Genitourinary Syndrome of Menopause (GSM): Your Treatment Guide

If you're experiencing vaginal dryness, pain during sex, sudden urges to urinate, or recurrent UTIs during perimenopause or the postmenopausal years, you're not alone. 

Genitourinary syndrome of menopause, or GSM, affects more than half of people going through the menopause transition. Yet most of us have never heard the name before, and less than 25% receive appropriate treatment for it. We weren't taught that menopause affects our entire genitourinary system, in addition to causing hot flashes, mood swings, and other symptoms. So when vaginal dryness and/or bladder urgency show up, it can feel confusing and isolating.

The truth is, GSM is incredibly common. But because we don't talk about it openly, many people suffer in silence, thinking their symptoms are just something they have to live with. Fortunately, they're not.

GSM is treatable. Whether it's vaginal dryness that's making sex painful, bladder urgency that's affecting your daily life, or recurrent UTIs that catch you off guard, there are treatment options that work. It all starts with understanding what's happening in your body and knowing the treatment options available to you.

What is genitourinary syndrome of menopause?

Genitourinary syndrome of menopause is a medical condition caused by declining estrogen levels during perimenopause (the years leading up to your final period) and after menopause. As hormone levels shift and estrogen drops, the entire genitourinary system, which includes the tissues throughout the vagina, vulva, bladder, and urethra, are structurally and functionally impacted.

During perimenopause (the phase before menopause when our ovarian function starts to wind down) and our estrogen levels decline, it is common to start noticing symptoms of pelvic floor dysfunction. Symptoms include new or worsened bladder leakage, urgency, or frequency, vaginal discomfort, sexual dysfunction, even symptoms of pelvic organ prolapse. 

Many people think they're experiencing separate, unrelated problems – vaginal dryness, pain during sex, sudden urinary urgency, or recurrent urinary tract infections — when in reality, these are all symptoms of the same underlying condition. This is why GSM is one of the most undertreated conditions affecting people going through menopause.

What are the symptoms of genitourinary syndrome of menopause?

The symptoms of genitourinary syndrome of menopause vary from person to person, but generally include vaginal, urinary, and/or pelvic floor symptoms. While some people may experience all of them, others may experience only a few. Common symptoms include:

Vaginal symptoms

• Vaginal dryness or reduced lubrication
• Vaginal itching or burning
• Vaginal irritation or soreness
• Painful sex (dyspareunia)
• Reduced sexual desire or difficulty with arousal
• Vaginal bleeding* after sex or during pap smears

Urinary symptoms

• Urinary urgency or frequent urination
• Urinary incontinence (especially with coughing, sneezing, or exercise, or due to an urge you can’t control)
• Pain or burning during urination
• Recurrent urinary tract infections
• Nocturia (waking more than once at night to urinate)

Pelvic symptoms

• Pelvic pressure or heaviness
• Feelings of vaginal fullness or like something is “falling out” of the vagina
• Pain during or after intercourse
• Reduced sensation or numbness in the genital area

If you're experiencing any combination of these symptoms during perimenopause or after menopause, GSM could be the cause. 

*Note that GSM can cause vaginal bleeding when the tissues are irritated, such as after sex. However, any vaginal bleeding that occurs in the postmenopause years requires medical workup: do not assume bleeding is due to GSM without first talking to your primary care provider to rule out other causes.

Why does genitourinary syndrome of menopause happen?

Genitourinary syndrome of menopause happens because estrogen levels drop during perimenopause and after menopause. Estrogen keeps the tissues in the vagina, urethra, and bladder thick, elastic, and well-lubricated. When estrogen levels fall, as happens during perimenopause and after menopause, these tissues become thinner, drier, and less flexible.

This tissue change affects your whole genitourinary system. The vaginal tissue becomes fragile. The bladder lining becomes less stretchy and the urethra becomes less supported, signalling a need to pee more frequently and urgently. All of these changes can happen simultaneously, which is why people often experience multiple symptoms at once.

GSM is a natural part of the menopause transition, but that doesn't mean you have to suffer through the symptoms. Understanding what's happening in your body makes it easier to seek the right treatment.

Will genitourinary syndrome of menopause go away on its own?

Unfortunately, Genitourinary syndrome of menopause does not improve without treatment. Research shows that untreated GSM symptoms tend to persist or worsen over time. Some people hope that once they're through the menopause transition, the symptoms will fade on their own. The tissue changes caused by low estrogen are lasting, and symptoms typically don't resolve without intervention.

The good news: GSM is highly treatable. Early intervention, when symptoms first appear, tends to be more effective than waiting to treat. The sooner you seek treatment, the sooner you can find relief and improve your quality of life.

Treatment options for genitourinary syndrome of menopause

There are several treatments available to those dealing with Genitourinary syndrome of menopause, including hormone therapy, vaginal estrogen therapy, hormone-free vaginal treatments, and pelvic floor physical therapy. Many people benefit from a combination of treatments.

Hormone therapy

Systemic menopause hormone therapy (formerly called hormone replacement therapy, or HRT) works by increasing estrogen and progesterone levels throughout your body, including in the genital tissues. HRT comes in several forms, including pills, patches, gels, and injections. MHT targets GSM symptoms by increasing estrogen levels and strengthening the genitourinary tissues, helping to improve vaginal dryness, sexual pain, and urinary symptoms.

MHT is not right for everyone. It's important to consult with your healthcare provider to discuss whether MHT is an appropriate treatment for you. Your provider can help you weigh the benefits and risks based on your individual health situation. 

Vaginal estrogen therapy

Vaginal estrogen therapy is a form of MHT that delivers estrogen directly to vaginal tissue without significantly affecting systemic hormone levels throughout the body. It’s available as creams, tablets, or rings. Vaginal estrogen is effective for vaginal dryness, pain with sex, and may even help lower the risk of recurrent UTIs. 

