*Content reviewed by HotPause Health  Medical Advisor and OBGYN, Dr. Beverly Joyce.

How to Treat Genitourinary Syndrome of Menopause (GSM)

If you’ve ever experienced vaginal dryness, painful sex, recurrent UTIs, or that all-too-familiar urgency to pee, you’re not alone—and you’re not imagining things. These are hallmark symptoms of Genitourinary Syndrome of Menopause (GSM), a condition that affects up to 87% of postmenopausal individuals yet remains widely underdiagnosed and undertreated.

But a new clinical guideline just released by the American Urological Association (AUA) could mark a turning point in how GSM is understood and managed. This evidence-based update outlines how to properly identify, diagnose, and treat GSM—with a firm emphasis on shared decision-making and patient empowerment.

Here’s what the new guidance means for you:

Diagnosis Is Symptom-Based—Not Lab-Based

One of the most important changes? Hormone levels are no longer needed to diagnose GSM. Instead, diagnosis should be based on what you report—symptoms like:

• Vaginal dryness or irritation
  
• Pain during sex (dyspareunia)
  
• Urinary symptoms (urgency, dysuria, or recurrent UTIs)
  

A physical exam may support the diagnosis (e.g., signs of tissue thinning or pH changes), but it’s not required. However, if symptoms do not improve with treatment, an exam is recommended to rule out other conditions.

Translation: If you’re feeling symptoms, your voice matters. You shouldn’t need a lab test to prove it.

Shared Decision-Making Is the Standard

The guideline puts shared decision-making front and center. Your doctor should listen to your concerns, assess your history, and involve you in choosing the right treatment approach based on your goals, values, and lifestyle.

This may include referrals to:

• Pelvic floor physical therapy (especially if you have pain or pelvic dysfunction)
  
• Sex therapy (if intimacy or emotional well-being is affected)
  

GSM First-Line Therapy: Local Vaginal Estrogen

Low-dose vaginal estrogen remains the go-to treatment for most GSM symptoms. Whether delivered as a cream, tablet, ring, or insert, it’s effective in relieving dryness, irritation, and painful sex—and is considered safe, even for long-term use. (Even in breast cancer survivors in most cases!)

Notably, local estrogen also reduces the risk of recurrent UTIs. That’s a big deal for women constantly battling infections post-menopause.

Other treatment options include:

• Vaginal DHEA: A hormone therapy that can improve dryness and sexual discomfort
  
• Ospemifene (oral): A non-estrogen option (a Selective Estrogen Receptor Modulator) for those who prefer pills—though it carries a conditional recommendation due to more limited data
  

What About Non-Hormonal Options To Treat GSM?

Yes, you have choices. Moisturizers and lubricants are strongly recommended—either alone or as add-ons to other therapies. But the guideline makes it clear:

• Skip the vaginal “rejuvenation” lasers—no strong evidence supports them
  
• Avoid irritants or cleansers that can worsen symptoms
  
• Be wary of supplements; most don’t hold up to scrutiny
  

GSM Is A Chronic Condition – Expect Ongoing Care

Just like other chronic conditions, GSM often requires long-term management. Treatments may need to continue indefinitely for symptoms to stay under control. Your doctor should reevaluate regularly to make sure your plan is working and evolve it as needed.

The Bottom Line

These new guidelines send a clear message: GSM is real. It’s treatable. And you deserve care that reflects the latest science—not outdated assumptions. If you’ve been dismissed or told to “just use lube” without a deeper conversation about what you’re going through, it’s time for better. Because menopause shouldn’t mean suffering in silence. Find a doctor who can help you today!