Updated April 14, 2026

Menopause is a natural stage in every woman's life. While many expect the common symptoms that come with this transition like hot flashes and mood swings, some changes can be unexpected or confusing. Understanding what’s typical and what may signal something more is an important step toward getting the support and care you deserve.”

If you are experiencing symptoms that include vaginal dryness, painful intercourse and/or a frequent “urge to go,” Dr. Wen Shen, Co-Director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins says it may be something called Genitourinary Syndrome of Menopause (GSM).

What is Genitourinary Syndrome of Menopause?

GSM is a collection of vaginal, vulvar, sexual and urinary symptoms that occur when estrogen levels decline during and after menopause. This drop in estrogen causes the tissues of the vagina, vulva, urethra and bladder to become thinner, drier, less elastic and more fragile, leading to a range of uncomfortable or disruptive symptoms.

GSM is very common, affecting more than half of postmenopausal women, yet it is often underdiagnosed because many people feel uncomfortable discussing symptoms.

Symptoms of Genitourinary Syndrome of Menopause

• Vaginal symptoms: dryness, burning, itching, irritation, thinning of tissues or discharge 

• Sexual symptoms: pain with intercourse, decreased lubrication, reduced arousal or difficulty achieving orgasm

• Urinary symptoms: urgency, frequency, burning with urination, incontinence or recurrent urinary tract infections

Treatment Options for GSM

Treatment options that are safe and effective are available to many patients, including breast cancer survivors. Treatment options can include:

• Over the counter ointments and creams

• Hyaluronic acid creams

• Local ultra-low dose estrogen

• Ultra-low dose estrogen is delivered topically. Clinical trials to date indicate there is minimal to no systemic absorption resulting in no increased risk of breast cancer recurrence. This locally applied, ultra-low dose estrogen comes in several forms: cream, vaginal tablet or ring.

• Hormonal treatments like local vaginal dehydroepiandrosterone (DHEA) 

• Oral medication, including Selective Estrogen Receptor Modulator (SERM)

Although not currently FDA‑approved, Vaginal Laser Ablation (VLA)—a technique adapted from dermatology—may offer symptom relief for some individuals. VLA works by creating controlled micro‑abrasions in the vaginal tissue, which stimulates new blood vessel growth and encourages temporary remodeling of the vaginal mucosa. However, because the underlying issue is estrogen deficiency, the tissue will gradually thin again without ongoing treatment. As a result, VLA typically requires annual maintenance sessions. Since it is not FDA‑approved for this use, it is generally not covered by insurance.

Talk to Your Doctor About GSM

GSM is highly treatable. Talking to your doctor opens the door to relief, restored function and a better overall sense of wellbeing. A gynecologist can help you understand the full range of evidence‑based options—from non‑hormonal therapies to localized estrogen treatments—and guide you toward what fits your health needs and preferences. If your symptoms cannot be managed by your gynecologist, you might be referred to a urogynocologist or menopause specialist for additional care. If you have persistent symptoms that are not resolved by the treatments discussed above, you should consult with a menopause specialist about other possible conditions including lichen sclerosus, vaginitis or pelvic floor dysfunction.

Medically Reviewed by Wen Shen, M.D.