Hormone-free vaginal treatments

Non-hormonal vaginal treatments like vaginal moisturizers (used regularly) and vaginal lubricants (used during sex) can provide temporary relief, but don't address the underlying tissue changes causing GSM.

Non-hormonal vaginal treatments can provide relief from GSM symptoms. Vaginal moisturizers used regularly help maintain hydration, while vaginal lubricants used during sex reduce friction and discomfort. Some vaginal products like Bonafide’s Vaginal dryness relief suppositories contain hyaluronic acid, which has research supporting its effectiveness for vaginal dryness and tissue hydration. These options can be helpful for managing symptoms, especially when used consistently.

However, these treatments provide temporary relief and don't address the underlying tissue changes causing GSM. They're most effective when combined with other treatment approaches like hormone therapy or pelvic floor physical therapy.

Pelvic floor physical therapy

Pelvic floor physical therapy is often overlooked as a treatment for GSM, but it can be highly effective for symptom management and is increasingly recognized as a first-line treatment option. Most people don't realize that pelvic floor dysfunction frequently accompanies GSM, and addressing the pelvic floor can make a significant difference in how you feel.

A pelvic floor physical therapist can help by:

• Releasing tight pelvic floor muscles that might be contributing to vaginal, pelvic, and/or urinary symptoms associated with GSM
• Strengthening and improving the coordination of muscles that support bladder control and reduce urinary urgency
• Teaching techniques to manage urinary urgency and frequency
• Improving blood flow to vaginal tissue through manual techniques and exercises
• Helping you understand how your pelvic floor muscles contribute to your symptoms
• Building a mind-body connection: helping you be aware of your muscles and how they are working with or against you
• Providing education about your body and how the menopause transition affects the pelvic floor

Physical therapy is especially helpful for sexual pain related to pelvic floor tension; urinary urgency and frequency; and incontinence. When combined with other treatments, pelvic floor therapy addresses the whole picture of GSM. Unlike some treatment options that require ongoing prescriptions, pelvic floor physical therapy gives you tools and techniques you can use long-term to manage your symptoms and resolve underlying problems.

What does pelvic floor physical therapy for Genitourinary syndrome of menopause look like?

At Origin, your clinician  will start by understanding your symptoms. They'll ask about your medical history, your symptoms, and how Genitourinary syndrome of menopause is affecting your daily life and relationships. They'll perform a physical examination to assess your pelvic floor muscles and identify any tension, weakness, or dysfunction. 

Learn more about what to expect during an Origin pelvic floor therapy appointment and examination.

From there, treatment is personalized to your unique needs. If you have tight pelvic floor muscles contributing to pain with sex, your therapist might teach you relaxation techniques and manual release strategies. If you're experiencing urinary urgency, they'll often work on bladder retraining and pelvic floor coordination. If tissue health is a concern, they may use techniques to improve blood flow and tissue elasticity.

Treatment typically includes exercises you do at home in-between sessions, education about your pelvic floor and how it relates to your symptoms, and hands-on treatment during appointments.

If you would prefer to work with a pelvic floor therapist from home, Origin offers virtual care options. During a virtual visit at Origin, you meet one-on-one with a licensed physical therapist via a secure, HIPAA-compliant Zoom meeting. You'll receive a personalized home program of exercises and techniques tailored to your symptoms.

In the virtual setting, your adherence to the home program is especially critical. Without in-person hands-on techniques, your progress depends heavily on consistently doing the work between sessions. This actually works well for many people, as it puts you in control of your recovery and builds sustainable long-term management skills.

If you’re unsure about which care option suits you, read more: Is Virtual Care at Origin Right for You?

The bottom line

You don't have to accept vaginal dryness, painful sex, constant urinary urgency, or recurrent UTIs as an inevitable part of menopause. Genitourinary syndrome of menopause is treatable, and the relief you're looking for is available.

Pelvic floor physical therapy is often the missing piece in GSM treatment. It helps address the root causes of your symptoms, not just the surface-level discomfort. Combined with other treatment options such as hormone therapy or vaginal estrogen, physical therapy can transform how you feel in your body and your quality of life.

If you're experiencing any of these symptoms, reach out to your healthcare provider. Ask about pelvic floor physical therapy as part of your treatment plan. You deserve to feel comfortable in your own body again.

Book a visit with an Origin pelvic floor therapist today.

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Sources

Carlson K, Nguyen H. Genitourinary Syndrome of Menopause. [Updated 2024 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/

Kao, A et al. “Dyspareunia in postmenopausal women: a critical review.” Pain research & management vol. 13,3 (2008): 243-54. doi:10.1155/2008/269571

Harper-Harrison G, Carlson K, Shanahan MM. Hormone Replacement Therapy. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493191/

Rosenblum, Nirit. “Update in Female Hormonal Therapy: What the Urologist Should Know: NYU Case of the Month, December 2020.” Reviews in urology vol. 22,4 (2020): 182-185.

Krause, Megan et al. “Local Effects of Vaginally Administered Estrogen Therapy: A Review.” Journal of pelvic medicine & surgery vol. 15,3 (2009): 105-114. doi:10.1097/SPV.0b013e3181ab4804

Mercier, J., Dumoulin, C., & Carrier-Noreau, G. (2023). Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when? Climacteric, 26(4), 302–308. https://doi.org/10.1080/13697137.2023.2194527

Tiwari, Megha et al. “Navigating the Vaginal Milieu During Perimenopause: A Narrative Review of Physiological Changes and Clinical Implications.” Journal of pharmacy & bioallied sciences vol. 17,Suppl 1 (2025): S92-S95. doi:10.4103/jpbs.jpbs_1493_24