Let’s Talk About It: Genitourinary Syndrome of Menopause (GSM)
Why no one talks about it—and why we absolutely should.
Let’s be honest—there are no “fun” perimenopause symptoms. But the ones that happen below the belt? Those can feel downright isolating.
If you’ve noticed changes in your vaginal, sexual, or urinary health over the past few years, you are so not alone. In fact, nearly 84% of women experience symptoms in this area during or after perimenopause. Yet very few ever bring it up with their doctor.
Why? Because it’s uncomfortable. We’re taught to power through things like dryness, irritation, or leaks, and to laugh off the “I peed when I sneezed” moments. But these symptoms are not just “part of getting older.” They’re part of a very real—and very treatable—condition called Genitourinary Syndrome of Menopause (GSM).
What Exactly Is GSM?
GSM is the medical term that covers the changes that happen in the vagina, vulva, bladder, and urinary tract when estrogen levels decline. It’s not just “vaginal dryness.” It can show up as:
Vaginal dryness, burning, or itching
Pain or tearing during sex
Urinary urgency, frequency, or leakage
More frequent urinary tract infections (UTIs)
A feeling of pressure or heaviness in the pelvic area
Changes in vulva appearance or sensitivity
And if that sounds like a lot—it is. GSM is basically what happens when estrogen, the hormone that keeps the tissues of your vagina, bladder, and urethra plump, elastic, and well-lubricated, starts to decline.
Estrogen doesn’t just regulate your menstrual cycle—it maintains blood flow, collagen, and moisture in the urogenital tissues. When that estrogen support fades, these tissues become thinner, drier, less elastic, and more prone to inflammation and infection.
Why It Happens (and Why It’s So Common)
As estrogen levels fluctuate in perimenopause, several changes occur:
The vaginal walls thin and lose elasticity.
Blood flow decreases, reducing natural lubrication.
The pH of the vagina rises, which can disrupt the microbiome and make it easier for bad bacteria to thrive (hello, recurring UTIs).
Pelvic floor muscles weaken, especially after childbirth, which can lead to urinary leakage and loss of bladder control.
You might also notice physical changes: the labia may become less full, the clitoris may shrink, and the vulva can lose some of its natural color and firmness. These are all part of the tissue changes that happen when estrogen and collagen production drop.
Add in the daily stress, dehydration, tight jeans, and perfumed soaps that can irritate already sensitive tissue—and it’s no wonder so many women are uncomfortable.
The Emotional Side No One Talks About
For many women, GSM affects more than just physical comfort—it can hit confidence, intimacy, and self-image hard. Painful sex, bladder leaks, or feeling “different down there” can create shame and avoidance… but listen - there is nothing to be embarrassed about!
It’s hormonal, it’s common, and it’s treatable. And the more we talk about it, the easier it becomes to get help.
What Helps: Relief Starts with Awareness
You don’t need to overhaul your life overnight—but these changes can make a big difference.
Avoid Irritants That Worsen Symptoms
Skip products with fragrance, dyes, or antibacterial agents (soaps, wipes, douches, bubble baths).
Avoid perfumed laundry detergents, scented toilet paper, and “warming” lubricants.
Stick with gentle, pH-balanced cleansers like clear glycerin soap.
Rebuild Hydration + Elasticity
Drink half your body weight in ounces of water daily. Hydration supports all mucous membranes—including vaginal tissue.
Add vitamin D and omega-3s for tissue health and reduced inflammation.
Vaginal moisturizers can be used regularly (not just during sex) to restore hydration and elasticity.
During Sex
Use a water- or silicone-based lubricant every time to reduce friction and pain.
Keep intimacy regular: increased blood flow from sexual activity can actually help preserve vaginal health and elasticity.
Support from the Inside
Incorporate foods that nourish your “love zone”:
Avocados: Healthy fats for natural lubrication.
Sweet potatoes: Vitamin A + beta carotene support mucous membranes.
Soy (edamame, tofu, tempeh): Phytoestrogens help mimic mild estrogen activity.
Dark leafy greens: Magnesium, vitamin E, and antioxidants for circulation and tissue repair.
Probiotics: Lactobacillus strains help maintain a balanced vaginal microbiome.
Medical + Hormonal Support Options
If symptoms are moderate to severe, don’t hesitate to talk with your healthcare provider. There are effective medical treatments available, including:
Vaginal estrogen therapy: Available as a cream, tablet, or ring—this is one of the most effective, low-risk treatments for GSM. It works locally to restore thickness, moisture, and pH without raising systemic estrogen levels significantly.
Vaginal DHEA (prasterone): A newer option that helps boost both estrogen and androgen activity locally to improve elasticity and lubrication.
Laser and radiofrequency therapies: Some women find relief with in-office treatments that stimulate collagen and blood flow.
If your doctor brushes it off, find someone who won’t. The North American Menopause Society (NAMS) directory lists clinicians trained specifically in menopause care. You deserve a provider who listens and understands this phase of life.
Mind-Body Connection: Don’t Forget Stress + Sleep
Cortisol and estrogen are deeply intertwined. Chronic stress or poor sleep can amplify inflammation and worsen GSM symptoms. Prioritizing rest, hydration, and simple stress-reduction practices (like yoga, walking, or breathwork) will help your hormones—and your comfort—stay steadier.
The Bottom Line
Genitourinary Syndrome of Menopause may sound clinical—but what it really means is that the tissues that make you YOU are asking for a little extra care.
Understanding GSM is one of the most empowering parts of perimenopause. You can nourish, strengthen, and even restore vaginal and urinary health with the right combination of awareness, self-care, and medical support.
And the next time you hear yourself thinking, “It’s just part of aging,” remember: it’s not. It’s your body asking for attention—and it deserves it.
🌿 Ready to Feel Comfortable in Your Body Again?
Perimenopause doesn’t have to mean feeling disconnected from your body—or avoiding conversations about what’s changing. My 6-Week Rise + Reset Hormone Rebalance Plan helps you understand what’s driving these changes and gives you the tools to find relief, balance, and confidence in your body again.
