What is GSM?

Falling oestrogen affects tissues in the vulva, vagina, urethra and bladder. They may become thinner, drier and less elastic, and the vaginal environment changes. The Australian Government explains how lower oestrogen affects genital and urinary tissues.

Unlike hot flushes, which may settle over time, vaginal and urinary symptoms can continue for the rest of life if untreated, according to the national menopause symptoms resource.

Symptoms people often do not connect

• Vaginal or vulval dryness, burning, itching or irritation.
• Pain, tearing or light bleeding with penetration.
• Reduced arousal or avoiding intimacy because it hurts.
• Urinary urgency, frequency or burning.
• Recurrent urinary tract infections.
• A feeling that the tissues are fragile or easily irritated.

Healthdirect notes that vaginal dryness may be accompanied by more frequent urination and recurrent UTIs. These symptoms still need assessment because infection, skin conditions, pelvic-floor problems and other causes can coexist.

Treatment options

Vaginal moisturisers and lubricants

A vaginal moisturiser is used regularly to improve comfort; a lubricant is used during sexual activity to reduce friction. Product ingredients matter if tissues are sensitive. These can be used alone or alongside prescription treatment.

Low-dose vaginal oestrogen

Local oestrogen is available in forms such as creams, pessaries or vaginal tablets. It acts mainly at the tissue where it is used and can improve dryness, pain and urinary symptoms. The Australasian Menopause Society provides a detailed GSM information sheet.

Systemic MHT

Systemic MHT may help some people who also have hot flushes, night sweats or other symptoms, but local symptoms can persist even when systemic treatment is used. Local therapy may still be considered.

Pelvic-floor and sexual-pain care

Pelvic-floor physiotherapy, gradual rehabilitation, attention to arousal and treatment of related skin or pain conditions can be important. Pain should not be pushed through.

What if you have had breast cancer?

Start with non-hormonal measures and discuss persistent symptoms with your treating team. Decisions about local oestrogen depend on cancer type, treatment, symptom severity and individual risk. Do not assume you have no options, and do not self-prescribe hormone products without advice.

When symptoms need prompt assessment

• Any bleeding after 12 months without a period.
• Persistent bleeding after sex, a new lump, ulcer or skin change.
• Fever, flank pain, vomiting or feeling very unwell with urinary symptoms.
• Visible blood in urine.
• Pain that is severe, sudden or not improving.

What to say at the appointment

You can be direct: ‘I have dryness and pain with sex,’ ‘I keep getting urinary symptoms,’ or ‘I think this may be menopause-related.’ Note how long symptoms have been present, whether they are local or accompanied by hot flushes and cycle changes, and what products you have tried.