Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause (GSM), formerly known as vulvovaginal atrophy (VVA) or atrophic vaginitis, is a common condition that affects many women during and after menopause. It is primarily caused by the hormonal changes that occur during menopause, specifically the decline in estrogen levels. Estrogen plays a crucial role in maintaining the health of the genital and urinary tissues in women.

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What are the symptoms of Genitourinary Syndrome of Menopause?

GSM encompasses a range of symptoms and changes in the genital and urinary tract, including:

  1. Vaginal dryness: Reduced estrogen levels can lead to a decrease in vaginal lubrication, making sexual intercourse uncomfortable or painful.
  2. Vaginal atrophy: The vaginal walls become thinner, less elastic, and more fragile, which can cause itching, burning, and discomfort.
  3. Genital discomfort: Women with GSM may experience pain, soreness, or a sense of irritation around the vulva.
  4. Dyspareunia: Painful sexual intercourse is a common symptom of GSM due to the thinning and dryness of the vaginal tissues.
  5. Urinary symptoms: Some women with GSM may experience urinary problems, such as urinary urgency, frequency, or recurrent urinary tract infections, as the tissues in the urinary tract also become affected by the estrogen deficiency.
  6. Recurrent urinary tract infections: Changes in the urinary tract can make women more susceptible to urinary tract infections.

Treatment for Genitourinary Syndrome of Menopause

GSM treatment typically involves the use of estrogen therapy, which can be administered in various forms, including vaginal creams, tablets, rings, or patches. These treatments can help restore the thickness and elasticity of the vaginal tissues and alleviate many of the associated symptoms.

Additionally, pelvic floor muscle training, lubricants, moisturizers, selective estrogen receptor modulators, vaginal DHEA and vaginal vibratory devices may also aid in the therapy.

Is Vaginal Estrogen Safe?

The use of vaginal estrogen therapy for the treatment of Genitourinary Syndrome of Menopause (GSM) is generally considered safe and effective when used as prescribed and under the guidance of a healthcare provider. However, as with any medical treatment, there are potential risks and benefits to consider.

Here are some key points to keep in mind regarding the safety of vaginal estrogen therapy:

1. Localized Treatment: Vaginal estrogen therapy is a localized treatment, meaning it primarily affects the vaginal and urinary tissues. The estrogen is absorbed in smaller amounts compared to systemic (whole-body) hormone replacement therapy (HRT), which minimizes the risk of some systemic side effects.

2. Effectiveness: Vaginal estrogen therapy is highly effective at relieving the symptoms of GSM, such as vaginal dryness, atrophy, and discomfort, as it helps restore the health of the vaginal and urinary tissues.

3. Low Absorption: When used as directed, vaginal estrogen preparations have minimal absorption into the bloodstream. This reduces the risk of systemic side effects associated with estrogen therapy.

4. Minimal Systemic Effects: While systemic estrogen therapy (like a pill or pellets under the skin) may have potential risks like an increased risk of blood clots, breast cancer, and cardiovascular issues, these risks are eliminated with vaginal estrogen because of the lower systemic absorption.

The latest study published in 2023 looking at a large group of women with previous history of breast cancer, the use of vaginal estrogen did NOT increase their risk of cancer recurrence.1


  1. Agrawal P, Singh SM, Able C, Dumas K, Kohn J, Kohn TP, Clifton M. Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. Obstet Gynecol. 2023 Sep 1;142(3):660-668. doi: 10.1097/AOG.0000000000005294. Epub 2023 Aug 3. PMID: 37535961.

Written by Dr. Vladislav Gorbatiy