tissue becomes thinner, drier, and more fragile. GSM leads to symptoms like vaginal dryness, burning, discomfort, pain, urinary problems, and increased infections. It can be treated with vaginal moisturizers, lubricants, and hormonal therapy.

A Word From Verywell

If you’re experiencing vaginal discomfort after menopause, don’t hesitate to reach out to your healthcare provider. Remember, they talk about these topics regularly, and they can help you find options to relieve your symptoms. 

It can be uncomfortable and challenging to discuss sexual health and vaginal changes. Still, you can get help to relieve your symptoms and manage vaginal discomfort.