Victara x Pause Health
In our previous article (see link here), we explored what Genitourinary Syndrome of Menopause (GSM) is, why it happens, and why it’s not simply something you have to accept as you age. GSM can affect vaginal, urinary, and sexual health when estrogen and androgen levels decline—and it can occur not only during menopause, but also with breastfeeding, certain hormonal contraceptives, and some medical treatments.
The good news? GSM is common, treatable, and there are several evidence-based options available.
So, what does treatment actually look like? Let’s take a closer look at the options we consider and how we determine what may be right for you.
How we actually treat it?
Treatment for GSM is individualized and depends on your symptoms, medical history, treatment goals, and personal preferences.
The good news? We have safe and effective options that address the underlying tissue changes—not just the symptoms.
For moderate to severe GSM, the most effective and best-studied treatment options are local vaginal hormone therapies.
Here’s what that actually looks like.
Vaginal Estrogen
Vaginal estrogen remains the gold-standard treatment for GSM.
It comes in several formulations, including creams (applied to the external vulvar and vaginal tissues), tablets or inserts (small dissolvable medications placed directly inside the vagina), and low-dose vaginal rings (worn continuously and replaced every three months).
All formulations work by delivering estrogen directly to the tissues that need it most.
Here’s something many patients are never told:
At these low doses, systemic absorption is minimal (Beste et al., 2025; Vaginal Estrogen Therapy for Treatment of Menopausal Genitourinary Syndrome, 2025).
That matters because it means vaginal estrogen can be an appropriate option for many people who are understandably cautious about hormones, including some individuals with a history of breast cancer.
Research, including studies involving breast cancer survivors and those taking aromatase inhibitors, has generally been reassuring and has not demonstrated an increased risk of recurrence or mortality (American Urological Association News, 2024; Beste et al., 2025). However, treatment decisions should always be individualized and made in collaboration with your healthcare team, particularly your oncology team when appropriate.
The goal isn’t to give everyone hormones. The goal is to understand your symptoms, your risks, and your goals, then choose the treatment that makes the most sense for you.
Vaginal DHEA (Prasterone)
Vaginal DHEA (prasterone) is a nightly vaginal suppository containing DHEA, a precursor hormone.
Once inside the vaginal tissue, your own cells convert DHEA locally into small amounts of estrogen and testosterone where they’re needed, a process called intracrinology. Importantly, this occurs without significantly increasing hormone levels in the bloodstream (New Possibilities for Hormonal Vaginal Treatment, 2023).
Prasterone is Health Canada approved specifically for the treatment of painful intercourse related to GSM. Emerging research suggests it may also be a reasonable option for some breast cancer survivors, including those taking aromatase inhibitors, although individualized discussion with your healthcare team is important (Vaginal DHEA in the Management of Genitourinary Syndrome of Menopause, 2021).
Vaginal Testosterone
Vaginal testosterone is an emerging area of research.
The vulva, vestibule, and vaginal tissues all contain androgen receptors, so biologically, the concept makes sense. Small studies, including those using compounded vaginal testosterone, have shown potential benefits for symptoms such as pain with orgasm and aspects of sexual function (International Society for the Study of Women’s Sexual Health [ISSWSH], 2018).
However, the evidence is still evolving. Larger reviews have not consistently demonstrated benefit across all GSM symptoms, and we do not yet have the same level of evidence that exists for vaginal estrogen and DHEA (Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause, 2024).
One challenge in Canada is that we do not currently have a commercially available testosterone product specifically designed for women. The available male formulations are alcohol-based and are not appropriate for genital application, meaning we often rely on compounded preparations that may have more variability in dosing.
For select patients, vaginal testosterone may be a reasonable option to discuss, particularly when estrogen or DHEA have not fully addressed symptoms. However, it is not currently considered a first-line, guideline-supported treatment.
