What is GSM?
At menopause, falling oestrogen can cause vaginal dryness, burning, itching, irritation, pain during sex, and urinary symptoms such as frequency, leakage or recurrent urinary infections. Together these are called genitourinary syndrome of menopause (GSM).[1]
Getting older does not mean you have to accept these symptoms; effective treatment is available.[1]
Why treatment is worthwhile
GSM affects both sex life and daily activities such as sitting, exercise and passing urine.[1] Unlike hot flushes, which often ease over time, GSM tends to persist or slowly worsen without care.
Many women feel unable to mention it or assume it is just part of ageing, but treatment can improve quality of life considerably.
How common is it?
Genital and urinary symptoms are common around and after menopause, but not universal, and their severity varies.[1] Symptoms can start before periods stop or many years afterwards.
Why symptoms develop
Oestrogen keeps the vaginal, vulval and lower urinary tissues thick, elastic and moist. When it declines[1],[2]:
- Tissues thin and lose elasticity, so they hurt or tear more easily.
- Natural lubrication falls.
- Vaginal pH changes, making infection more likely.
- Lower urinary tract tissues change, causing urinary symptoms.
Similar changes can occur with hormone-lowering medicines, for example after breast cancer treatment, or while breastfeeding.
Assessment
A doctor will ask about dryness, irritation, pain and urinary symptoms, along with your medical history and medicines, and may examine the tissues and rule out other causes such as infection or skin conditions.[1],[2]
Bleeding after menopause always needs further investigation to exclude other important conditions.[1]
Treatment options
Moisturisers and lubricants. Vaginal moisturisers are used regularly to ease dryness, while lubricants are used during sex. They suit mild symptoms or can be combined with other treatment.[1]
Local vaginal oestrogen is an effective option when appropriate. It comes as creams, pessaries or a ring, chosen to suit symptoms and history. Low-dose local treatment is absorbed into the bloodstream only minimally.[1]
After breast cancer, local hormone use should be decided together with the cancer team; there is no single blanket rule.[1]
Vaginal laser. NICE advises against laser treatment for GSM outside a randomised trial because evidence is insufficient.[1]
How we care for you at Dr. Kris Clinic
We discuss dryness and pain openly and privately, check for other causes of similar symptoms, and explain both non-hormonal and local hormonal options, in English or Thai.
For people with a cancer history, we coordinate with your treating team to choose a safe approach. If symptoms are affecting your relationship, couples counselling at Kris Care Space can help.
Frequently asked questions
Do I just have to live with dryness after menopause?
No. Effective treatments exist, including moisturisers and local hormones.
Is vaginal oestrogen safe?
Low-dose local treatment is absorbed only minimally, but your doctor will consider your individual history.
I've had breast cancer. Can I use local hormones?
That decision should be made with your cancer team, and non-hormonal options are usually tried first.
Does vaginal laser help?
NICE advises against using it for GSM outside research, because evidence is insufficient.
Discuss moisturisers, lubricants and local hormones where appropriate.[1] GSM is treatable, and bleeding after menopause always needs assessment.
Talk to a doctor about this
Confidential care in Surat Thani, the mainland gateway to Koh Samui, Koh Phangan and Koh Tao. Tue–Fri 17:00–20:00 · Sat–Sun 10:00–15:00 (UTC+7)
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Dr. Krida Uakridathikarn (Dr. Kris)
Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV
References
- NICE NG23: Menopause—identification and management; recommendations
- ACOG: When Sex Is Painful
- ACOG: Your Sexual Health
Keep reading
Main guide: Women's sexual health
Low Sexual Desire in Women: When to Seek Help and What Helps
Pain During Sex: Causes, Assessment and Treatment
Vaginismus and Fear of Penetration: Understood and TreatableThis article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.