Let’s Talk About Vaginal Dryness (Yep, We’re Going There)

by Dr. Mary Knudsen ND

Hot flashes and mood swings tend to steal the spotlight during menopause, but there’s another major player that doesn’t get talked about enough: Genitourinary Syndrome of Menopause, or GSM.

If you’ve noticed things feeling… different down there—think dryness, burning, frequent UTIs, or pain during sex—you’re not alone. And more importantly, you’re not stuck with it.

Let’s break the silence around vaginal and urinary changes and talk about what GSM actually is, why it happens, and how you can take your comfort back.

So, What Is GSM?

GSM is the name for a cluster of symptoms that affect your vaginal and urinary health during menopause. As estrogen levels drop, the tissues in that area can become thinner, drier, and less elastic. Cue the discomfort.

Common symptoms include:

• Vaginal dryness and irritation

• Pain or discomfort during sex

• A frequent or urgent need to pee

• An increased risk of UTIs and vaginal infections like BV (bacterial vaginosis) that can increase odor

It’s extremely common—but often underdiagnosed and under-discussed. Time to change that.

Why GSM Happens

Estrogen isn’t just for periods and pregnancy. It also keeps the vaginal and urinary tissues healthy and hydrated. When estrogen levels decline (hello, menopause), those tissues start to change—and not in a fun way.

This is what causes the burning, itching, dryness, and even the bladder changes that so many women chalk up to “just getting older.” But here’s the truth: you don’t have to just live with it.

Real Relief: How to Manage GSM

You’ve got options—real, effective ones that can bring you relief and help you feel like yourself again.

Hormonal Treatments

• Vaginal Estrogen (cream, tablet, or ring): Delivers estrogen directly to the tissues that need it most, helping restore moisture and elasticity.

• Systemic Hormone Therapy: For those dealing with hot flashes or mood swings as well, this whole-body option can be a game-changer.

Non-Hormonal Solutions

• Vaginal Moisturizers + Lubricants: Think daily hydration and smoother sex. Moisturizers help maintain comfort, while lubricants are your best friend in the bedroom.

• Ospemifene: A non-hormonal prescription that improves vaginal tissue health and comfort.

• Pelvic Floor Exercises: These simple exercises can help with bladder control and even improve sensation.

Lifestyle Tweaks

• Hydrate: Drink plenty of water to support overall tissue health and bladder function.

• Ditch the Irritants: Skip scented soaps, synthetic underwear, and tight clothes that trap moisture.

• Eat for Hormone Health: A diet rich in fiber, healthy fats, and antioxidants supports your body’s natural hormone detox and balance.

Stress Less (Seriously)

Stress makes everything worse—including your hormones. Incorporate yoga, breathwork, or journaling into your routine to calm your nervous system and support healing.

When to Call in the Pros

If any of this sounds familiar, talk to your healthcare provider (preferably one who gets menopause). There are so many options available, and they can help you find the one that fits your body and your comfort level best.

You deserve answers—and relief.

The Take-Home Message: You Don’t Have to “Tough It Out”

Vaginal dryness, pain with sex, and bladder issues are not “just part of aging.” They’re symptoms of hormonal shifts—and they’re treatable.

Your comfort, pleasure, and health still matter. So let’s stop suffering in silence and start owning our menopause journey, one empowered decision at a time.