Non-Hormonal Options
Vaginal moisturizers, lubricants and energy based services such as EMFEMME 360 absolutely still have a role.
They can be helpful for mild symptoms, as an addition to hormonal therapy, or for individuals who prefer to avoid hormones entirely.
However, for moderate to severe GSM, they do not address the underlying hormonal changes affecting the tissue. They are often best used as part of a broader treatment plan rather than as a replacement for therapies that restore the tissue environment.
If symptoms don’t fully improve with appropriate GSM treatment, it’s important to consider overlapping conditions such as vulvodynia, pelvic floor dysfunction, or interstitial cystitis, which can coexist with or mimic GSM.
The Bottom Line
Genitourinary Syndrome of Menopause is common. It’s treatable. And despite its name, it is not exclusively a menopause diagnosis.
Whether your symptoms are related to menopause, breastfeeding, hormonal contraception, or another medical treatment that affects hormone levels, the tissue changes are real—and they often respond to targeted treatment.
It’s time to retire the silent suffering.
The “I guess this is just how it is.”
The assumption that painful sex, vaginal dryness, urinary symptoms, or recurrent UTIs are simply something you have to accept.
And the fifth course of antibiotics for a “UTI” that was never actually the underlying problem.
You deserve to be heard. You deserve to have your symptoms taken seriously. And you deserve a treatment plan that considers your unique symptoms, goals, and preferences.
Because feeling better isn’t about returning to some version of your “old self.”
It’s about understanding what is happening in your body and having access to evidence-based options that help you feel and function at your best.
This article is intended for general education and is not a substitute for individualized medical advice. If any of these symptoms sound familiar, book a visit so we can understand what’s actually going on and build a treatment plan together.
References
American Urological Association. (2025, April 30). New guidelines for managing genitourinary syndrome of menopause. AUA Daily News. https://www.auadailynews.org/previews/article/22938595/new-guidelines-for-managing-genitourinary-syndrome-of-menopause
American Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, & American Urogynecologic Society. (2025). Genitourinary syndrome of menopause: AUA/SUFU/AUGS guideline. American Urological Association. https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
American Urological Association News. (2024, June). Vaginal estrogen safety for genitourinary syndrome of menopause in breast cancer survivors. https://auanews.net/issues/articles/2024/june-extra-2024/vaginal-estrogen-safety-for-genitourinary-syndrome-of-menopause-in-breast-cancer-survivors
Beste, M. E., Kaunitz, A. M., & McKinney, J. A. (2025). Vaginal estrogen use in breast cancer survivors: A systematic review and meta-analysis of recurrence and mortality risks. American Journal of Obstetrics & Gynecology, 232(3), 262.e1–270.e1. https://www.ajog.org/article/S0002-9378(24)01126-8/abstract
Hormonal contraception and vulvodynia: An update. (2021). GREM Journal, (3). https://gremjournal.com/journal/03-2021/hormonal-contraception-and-vulvodynia-an-update/
Hormonal treatments and vaginal moisturizers for genitourinary syndrome of menopause: A systematic review. (2024). Annals of Internal Medicine, 177(10). https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610
International Society for the Study of Women’s Sexual Health. (2018). The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): ISSWSH expert consensus panel review. https://pubmed.ncbi.nlm.nih.gov/29870471/
Joy Women’s Health. (2021). Vulvovaginal disorders: An algorithm for basic adult diagnosis and treatment. https://joywomenshealth.com.au/wp-content/uploads/2021/08/vaginal_atrophy.pdf
New possibilities for hormonal vaginal treatment in menopausal women. (2023). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10380877/
Vaginal DHEA in the management of genitourinary syndrome of menopause: A Swiss consensus. (2021). Climacteric. https://www.tandfonline.com/doi/full/10.1080/13697137.2021.2008894
Vaginal estrogen therapy for treatment of menopausal genitourinary syndrome among breast cancer survivors: A systematic review and meta-analysis. (2025). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12266873/