Victara x Pause Health
Let’s talk about the symptoms that nobody brings up at their annual physical. The vaginal dryness. The burning. Leaking urine every time you sneeze. Painful sex. Recurrent urinary tract infections.
Here’s the part that surprises most people: many women don’t even make the connection that these symptoms might be related to their hormones. Why would they? Nobody told them. And, to be fair, many healthcare providers weren’t taught much about this either.
Vaginal and urinary symptoms have long been treated as something we simply don’t talk about. They’re considered private, embarrassing, or shameful, so we stay quiet. Women assume it’s just part of getting older, something that happens after having a baby, or that pain is simply part of having sex. Grin and bear it. It’s “normal.” It’s “just aging.” A reassuring pat on the back, and onto the next patient.
Or maybe you’re treated for UTI after UTI after UTI with antibiotics that never seem to solve the problem, until someone finally pauses and asks, “Wait… could something else be going on here?”
That “something else” has a name: Genitourinary Syndrome of Menopause (GSM).
The good news? GSM is one of the most treatable conditions I see in practice.
Once you understand what it is and how effectively it can often be treated, you’ll probably find yourself saying, “I wish someone had told me this sooner.”
And if you’re reading this thinking, “I’m not even in menopause,” keep reading. That’s exactly the point.
So what is GSM, actually?
Genitourinary Syndrome of Menopause (GSM) is the umbrella term used to describe the vaginal, vulvar, urinary, and sexual changes that occur when estrogen and androgen levels decline in the tissues of the lower genitourinary tract.
The tissues of the vagina, vulva, bladder, and urethra are rich in estrogen and androgen receptors. When hormone levels decline—whether during perimenopause and menopause, breastfeeding, hormonal contraceptive use, or certain medical treatments—these tissues begin to change.
The vaginal lining becomes thinner, drier, and less elastic. The vaginal pH becomes less acidic, making it easier for bacteria associated with urinary tract infections to thrive. Blood flow and natural lubrication decrease, and the tissues become more fragile and sensitive (American Urological Association [AUA], Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction [SUFU], & American Urogynecologic Society [AUGS], 2025). These changes can contribute to a wide range of symptoms, including:
- Vaginal dryness
- Burning or irritation
- Pain during intercourse
- Decreased lubrication
- Urinary urgency or frequency
- Recurrent urinary tract infections
- Bladder irritation
- Pain with urination despite negative urine cultures
- Decreased sexual function
And it’s common.
An estimated 50–70% of women experience GSM after menopause to some degree, yet it remains consistently underdiagnosed and undertreated (American Urological Association [AUA], 2025). While it’s incredibly common, it’s important to remember that common does not mean normal, and it certainly doesn’t mean you have to live with it.
One of the biggest takeaways from the 2025 guideline is that GSM is a clinical diagnosis. In other words, we don’t diagnose it with hormone bloodwork. We diagnose it by listening to your symptoms, understanding your medical history, and performing an examination when appropriate (AUA, SUFU, & AUGS, 2025).
What’s New: The 2025 Guideline
For years, there wasn’t a single, evidence-based approach to diagnosing and treating GSM. No playbook or guidelines. There was no consensus on which symptoms were needed to make the diagnosis, and many of the urinary symptoms overlap with other common conditions, like overactive bladder. It’s easy to see why so many women bounced between healthcare providers without clear answers.
The new joint guideline from the American Urological Association (AUA), the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), and the American Urogynecologic Society (AUGS)—endorsed by The Menopause Society, the International Society for the Study of Women’s Sexual Health (ISSWSH), and the Sexual Medicine Society of North America (SMSNA)—changes that.
The guideline provides clinicians with a consistent, evidence-based framework for diagnosing and managing GSM while emphasizing shared decision-making (AUA, SUFU, & AUGS, 2025). In other words, your symptoms, your goals, and your preferences should all be part of deciding on the right treatment plan.
It also reinforces that despite its name, GSM isn’t exclusively a menopause diagnosis.
The guideline recognizes that the same constellation of symptoms and physical changes can occur whenever estrogen and androgen exposure declines, whether that’s during menopause, breastfeeding, hormonal contraceptive use, or as a result of medical treatments that suppress hormone production (AUA, SUFU, & AUGS, 2025).
That shift in thinking matters. It means more people can be recognized, validated, and treated appropriately instead of being told they’re “too young” for these symptoms or that it’s “just part of getting older.”
Plot Twist: It’s not always menopause
Despite the name, Genitourinary Syndrome of Menopause isn’t exclusively a menopausal condition.
This is probably my biggest frustration with the name itself. It implies that these symptoms only happen during menopause, when in reality the same constellation of symptoms can occur anytime someone experiences a meaningful decline in estrogen and androgen exposure.
Breastfeeding
Many women develop GSM-like symptoms while breastfeeding because of the normal hormonal changes that support milk production. During lactation, prolactin levels rise while estrogen levels remain low, temporarily suppressing the body’s natural estrogen production (Joy Women’s Health, 2021).
The result? Vaginal dryness. Burning. Pain with intercourse. Bladder irritation. Sound familiar?
For many women, these symptoms improve once breastfeeding tapers and hormone levels recover. But that doesn’t mean you have to simply “wait it out.”
Because low-dose vaginal estrogen results in minimal systemic absorption, it is generally considered compatible with breastfeeding when clinically indicated (Beste et al., 2025; Vaginal Estrogen Therapy for Treatment of Menopausal Genitourinary Syndrome, 2025). If symptoms are affecting your quality of life, it’s worth having a conversation with your healthcare provider about whether treatment is appropriate for you.
Hormonal Birth Control
Certain hormonal contraceptives, particularly those that significantly suppress ovarian estrogen production, can produce tissue changes that closely resemble GSM.
Methods such as Depo-Provera and some continuous low-dose combined oral contraceptives have been associated with vaginal dryness, irritation, and painful intercourse (Joy Women’s Health, 2021). Research has also shown structural changes within the vulvar vestibule that may contribute to pain during sex in some individuals (Hormonal Contraception and Vulvodynia: An Update, 2021). Stopping the contraceptive isn’t always an immediate fix. The tissue changes can take time to recover, but targeted treatment can often help relieve symptoms while that healing occurs.
Other Medical Causes
GSM-like symptoms can also develop after medical treatments that intentionally suppress estrogen production, including:
- GnRH agonists (such as Lupron)
- Endocrine therapy for breast cancer
- Chemotherapy
- Pelvic radiation
- Certain selective estrogen receptor modulators (SERMs)
- Some medications used to treat endometriosis
Although the underlying reason for the hormone decline may be different, the changes happening within the vaginal and urinary tissues are remarkably similar—and so are the symptoms.
The Takeaway
If you’re in your 20s, 30s, or 40s and experiencing vaginal dryness, painful sex, bladder irritation, urinary symptoms, or recurrent UTIs, don’t let someone dismiss your concerns simply because you’re “too young” for menopause.
Your hormones may still be playing an important role, and these symptoms deserve a proper evaluation.
*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/
