What Is Genitourinary Syndrome of Menopause? Most women will have it but have never heard of it

Kristyn Zalota
6 days ago
4 min read

Are you in perimenopause or menopause? Have you noticed vaginal dryness/discomfort, more frequent UTIs, pain during sex or unexpected leaks when you run, jump, laugh or sneeze? There's a name for what you're experiencing: Genitourinary Syndrome of Menopause, or GSM.

Most women have never heard the term. tI remains one of the most underdiscussed parts of the menopause transition, despite affecting the majority of postmenopausal women.

What GSM actually is

GSM is the medical term for the collection of vaginal, vulvar, sexual, and urinary changes caused by declining estrogen (and androgen) levels during and after menopause.

It was introduced in 2014 by a joint consensus panel from the International Society for the Study of Women's Sexual Health (ISSWSH) and the North American Menopause Society (NAMS), replacing the older term "vulvovaginal atrophy."

The renaming wasn't just cosmetic. The panel felt the old term was too narrow - it focused only on the vagina, when the condition actually affects a broader system: the vulva, vagina, urethra, and bladder all respond to estrogen, and all can be affected as levels decline (Portman & Gass, Menopause, 2014).

How common is it

Estimates vary depending on how studies measure symptoms, but GSM is thought to affect somewhere between 27% and 84% of postmenopausal women (NAMS, 2020 GSM Position Statement). Put simply: this is not a rare or unusual experience. It's closer to the norm than the exception. Yet it remains one of the least talked-about aspects of menopause.

women don't know they have it

Awareness and diagnosis rates tell a sad story. One survey found only 4% of women attributed symptoms like vaginal dryness, itching, or burning to GSM at all (Nappi & Kokot-Kierepa, Climacteric, 2012).

Among women with confirmed GSM symptoms, only around 21% had ever been formally diagnosed, and only 24% had ever used any treatment (Chua et al., Climacteric, 2017).

The full symptom picture

GSM symptoms fall into two broad categories:

Vulvovaginal and sexual symptoms:

Vaginal dryness
Burning or irritation
Itching
Pain during intercourse (dyspareunia)
Bleeding with intercourse
Thinning, fragile vaginal tissue

Urinary symptoms:

Urinary urgency
Burning or discomfort with urination
Recurrent urinary tract infections
Urinary incontinence (both stress incontinence - leaking with a cough, sneeze, laugh, or jump - and urge incontinence)

It's worth pausing on that last category. Many women experiencing recurrent UTIs or bladder leaks do not associate them with peri/menopause. But like the tissues of the vagina and vulva, the tissues of the urethra and bladder are estrogen- and androgen-responsive too (Simon et al., Menopause, 2018; Traish et al., Sex Med Rev, 2018). GSM really encompasses the genital and urinary systems.

Why GSM is different from other menopause symptoms

Hot flashes and night sweats, the symptoms most associated with menopause, gradually improve over time for most women. By contrast, without treatment, GSM tends to be progressive. It doesn't resolve on its own, and for many women it slowly worsens over the years following menopause (NAMS, 2020).

Left untreated, GSM can meaningfully affect comfort, sexual health, and quality of life indefinitely. It can also contribute to chronic UTIs, which in women over 55, are linked to higher rates of hospitalization and death when the underlying GSM isn't treated (Wells et al., J Urology, 2025)

Why it goes undiagnosed

Despite how common GSM is, most women affected by it never seek treatment, and many who do bring it up to a doctor find the conversation cut short. A few reasons show up consistently in the research:

Embarrassment. These are symptoms that are hard to talk about, even with a healthcare provider.
Normalization. Many women and their doctors assume these changes are simply an inevitable part of aging, not something treatable.
Time. Short appointment windows don't always leave room for a full discussion of symptoms that can feel awkward to raise in the first place.

The result is a significant gap between how common GSM is and how often it's actually diagnosed and treated.

What comes next

The good news: GSM is very treatable and the evidence for managing it has grown substantially in recent years. In Part 2 of this series, we'll look at what the research actually shows about treatment, starting with vaginal estrogen, how it works, and what the safety data really says (including some findings that may surprise you).

This article is for educational purposes only and does not constitute medical advice. Always consult your doctor about your specific symptoms and treatment options.

References:

Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-1068.
The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992.
Simon JA, Goldstein I, Kim NN, et al. The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review. Menopause. 2018;25(7):837-847.
Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev. 2018;6(4):558-571.
Wells BA, et al. Impact of Vaginal Estrogen on Serious Adverse Outcomes in Postmenopausal Women with Recurrent Urinary Tract Infections. Abstract, The Journal of Urology. 2025.
Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) — results from an international survey. Climacteric. 2012;15(1):36-44.
Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE survey. J Sex Med. 2013;10(7):1790-1799.
Chua YJ, Limpaphayom KK, Cheng B, et al. Genitourinary syndrome of menopause in five Asian countries: results from the Pan-Asian REVIVE survey. Climacteric. 2017;20(4):367-373.