Genitourinary Syndrome of Menopause (GSM) is the new medical term for what was previously called 'vaginal atrophy' or 'atrophic vaginitis'. The name was changed because the condition affects the entire genitourinary tract, not just the vagina.

How common is it?

GSM affects approximately 50% of postmenopausal women. However, less than 25% of those affected discuss it with their doctor — often because of embarrassment or the mistaken belief that nothing can be done.

Latest microbiome research (2026):

A systematic review in Maturitas (23 studies, 5,027 participants) confirmed that the postmenopausal microbiome is characterized by reduced Lactobacillus and increased microbial diversity. Key findings:

  • SWAN cohort (n=1,320): sexual pain independently associated with CST IV-C1 microbiome profile (OR 2.26, 95% CI 1.20-4.23)
  • Prevotella associated with urinary symptoms, Finegoldia magna with recurrent UTIs, Streptococcus with sexual pain
  • Parallel Lactobacillus depletion across vaginal, urinary, and gut compartments suggests a vaginal-bladder-gut axis ('estrobolome' disruption)
  • Estrogen therapy partially restored Lactobacillus dominance but did NOT uniformly improve symptoms — microbiome restoration alone does not predict symptom resolution

The Menopause Society recommends:

  • Low-dose vaginal estrogen (cream, tablet, or ring) — first-line; minimal systemic absorption, very safe. Applied locally to the vulva and vagina, it relieves vaginal dryness and sexual pain caused by GSM
  • Ospemifene (oral SERM) — approved to treat GSM
  • Vaginal moisturizers — use 2-3 times/week
  • Lubricants (water- or silicone-based) — for intercourse
  • Regular sexual activity after menopause stimulates blood flow and maintains vaginal tissue health
  • Postmenopausal women are especially vulnerable to STIs because fragile vulvar tissues allow viruses to enter more easily

⚠️ GSM is chronic — symptoms return if treatment stops. Vaginal estrogen has the best evidence-to-risk ratio of any menopause treatment. Safe even for most breast cancer survivors after discussion with oncologist.