Post-Menopausal Genitourinary Syndrome (GSM)

Post-menopausal genitourinary syndrome (GSM) is caused by the natural drop in estrogen after menopause and can lead to vaginal dryness, irritation, painful intercourse, urinary urgency, and recurrent UTIs. These symptoms can affect daily comfort but are very treatable with safe, evidence-based options.

At The Medical Group of New Jersey, our specialists offer personalized care, including vaginal estrogen, moisturizers, pelvic floor therapy, and other targeted treatments, to restore comfort and improve quality of life.

Symptom Onset & Initial Evaluation

GSM typically appears gradually during the menopausal transition but may progress steadily without treatment. Symptoms vary but are often persistent and may worsen over time. Common symptoms include:

• Vaginal dryness, irritation, or burning
• Pain during intercourse
• Vaginal tightness or narrowing
• Urinary urgency or frequency
• Burning with urination (even with negative urine cultures)
• Recurrent urinary tract infections
• Light bleeding after intercourse
• Decreased lubrication
• Discomfort with exercise or prolonged sitting

Because GSM affects both vaginal and urinary tissues, patients often present with overlapping pelvic symptoms.

Evaluation

The evaluation focuses on identifying GSM features, ruling out infection, and assessing whether symptoms also involve pelvic floor dysfunction or other urogynecologic conditions.

During your first visit at The Medical Group of New Jersey, your urogynecologist will:

• Review your menopause history and symptom progression
• Ask about sexual comfort, urinary habits, and lubrication changes
• Discuss prior hormone therapy or treatments
• Evaluate for recurrent UTIs or overactive bladder symptoms
• Perform a pelvic exam
• Determine whether additional testing is needed

This evaluation helps the provider create a personalized plan that targets both vaginal and urinary symptoms.

Diagnosis & Testing

GSM is primarily a clinical diagnosis, but additional tests may help rule out other conditions.

• Pelvic Examination: Assesses classic signs of GSM, including thinning of vaginal tissue, loss of elasticity, pale or dry mucosa, tissue fragility or small fissures, reduced lubrication, and elevated vaginal pH.
• Urinalysis & Urine Culture: Used to rule out infection and evaluate recurrent UTIs.
• Post-Void Residual (PVR): Helpful for women with urinary urgency or incomplete emptying.
• Vaginal pH Testing: Often elevated in GSM due to decreased estrogen.
• Assessment for Coexisting Pelvic Conditions: Such as pelvic floor dysfunction, vaginal stenosis, or overactive bladder.

All evaluations and testing can be performed or coordinated through The Medical Group of New Jersey.

Treatment & Ongoing Management

GSM treatment focuses on restoring vaginal and urinary tissue health, improving comfort, and reducing urinary symptoms. Most treatments are safe, effective, and appropriate for long-term use.

Lifestyle & Conservative Measures

• Vaginal Moisturizers: Used regularly (2–3 times per week) to improve baseline moisture.
• Lubricants for Intercourse: Water- or silicone-based lubricants reduce discomfort during sexual activity.
• Healthy Pelvic Habits: Regular sexual activity or vaginal stimulation increases blood flow, avoiding harsh soaps or irritants, and managing constipation. These measures help maintain vaginal health and comfort.

Hormonal Therapy (Gold-Standard Treatment)

Low-dose vaginal estrogen is the gold-standard treatment for GSM because it safely and effectively restores vaginal and urinary tissue health.¹ It is applied locally, through a vaginal cream, tablet, or ring, so only minimal amounts enter the bloodstream.

This therapy can significantly improve lubrication, reduce dryness and irritation, ease pain during intercourse, improve urinary urgency and frequency, and lower the risk of recurrent UTIs. Because the absorption is extremely low, it is safe for most patients, including many who cannot take systemic hormone therapy.

Your provider at The Medical Group of New Jersey will review your options and help you choose the formulation that fits your needs.

Non-Hormonal Treatments

For patients who prefer to avoid estrogen or need additional symptom relief, several non-hormonal therapies can help improve comfort and vaginal health. Your provider at The Medical Group of New Jersey will work with you to choose options that match your symptoms, goals, and medical history.

Non-hormonal treatments may include:

• Vaginal DHEA or Testosterone: These options can improve vaginal dryness, enhance lubrication, and support sexual comfort in select patients.
• Laser or Radiofrequency Vaginal Therapy: Some patients explore energy-based treatments to improve tissue elasticity and moisture. Because evidence is mixed, our specialists discuss the potential benefits, risks, and alternatives so you can make an informed decision.
• Pelvic Floor Physical Therapy: Helpful for women with pelvic pain, muscle tightness, or discomfort during intercourse. Therapy focuses on relaxation, improved coordination, and relief of tension that may contribute to GSM symptoms.

Advanced or Additional Interventions

Because GSM can make the vaginal and urinary tissues more vulnerable to infection, treating GSM often leads to fewer recurrent UTIs. In addition to restoring tissue health, your provider may recommend simple preventive strategies to lower infection risk, such as vaginal estrogen to strengthen the vaginal and urethral tissues, staying well-hydrated to help flush bacteria, and post-coital antibiotic prophylaxis when appropriate. These steps can meaningfully reduce both the frequency and severity of urinary infections.

Treatment of Associated Overactive Bladder

If urinary urgency or frequency continues even after GSM treatment, your provider may incorporate additional overactive bladder (OAB) therapies. These may include bladder training, medications, pelvic floor therapy, or other evidence-based options to help restore bladder control and comfort.

1. Abdelgader, Ahmed, et al. “Intravaginal Drug Delivery Systems to Treat the Genitourinary Syndrome of Menopause: Towards the Design of Safe and Efficacious Estrogen-Loaded Prototypes.” Journal of Pharmaceutical Sciences, vol. 112, no. 6, 1 June 2023, pp. 1566–1585.

Monitoring & Follow-Up

Follow-up ensures symptom improvement, treatment tolerance, and adjustment of therapy based on individual response. Follow-up visits may include:

• Evaluation of symptom improvement
• Review of treatment adherence
• Adjustment of estrogen dose or formulation
• Monitoring for urinary symptoms or UTIs
• Assessment of pelvic floor therapy progress

Long-term treatment is safe and often necessary to maintain symptom relief, and patients at The Medical Group of New Jersey receive ongoing support to help maintain comfort and quality of life.