Vaginal dryness in menopause: genitourinary syndrome of menopause (GSM)

Lower estrogen around menopause thins and dries the tissues of the vagina, vulva and lower urinary tract. The group of symptoms — dryness, burning, irritation, pain with sex and some urinary symptoms — is called genitourinary syndrome of menopause (GSM). Unlike hot flashes, GSM usually does not ease with time, but it is very treatable.

Common symptoms

• Vaginal dryness, burning or itching
• Pain or discomfort during sex, and less lubrication
• Needing to urinate urgently or often, or discomfort when urinating
• Repeated urinary tract infections in some women

Why it happens

Estrogen supports the thickness, moisture and elasticity of genital and urinary tissues. As estrogen falls, these tissues change. The Menopause Society notes GSM is common and often progressive, yet under-reported because many women don't raise it.

Treatment options

• Over-the-counter vaginal moisturizers (used regularly) and lubricants (used during sex) are first-line for mild symptoms.
• Low-dose vaginal estrogen (cream, tablet, insert or ring) acts locally with minimal absorption into the bloodstream.
• Vaginal prasterone (DHEA) and oral ospemifene are FDA-approved for painful sex due to menopause.
• Pelvic floor physical therapy can help when pain or muscle tension is part of the picture.

When to talk with a healthcare professional

• Symptoms are affecting your sleep, work, relationships or daily life.
• You want to know whether a treatment fits your personal and family health history.
• Moisturizers and lubricants are not enough, or sex is painful.
• You have urinary symptoms, repeated infections, or any unusual discharge or bleeding.

When to get prompt care

• Vaginal bleeding after menopause, or fever with pelvic or back pain, should be checked promptly.

How Dot can help

Dot lets you log dryness, discomfort and urinary symptoms privately alongside your cycle and sleep, so you can bring a clear history to an appointment. Dot does not diagnose GSM or recommend a treatment.

How Dot works · Kindr Care clinical care

Related topics

• Vaginal estrogen
• Prasterone
• Ospemifene
• Libido & intimacy
• Estrogen
• Postmenopause

Sources

1. The Menopause Society. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause 2020;27(9):976–992 (2020).
2. American College of Obstetricians and Gynecologists. The Menopause Years (patient FAQ).
3. National Institute on Aging (NIH). What Is Menopause?.
4. U.S. Food and Drug Administration. Menopause: Medicines to Help You.

This page is educational and not medical advice. Dot does not diagnose or prescribe. See our editorial policy.