Understanding Vaginal Atrophy (Genitourinary Syndrome of Menopause): A Common but Overlooked Problem

This medical blog explains vaginal atrophy now know as Genitourinary Syndrome of Menopause ( a new term), why it’s common, and how it leads to problems from irritation to UTIs and—even in rare cases—sepsis.

If you have any questions you can leave a comment below.

Treating this early with oestrogen creams of HRT patches can make a huge difference

Vaginal atrophy is one of the most common yet least talked-about health issues affecting women in midlife and beyond. Today, clinicians often use the term Genitourinary Syndrome of Menopause (GSM) because the condition affects far more than just the vagina. It can involve the vulva, bladder, urethra, and the surrounding tissues. Despite how widespread it is, many women suffer in silence, believing the symptoms are simply an unavoidable part of aging.

Here’s what you need to know—why it happens, what problems it causes, and why awareness and treatment matter.

What Is Vaginal Atrophy / GSM?

Vaginal atrophy happens when the body’s estrogen levels fall, usually during and after menopause. Estrogen isn’t just a “period hormone”—it plays a major role in keeping the tissues of the vagina and urinary tract healthy. When estrogen levels drop, these tissues become thinner, drier, and less elastic. Blood flow decreases. Natural lubrication reduces. The vaginal pH changes, allowing different kinds of bacteria to thrive.

The British Menopause Society gives a clear summary of what's happening:

“Genitourinary Syndrome of Menopause (GSM) … is a chronic and progressive condition due to estrogen deficiency, most commonly associated with the menopause. There is a potential negative impact on all urogenital tissue quality including the vulva, vagina, bladder and urethra. Symptoms may not become apparent for several years after the menopause and therefore any association is lost, with women accepting symptoms as a normal part of the aging process. There may be reluctance to discuss symptoms with a clinician, and this is likely to be linked with under diagnosis and under treatment. GSM has been described as a silent epidemic with lack of awareness affecting an accurate diagnosis and access to treatment.”

This quote highlights two key problems: the symptoms can creep in slowly, and many women don’t talk about them—even though effective treatments exist.

Why Is It So Common?

GSM is extremely common, affecting more than half of postmenopausal women. There are a few reasons why:

1. OEstrogen levels drop sharply during menopause

This is the main trigger. Without estrogen, the tissues of the urogenital area gradually lose strength, thickness, and moisture.

2. It progresses slowly

Symptoms may not start immediately after menopause. They can show up years later, which makes it harder for women to recognise the connection.

3. Women may feel embarrassed to bring it up

Topics like vaginal dryness, discomfort during sex, or urinary issues can feel personal. Many women assume it’s just “what happens with age,” so they don’t mention it to a clinician.

4. Lack of awareness

Despite being so common, GSM isn’t talked about nearly enough. This leads to underdiagnosis and under-treatment.

What Symptoms Can Vaginal Atrophy Cause?

GSM affects both vaginal and urinary tissues. Symptoms can vary, but many women experience a mix of the following:

Vaginal Symptoms

Dryness
Burning or irritation
Pain during sex (dyspareunia)
Light bleeding after intercourse
Itching
Reduced elasticity or tightening (“the vagina feels smaller”)

Urinary Symptoms

Because the bladder and urethra also depend on estrogen, GSM commonly affects urinary health too. This is a part many women don’t realise is connected.

Common urinary symptoms include:

Needing to urinate more often
Urgency (sudden strong urges)
Burning during urination
Recurrent urinary tract infections (UTIs)
Stress incontinence (leaking when coughing or exercising)

How GSM Leads to UTIs and, in Rare Cases, Sepsis

Many women are surprised to learn that vaginal atrophy is a major cause of recurrent UTIs after menopause.

Why does this happen?

When estrogen levels fall:

The natural acidity of the vagina changes.
“Good” bacteria (like lactobacilli) decrease.
“Bad” bacteria grow more easily.
The urethra becomes thinner and more fragile.
The bladder lining becomes more vulnerable to infection.

Combined, these changes make it easier for bacteria to travel up the urinary tract and cause infections.

Why some women get repeated UTIs

Some women find themselves trapped in a cycle—an infection improves with antibiotics but returns soon after. Unless the underlying estrogen loss is addressed, the tissues remain delicate, and the infection risk stays high.

Can it lead to sepsis?

Yes—although rare, any untreated or severe UTI can progress to a kidney infection and, in some cases, lead to sepsis. Sepsis is a life-threatening response to infection. This is why it’s so important not to ignore repeated UTIs, pelvic pain, fever, or feeling suddenly very unwell.

The link between GSM and serious urinary infections is one of the strongest reasons to raise awareness. Proper diagnosis and treatment can prevent unnecessary suffering and reduce antibiotic use.

Why So Many Women Go Undiagnosed

Despite being common, GSM often goes unrecognised for years. Reasons include:

1. Symptoms sneak up slowly

A woman may only notice a small amount of dryness or irritation at first. Over time it gets worse, but gradually enough that it doesn’t feel like a medical issue.

2. Women assume it’s “just aging”

Because GSM isn’t widely talked about, many assume it’s something they have to put up with.

3. There’s embarrassment

Talking about intimacy or urinary symptoms can feel awkward. Many women stay quiet even though clinicians are used to discussing these issues.

4. Lack of routine education

Menopause discussions often focus on hot flushes and mood changes, not the long-term impact on vaginal and urinary health.

The Good News: GSM Is Treatable

One of the most important messages for women is this: You don’t have to live with these symptoms. GSM is treatable, and treatment can dramatically improve quality of life.

Common treatments include:

1. Vaginal Oestrogen (local Oestrogen therapies)

This is the best-known and most effective treatment. It delivers a tiny dose of estrogen directly to the vaginal tissues.

Benefits:

Restores moisture
Thickens and strengthens tissues
Reduces UTIs
Improves comfort during sex
Reverses changes over time

Because the dose is very low and stays local, it’s considered safe for most women, even long-term.

2. Non-hormonal moisturisers and lubricants

These can help with dryness and irritation, though they don’t treat the underlying cause.

3. Newer therapies

As the British Menopause Society notes, “newer drugs and interventions are now available.” These may include medications like ospemifene or laser-based treatments in some countries.

4. Pelvic floor therapy

Useful if GSM symptoms have affected bladder control or muscle tone.

When to See a Clinician

If you are experiencing:

Recurrent UTIs
Vaginal dryness, burning, or pain
Pain during sex
Sudden urinary urgency or frequency
Bleeding after intercourse
Unusual discharge
Any symptoms that affect daily life or intimacy

…then it is absolutely worth discussing this with a clinician. These symptoms are not something you need to put up with, and treatment can make a profound difference.

Final Thoughts

Vaginal atrophy or Genitourinary Syndrome of Menopause is extremely common, highly treatable, and greatly under-recognised. Too many women suffer in silence—sometimes for years—because they believe these changes are an inevitable part of aging. They’re not. With the right understanding and treatment, women can regain comfort, sexual wellbeing, and urinary health.

The first step is awareness. The second is starting the conversation—because no one should have to face these symptoms alone or untreated.

why do I get Vaginal dryness and urine infections during the Menopause?