Genitourinary Syndrome of Menopause (GSM): Understanding Your Options
When we think of menopause, we often picture hot flushes, night sweats, or mood changes. But there’s another set of symptoms that affect many women, and they’re just as important to talk about — Genitourinary Syndrome of Menopause (GSM).
If you’ve noticed vaginal dryness, irritation, discomfort with intimacy, or even urinary changes like frequency or recurrent infections, you’re not alone. GSM is caused by the natural drop in oestrogen after menopause, and without treatment, symptoms often get worse over time. The good news? There are lots of effective treatment options.
What does GSM feel like?
Every woman’s experience is slightly different. For some, it’s persistent dryness or itching. For others, it’s pain or bleeding during sex, burning, or constant trips to the loo. GSM can affect relationships, self-esteem, and quality of life — but it’s treatable, and you don’t have to just put up with it.
First steps: non-hormonal support
If your symptoms are mild, you might find relief with non-hormonal options. These don’t contain oestrogen and can often be picked up from a pharmacy or ordered online.
Lubricants such as Sylk® or Yes WM® can make sex more comfortable. They’re used at the time of intercourse to reduce friction and discomfort.
Moisturisers such as Replens® or Yes VM® are designed for regular use, a few times a week, to help keep the vagina hydrated day-to-day.
Simple lifestyle changes also help — switching to non-perfumed soaps, wearing cotton underwear, and avoiding bladder irritants like caffeine. And don’t forget your pelvic floor. Working with a women’s health physiotherapist, such as Claire Fitzpatrick at Fitz & Physio, can strengthen muscles, boost blood flow, and improve comfort.
Hormonal options: restoring oestrogen locally
For many women, non-hormonal options aren’t quite enough. In that case, local oestrogen therapy can make a real difference. This involves a tiny dose of oestrogen applied directly to the vaginal tissues, where it’s needed most. Because very little is absorbed into the bloodstream, it’s generally considered safe for long-term use.
In the UK, the choices include:
Vaginal tablets or pessaries: such as Vagifem®, Vagirux®, or Imvaggis® (a soft pessary that dissolves once inserted).
Creams: such as Ovestin® or Ovesse®, which can be applied inside the vagina or around the vulva for external irritation.
Gel: such as Blissel®, which spreads easily across the tissues.
Vaginal ring: such as Estring®, which slowly releases oestrogen for three months at a time.
And here’s some good news: you can now buy Gina® (10mcg estradiol vaginal tablets) and Ovesse® (1mg/g vaginal cream) over the counter in UK pharmacies, making treatment more accessible without needing a GP appointment.
When vaginal oestrogen isn’t enough: prasterone
Sometimes, women don’t get full relief from vaginal oestrogen, or they may not tolerate it. In that case, another option is vaginal prasterone (DHEA).
Prasterone is a hormone that’s converted inside the vaginal tissues into both oestrogen and androgen. This helps rebuild thickness, elasticity, and natural lubrication. In some NHS areas, prasterone is available if vaginal oestrogen or non-hormonal treatments haven’t been effective. It’s worth asking your GP or menopause specialist if this could be right for you.
Why it matters
GSM doesn’t just affect your body — it can influence intimacy, confidence, and everyday comfort. It’s common, but it’s not something you have to accept as “just part of menopause.”
From non-hormonal lubricants and moisturisers, to over-the-counter treatments like Gina®, to prescription options including Imvaggis® and prasterone, there are safe and effective solutions out there. The key is finding the right one for you.
If you’re struggling, don’t wait. Speak to your GP or a menopause specialist. Getting treatment can stop symptoms from progressing and help you feel like yourself again.
FAQ
-
GSM is the name for vaginal and urinary symptoms that occur after menopause due to low oestrogen levels. It can include dryness, irritation, burning, painful sex, and urinary frequency or infections.
-
Yes — more than half of postmenopausal women experience it. But “common” doesn’t mean you have to live with it. There are effective treatments that can restore comfort and improve quality of life.
-
Lubricants like Sylk® and Yes® can make sex more comfortable. Vaginal moisturisers such as Replens® and Yes VM are used regularly to hydrate tissues and relieve daily dryness.
-
Local oestrogen therapies include creams (like Ovestin® or Ovesse®), vaginal tablets (Vagifem®, Gina®), gels (Blissel®), pessaries (Imvaggis®), and the Estring® vaginal ring. Gina® is now available to buy over the counter without a prescription.
-
If symptoms persist, you may be offered prasterone (DHEA) vaginal pessaries on the NHS in some areas. These are especially helpful if oestrogen, lubricants, or moisturisers haven’t worked or aren’t tolerated.
-
Yes. Strengthening the pelvic floor improves blood flow, bladder control, and vaginal comfort. A women’s health physiotherapist, such as Claire Fitzpatrick at Fitz & Physio, can guide you through exercises tailored to your needs.
-
Yes. Because the dose is so low and stays mainly in the vaginal tissues, it does not require progestogen protection and is considered safe for long-term use. Always discuss your individual risks with your doctor.