Vaginal Dryness, Recurrent UTIs, and Urinary Urgency: Genitourinary Syndrome of Menopause (GSM)

Genitourinary Syndrome of Menopause (GSM) doesn’t only happen after menopause. In this episode of Phase to Phase: The Hormone Health Show, Naturopathic Doctor Anne Hussain tackles this common yet under-discussed condition. Vaginal dryness, vulvovaginal irritation, painful intimacy, recurrent UTIs, and running to the washroom because you can’t hold your pee can all be part of GSM. They can begin during perimenopause due to fluctuating and declining estrogen levels.

She breaks down the physiological connection between the vulvovaginal tract, pelvic floor, and urinary system, clarifies the difference between daily non-hormonal vulvovaginal moisturizers and lubricants, outlines why low-dose local vaginal estrogen is considered the gold-standard prescription treatment, and highlights the essential role of pelvic health physiotherapy. Let’s stop normalizing pain and leakage to explore evidence-based treatment options that you can bring up with your medical team. 

Key Takeaways

• GSM starts in perimenopause, not just after menopause. It's driven by declining estrogen receptors across the vulva, vagina, pelvic floor, and urinary tract. As estrogen declines, the tissue can become tighter, drier, and more fragile. Irritation, pain, dryness, and recurrent UTIs can all be part of GSM.

• Recurrent UTIs and urgency can happen with GSM as estrogen decline. The vaginal tract and urinary system share the same environment, and falling estrogen alters the local microbiome and thins urethral tissue. This shift leaves you more vulnerable to UTIs, burning, frequency, and incontinence (leakage). Instead of countless rounds of antibiotics, treatment for GSM can be helpful.

• Vaginal moisturizers and lubricants serve different purposes. Lube is used as needed to reduce friction. Non-hormonal vaginal moisturizers often contain hyaluronic acid and are used regularly to increase moisture and soothe daily irritation.

• Low-dose vaginal estrogen is the gold standard treatment. Prescription low-dose local vaginal estrogen (creams, inserts, or rings) acts directly on the target tissues with minimal systemic absorption. It rebuilds tissue strength, eliminates micro-tears, and reduces recurrent UTIs. Vaginal DHEA is also an option for this purpose.

• GSM tends to worsen over time without treatment. Unlike hot flashes, which may eventually subside, GSM often progresses if left untreated. Early intervention improves your symptoms and life.

• Pelvic health physiotherapy is also important for GSM. Pelvic health physios provide gentle internal evaluations to assess muscle tone, strength, and tension. They can really help with painful sex, urinary urgency, and incontinence by correcting habits like "peeing just in case" or chronic abdominal bracing.

Chapters

00:00 Impacts of GSM

2:38 GSM symptoms and relationship with estrogen

5:58 GSM in perimenopause

7:44 Vaginal moisturizer and lubricant

9:30 Vaginal estrogen and DHEA

13:16 Non-hormonal GSM options

Resources and References

The Menopause Society. MenoNote: Genitourinary Syndrome of Menopause, 2025. 

Canadian Menopause Society. Menopausal Hormone Therapy (MHT) Products in Canada, 2025. 

Zuo et al. 2026. PMID: 42492951 

Blog post: Vaginal Dryness, Vulvovaginal Health, GSM, and Recurrent UTIs

Blog post: Where Did My Libido Go? Vaginal Dryness, Desire, and Intimacy

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