Feeling “Off” Down There? It Might Be Genitourinary Syndrome of Menopause(GSM)
- HonorYourBody
- May 31, 2025
- 5 min read
Updated: Aug 16, 2025
By Bekah Johnson. FNP
As we move through our 40s and 50s, it can feel like our bodies are changing in ways
no one warned us about. Maybe sex has become painful. Maybe you are running to the
bathroom more often. Maybe you are constantly battling dryness, irritation, or even
recurrent UTIs.
You’re not imagining things—and you’re not alone.
This constellation of symptoms is now known as Genitourinary Syndrome of
Menopause (GSM), and nearly 50% of women over 50 experience at least one pelvic floor disorder.
But here’s the good news: these symptoms are not just “part of getting older”—they’re treatable. Pelvic floor issues are one of the most common, yet under-discussed, health concerns for women entering perimenopause and post menopause. And they’re not just about inconvenience—they can deeply affect your physical health, emotional well-being, and intimacy.
But here’s the empowering news: In 2025, the American Urological Association
released new clinical guidelines backed by research and supported by The Menopause
Society and the International Society for the Study of Women’s Health. This means
better care and better options are available—and you deserve to know about them.
Let’s break down what GSM is, what the latest research says, and how you can
advocate for care that helps you feel like yourself again.
What’s Going On Exactly- Here’s the biology?Feeling “Off” Down There? It Might Be Genitourinary Syndrome of Menopause(GSM)
The pelvic floor is a group of muscles and connective tissues that support your bladder, uterus, and bowel. As estrogen declines with age, these tissues lose elasticity and
strength, leading to a cascade of symptoms. GSM isn’t just “vaginal dryness.” It’s a
broad syndrome involving the vulva, vagina, urethra, bladder, and even bowel function.
As estrogen declines with age, these tissues lose elasticity and strength leading to this
cascade of symptoms. The natural drop in progesterone, and testosterone during
menopause contributes to the following possible symptoms:
Vaginal dryness, burning, or itching
Painful sex (dyspareunia)
Urinary frequency or urgency
Recurrent UTIs
Decreased libido
Clitoral atrophy
Vaginal or bladder prolapse
Deferred muscle and joint pain from the weakened pelvic floor
If any of this sounds familiar, it’s time to talk to me (your women’s wellness provider)
and join the Honor Your Body group. We has created a blueprint to help guide the conversation and treatment.
How Is GSM Diagnosed?
Your clinician should:
Take a detailed history
Perform a genitourinary exam
Screen for alternative causes of symptoms
Review lab results.
Refer you to a specialist such as a pelvic floor therapist, urogynecologist. or mental health provider, as needed
Let’s Talk Solutions—Because You Have Them
You don’t have to suffer in silence. Here are proven, science-backed options to take
back control of your body.
Hormonal Options (And Yes, They're Safe!)
Low-Dose Vaginal Estrogen
Top choice for GSM
Works locally (not systemically)
Relieves dryness, pain with sex, and reduces UTIs
DHEA Vaginal Suppositories
Converts naturally into estrogen + testosterone
Boosts vaginal health, libido, and tissue strength
Bonus: No rise in overall hormone levels
Ospemifene (Oral SERM)
Estrogen-free pill that mimics estrogen in vaginal tissue
Systemic Estrogen Therapy
For women already on HRT—can enhance local treatment
Pelvic Floor Physical Therapy: Your Personal Trainer for Down There
Think Kegels—but targeted, effective, and guided by a specialist. A pelvic floor physical
therapist can help you:
Strengthen muscles for better bladder control
Relax tight muscles that cause pain
Improve sexual function and confidence
Pessary devices and Emsella chairs are helpful therapy options
Research shows this therapy reduces leakage and improves quality of life
dramatically.
Non-Hormonal Options That Work
Moisturizers: Use regularly (like skincare for your vagina)
Lubricants: For friction-free intimacy
Probiotics: Promote a healthy vaginal microbiome
Look for: Topical products with hyaluronic acid and pH-balanced formulas.
Avoid: Vaginal douches, perfumes, and harsh soaps—they disrupt your natural pH and
cause irritation
Lifestyle Makes a Difference Too
Eat fiber: Prevent constipation, which puts pressure on pelvic organs.
Hydrate: Keeps tissues healthy and supports bladder function
Lose excess weight: Reduces pressure on the pelvic floor and bladder.
And Don’t Forget Mental Health
Pelvic floor problems can affect your confidence, relationships, and mental well-being.
Cognitive behavioral therapy (CBT) and support groups can help you cope and feel
heard. You are not alone in this journey.
Energy-Based Treatments: Proceed with Caution
Lasers and radiofrequency treatments (like CO₂ or YAG) are marketed for “vaginal
rejuvenation,” but current evidence doesn’t support them as effective or safe.
You Deserve Comfort, Confidence, and Connection
Untreated GSM isn’t just uncomfortable—it can lead to serious health issues like
chronic UTIs, reduced intimacy, and even increased risk for dementia in older adults.
But with the right support and treatment, you can feel like yourself again.
✅ Comfortable in your body
✅ Empowered in your relationships
✅ Confident in your care
Don’t settle. Print this out. Bring it to your next appointment. Start the conversation—and keep going until you feel heard.
Join us inside the Honor Your Body app —where we listen, we guide, and we create care plans that actually work for you. Let’s reclaim your wellness together.
GSM Q&A: What You’ve Been Wondering—Answered, Feeling “Off” Down There? It Might Be Genitourinary Syndrome of Menopause(GSM)
Q: What exactly is GSM?
A: Genitourinary Syndrome of Menopause (GSM) is a collection of symptoms caused by hormonal changes during and after menopause. It affects the vagina, vulva, bladder, and pelvic floor. Symptoms include dryness, irritation, pain during intimacy, urinary urgency, and more.
Q: Is GSM just another name for vaginal dryness?
A: Not quite. While dryness is a common symptom, GSM is broader—it can include bladder issues, pelvic floor weakness, and even bowel changes. It’s a whole-body pelvic issue, not just a vaginal one.
Q: Is this something I just have to live with?
A: No. That’s the biggest myth. GSM is common, but it is very treatable. There are safe, effective therapies—from hormone-free moisturizers to localized estrogen, pelvic floor therapy, and more.
Q: Can I have GSM even if I haven’t reached full menopause?
A: Yes. Many women in perimenopause (the transition years before menopause) experience symptoms due to hormonal shifts. You don’t have to wait for a certain age to seek help.
Q: Are hormone therapies safe? I’ve heard mixed things.
A: Localized vaginal hormone therapy (like estrogen creams or DHEA suppositories) is considered safe for most women and doesn’t significantly raise overall hormone levels. Always talk with a qualified provider to find the best option for you.
Q: What if I’ve already tried lubricants and they don’t help?
A: That’s a signal that you might need something more targeted. Lubricants help during intimacy, but don’t treat underlying tissue changes. We can explore other solutions together—there’s more than one way to feel better.
Q: How do I get started?
A: Book a visit with us at Honor Your Body. We’ll listen to your symptoms, do a thorough assessment, and create a personalized plan that works for your body, lifestyle, and goals. You don’t have to navigate this alone.
Join us inside the Honor Your Body app!
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