What Is Genitourinary Syndrome of Menopause?

It’s three separate complaints, and you’ve mentioned each to a different person. The dryness and burning, to your friend. The two UTIs this year, to your doctor. The way sex has started to hurt, to a silence. You’ve filed them as unrelated. They may be the same thing.

The three groups of symptoms

The guideline lists:

• Vulvovaginal: dryness, burning, irritation, narrowing of the vaginal opening, thin tissue and tissue that’s easily irritated or bleeds.
• Urinary: urgency, frequency, waking at night to pee, painful urination, stress or urgency leakage and recurrent urinary tract infections.
• Sexual: pain with sex, reduced libido, arousal difficulties and orgasm difficulties.

See vaginal dryness, painful sex, bleeding after sex, waking to pee, menopause and bladder control and UTI symptoms.

Why it matters

The NIDDK² says that for people in perimenopause or menopause who get repeat infections, vaginal estrogen may be prescribed, alongside prevention habits such as wiping front to back and wearing cotton underwear. The AUA¹ guideline gives a strong recommendation that clinicians should recommend local low-dose vaginal estrogen to reduce the risk of future UTIs in people with GSM who have recurrent infections.

What the guideline recommends

The guideline’s statements, in plain terms:

• Moisturizers and lubricants. Clinicians should recommend them, alone or together with other therapy. The NHS³ suggests water-based lubricants before sex, and vaginal moisturisers inserted internally for ongoing dryness. It says to avoid perfumed soaps, washes and douches.
• Local vaginal estrogen. The guideline says clinicians should offer it for vulvovaginal symptoms, a strong recommendation.
• Vaginal DHEA. Clinicians should offer it for dryness and painful sex, a moderate recommendation.
• Ospemifene. Clinicians may offer it for dryness and painful sex, a conditional recommendation.
• Lasers and radiofrequency. The guideline says clinicians should counsel that the evidence doesn’t support CO2 laser, Er:YAG laser or radiofrequency for symptom improvement, though they may consider laser as an experimental option for patients who decline FDA-approved treatments.

On safety, the guideline says vaginal estrogen does not increase breast cancer or endometrial cancer risk, that DHEA and ospemifene carry no increased risk of either, and that no endometrial surveillance is required for these treatments. Your own clinician can tell you how that applies to your history. For systemic hormone therapy, a separate decision, see whether hormone therapy is safe.

The play

Try this: a one-page GSM list

Write down every symptom below the belt that’s changed since your periods changed or stopped: dryness, burning, itching, pain with sex, urgency, night peeing, leaks, UTIs, bleeding.

Next to each one, write when it started and how often it happens.

Bring the single page to your appointment. Say that you’d like to talk about genitourinary syndrome of menopause and the options in the guideline.

When to get checked

The NHS³ says to see a GP for dryness that persists for weeks despite self-care, dryness that affects daily life, unusual discharge, or bleeding after sex, between periods or after menopause.

Book an appointment if any of these fit:

• Dryness, burning or pain with sex hasn’t improved with a lubricant and moisturizer
• You’ve had repeat UTIs
• You leak urine, or feel urgency or frequency that’s new
• You bleed after sex, between periods or after menopause
• You’ve been told it’s a normal part of aging and nothing was offered
• You’d like to ask about vaginal estrogen

Bleeding after menopause and urinary symptoms with fever or back pain need prompt attention.

What changed was your estrogen, and it affects more than one part of you. A name for it makes it easier to ask for treatment.