Menopause changes many things — our energy, our sleep, even the way our skin and hair feel. But there’s one set of changes that doesn’t get talked about nearly enough: the shifts that causes vulvovaginal (VVA) changes. Doctors call it Genitourinary Syndrome of Menopause (GSM) — a long name for something very common. In fact, up to 60% of women after menopause experience symptoms like dryness, itching, irritation, burning, pain during intimacy, or even more frequent urinary tract infections. The surprising part? Most women never bring it up with their doctor.
If you’ve noticed changes in your vaginal or urinary health during or after menopause, you’re definitely not alone — and you don’t have to just live with it.
Why Does GSM Happen?
The biggest player here is estrogen. This hormone does more than regulate menstrual cycles; it helps keep vaginal tissue flexible, moist, and protected. When estrogen levels drop during and after menopause, those tissues thin out, lose elasticity, and produce less natural lubrication. It’s not just about age, either. Cancer treatments like chemotherapy or radiation, certain surgeries (such as hysterectomy or ovary removal), and even some medications can accelerate these changes. That’s why GSM isn’t limited to women in their 50s and 60s — it can affect younger women too.
What Are the Symptoms?
The changes of GSM can show up in different ways. Common symptoms include:
- Vaginal dryness, itching, or irritation
- Burning sensations
- Pain during sex (dyspareunia)
- Recurrent urinary tract infections (UTIs)
- Urgency or discomfort with urination
Here’s the important thing: these symptoms are chronic and progressive if untreated. That means they usually don’t just “go away” on their own.
A Menopause Issue: Why So Few Women Seek Help
In a large women’s health study, nearly two-thirds of postmenopausal women had physical signs of GSM, but only 10% reported symptoms — and only about 7% received treatment. Why? Many women feel embarrassed to bring it up, or assume it’s just “part of aging.” Others worry that their only option is hormone therapy, which not everyone is comfortable with. The truth is, GSM is extremely common — and there are safe, effective treatments that can make a huge difference.
Medical Treatment Options
For GSM, low-dose vaginal estrogen therapy is considered the most effective treatment. Unlike systemic hormone therapy (the kind taken by pill or patch), vaginal estrogen is delivered directly to the affected area in the form of creams, tablets, or suppositories. A progestogen isn’t usually needed with this low-dose treatment. Applying estrogen cream at the vaginal entrance can be especially helpful for pain with penetration. Because absorption into the bloodstream is minimal, these treatments are generally safe — even for breast cancer survivors, though consultation with an oncologist is always recommended.
It’s worth noting that GSM is different from hot flashes or night sweats, which may come and go. GSM tends to be ongoing, which is why treatment is so important for long-term comfort.
Natural and Self-Care Approaches
Not everyone wants to start with prescription options — and even if you do, combining medical treatment with self-care can maximize comfort. Here are a few approaches that can help:
Lubricants and Moisturizers
Over-the-counter vaginal lubricants and moisturizers can restore comfort and reduce irritation. Look for products that:
- Are free of parabens and fragrances
- Include lactic acid (to support healthy vaginal pH)
- May include natural ingredients like clary sage or caprylyl glycol, which help reduce infections and support hydration
Natural oils — like cocoa butter, olive, or grape seed — can provide temporary relief too, though keep in mind they can weaken latex condoms.
Probiotics and Phytoestrogens
Supporting your body from the inside out also helps. Foods and supplements with Lactobacillus probiotics can promote a healthy vaginal microbiome. Phytoestrogens — plant compounds found in soy, flax, red clover, or hops — may gently support hormone balance and reduce dryness.
Hydration
It sounds simple, but staying hydrated makes a real difference. Vaginal tissue, like skin, needs adequate moisture. Aim for plenty of water daily — and cut back on smoking and excessive caffeine, both of which can worsen dryness.
Lifestyle and Exercise
Pelvic floor exercises (like Kegels) improve circulation and muscle tone in the pelvic area. Pelvic floor yoga is another option. It is a form of yoga that focuses on strengthening and toning the pelvic floor muscles, which are located at the base of the pelvis and support the bladder, uterus, vagina, and rectum.
Avoid harsh soaps, douching, or scented products, which can irritate delicate tissue.
Gentle movement, stress reduction practices, and regular sexual activity (with or without a partner) all help keep vaginal tissue healthy and responsive.
What About Hormone Replacement Therapy (HRT)?
Systemic hormone replacement (taken by pill, patch, or injection) can help with dryness, but it’s not right for everyone. Women with certain health conditions — such as breast cancer, coronary artery disease, or a history of stroke — are typically advised against it. That’s why local therapies (low-dose vaginal estrogen) and non-hormonal remedies are often the safest, most effective place to start.
When to See a Doctor
Some symptoms are clear signals that it’s time to reach out:
- Persistent pain or dryness
- Bleeding after sex
- Any bleeding after menopause
- Unusual discharge, odor, or irritation
- Frequent urinary tract infections
Don’t ignore these changes. They aren’t just “a normal part of aging” — and treatment can help restore comfort, health, and quality of life.
Support for GSM and VVA
Genitourinary Syndrome of Menopause might sound like a mouthful, but what it really comes down to is this: menopause doesn’t have to mean discomfort. If you’re dealing with dryness, burning, pain during intimacy, or urinary changes, you’re not alone — and you don’t have to simply put up with it.
At Hawthorn Healing Arts, Dr. Stephanie Auerbach, ND, works with women to find solutions tailored to their needs — from low-dose estrogen therapies to natural, holistic approaches that support long-term vaginal and urinary health. Menopause is a transition, not a sentence. With the right support, you can move through it feeling comfortable, healthy, and confident in your own body.
Schedule a consultation with Dr. Auerbach today! Call 541-330-0334 or feel free to use our online appointment form.