Up to 87% of postmenopausal women experience vaginal dryness, pain during sex, urinary urgency and frequent urinary tract infections (UTIs). Called genitourinary syndrome of menopause, or GSM, this constellation of annoying symptoms happens when estrogen levels take a nosedive.

"Every woman who lives long enough will experience menopause,” said Karyn Eilber, MD, a urogynecologist at Cedars-Sinai. "Yet, genitourinary symptoms during menopause are often overlooked—both by patients and their healthcare providers."

As the name suggests, genitourinary syndrome of menopause describes the genital and urinary symptoms that often accompany perimenopause and menopause.

"GSM is a chronic, progressive condition that affects the vulva, vagina and lower urinary tract," said Eilber. "And it’s often missed in routine care."

While the American Urological Association has guidelines for GSM, there’s still no universally agreed-upon checklist of symptoms required for diagnosis.

GSM is the body’s response to a dramatic drop in estrogen that happens during menopause. These hormonal shifts cause the vaginal and urinary tissues to become thinner, drier and more fragile.

"But GSM doesn’t only affect menopausal women," said Alexandra Dubinskaya, MD, a urogynecologist and sexual medicine specialist at Cedars-Sinai. "Women who experience dips in estrogen after giving birth, while breastfeeding or during cancer treatment are also at risk. Even long-term use of oral contraception can lead to GSM in some women."

Read: A Health Guide for Women in Their 50s and 60s

Reduced estrogen affects every organ system in the body, but especially the genitourinary tract, where there are loads of estrogen receptors. The pronounced lack of estrogen can lead to a range of genital and urinary problems, including:

• Vaginal discomfort, such as dryness, itching, burning and irritation
• Pain during sex
• Difficulty with arousal and orgasm
• Urinary urgency or frequency
• Recurrent UTIs

In more severe cases, GSM can impact basic activities such as sitting, walking and working—not just sex and bladder control.

Read: The Emerging Ways to Treat Bladder Pain

Unlike other menopause symptoms such as hot flashes or mood swings, GSM doesn’t improve over time. In fact, it gets worse if left untreated. To combat these changes, doctors often rely on a combination of therapies, both hormonal and nonhormonal.

Nonhormonal therapies include:  

• Moisturizers and lubricant: Nonhormonal, over-the-counter moisturizers can help relieve vaginal dryness and, in some cases, plump up tissues. Lubricants help reduce friction during intercourse, enhancing sexual pleasure. 
• Pelvic floor therapy: Learning how to relax and contract your pelvic floor muscles can help improve bladder function, reduce urinary urgency and make sex more comfortable.
• Vibrators: “Using a vibrator two to three times a week can help release pelvic floor muscles, increase blood flow to the vaginal tissues and make it easier for women to achieve orgasm,” said Dubinskaya.
• Medication: Selective estrogen receptor modulators (SERMs), such as ospemifene, mimic estrogen in targeted tissues without affecting other organ systems.
• Vaginal laser ablation (VLA): VLA uses laser energy to stimulate collagen production and tissue repair. While some women report relief, the effects are temporary, and VLA is not approved by the U.S. Food and Drug Administration or covered by insurance.

Hormonal therapies, available by prescription, include:

• Vaginal estrogen: Topical estrogen (available as creams, suppositories or vaginal rings) can restore moisture and elasticity to vaginal tissues, and studies consistently link vaginal estrogen with a reduced risk of UTIs. "Vaginal estrogen is not absorbed systemically in any significant amount, making it a safe and effective option for all women, even those with a personal or family history of breast cancer," said Eilber.
• Androgens: Androgens, including dehydroepiandrosterone (DHEA) and testosterone, are sex hormones that play an important role in enhancing sexual desire and response.
• Oxytocin: Often called the "bonding hormone," oxytocin surges shortly after childbirth but can also enhance orgasm and contribute to improved sexual function.

"GSM is complex, so a comprehensive approach often works best," said Eilber. "That might mean combining systemic hormone therapy with topical estrogen or taking a SERM along with vibrator therapy."

Read: Sexual Healing: Vibrators as Medicine

Unfortunately, many women brush off GSM because they think it’s a normal part of aging. However, some GSM symptoms—including recurrent UTIs—are not only irritating, but they can lead to serious complications as women age.

If you're experiencing symptoms of GSM—or if you're approaching or in menopause and have questions—talk to your primary care provider or OB-GYN. You don't have to live with discomfort.

No matter what your unique experience is with GSM, effective, personalized treatment is available—and it’s never too late to start.