Why We Must Talk About Genitourinary Syndrome of Menopause (GSM): Every Woman Deserves to be Informed
- irenebarrows
- May 23, 2025
- 3 min read
Let’s talk about something that too often gets ignored: Genitourinary Syndrome of Menopause (GSM). Formerly known as "vaginal atrophy," GSM includes a collection of symptoms such as vaginal dryness, burning, irritation, painful intercourse, urinary urgency, recurrent urinary tract infections, and more. And it’s not rare — 24-87% of postmenopausal women experience these symptoms, yet only a fraction seek or receive treatment.
In 2020, the North American Menopause Society (NAMS) released a pivotal position statement reaffirming the significance of GSM and, more importantly, the safety and effectiveness of treatment options for women — at any age.
The Health Consequences of Ignoring GSM
Too often, women chalk up GSM symptoms to “just aging” and suffer in silence. But untreated GSM can have serious health implications:
Painful intercourse (dyspareunia) can lead to loss of intimacy and relationship strain.
Chronic urinary symptoms increase the risk of recurrent infections and even unnecessary antibiotic use.
Decreased estrogen in the vaginal tissues leads to tissue fragility, raising the risk of microtrauma and discomfort.
Loss of sexual function and self-esteem can impact mental health and quality of life.
These symptoms don’t get better over time — in fact, they tend to worsen the longer they're ignored. The vaginal tissue continues to atrophy until estrogen is restored to the area. FACT - not only are estrogen receptors found in the vagina but also the bladder, urethra, and pelvic floor muscles!
Treatment Is Safe — Even Years After Menopause
One of the most encouraging points from the 2020 NAMS position statement is this: treatment is safe and effective — even more than a decade after menopause.
Vaginal estrogen therapy, in particular, is a first-line treatment that has been shown to dramatically relieve symptoms with very low systemic absorption. This means it's safe even for many women with complex medical histories.
Let’s be clear:
A past diagnosis of breast cancer or a history of blood clots (such as pulmonary embolism) is not an automatic contraindication.
Instead, these cases call for a personalized, informed discussion between the patient and a knowledgeable healthcare provider about the risks and benefits.
As a physician assistant, I’ve had countless conversations with women who were terrified of hormone therapy — often based on outdated information or fear-mongering headlines. Let's remember - estrogen still carries a BLACK BOX WARNING after the results from the Women's Health Initiative regarding breast cancer risk were completely skewed by the media. But when we sit down, review the current evidence, and walk through the options together, something powerful happens: empowerment replaces fear.
What I See in Clinic — The "Aha!" Moment
One of the most rewarding parts of my job is seeing women after they’ve started vaginal estrogen. I’ve had patients come back and say things like:
“I had no idea how uncomfortable I had been until I wasn’t anymore.”
“I feel like myself again.”
“I thought sex was just over for me — now I know it’s not.”
These moments are profound. So many women assume their symptoms are just part of aging and that nothing can be done. But with proper education and treatment, we can dramatically improve quality of life — safely.
Let’s Change the Conversation
It’s time to bring GSM out of the shadows and into the light. That means:
Asking about symptoms proactively during wellness visits.
Educating women that these changes are common but treatable.
Empowering women of all ages to seek care — even if they are 10, 15, or 20+ years post-menopause.
Making it clear that treatment decisions are not one-size-fits-all, and that risk should always be personalized, not assumed.
Final Thoughts
Genitourinary Syndrome of Menopause isn’t just about vaginal dryness — it’s about living fully, comfortably, and confidently in your postmenopausal years. The science supports safe and effective treatment options. You deserve to know them.
If you're struggling with these symptoms — or even just wondering if what you’re feeling is “normal” — let’s talk. You don’t have to settle for discomfort. Relief is possible.
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