Hot flashes get all the attention. But there's another set of midlife changes that almost no one talks about at the dinner table, even though it's incredibly common: dryness, burning, discomfort with sex, and new urinary symptoms like urgency or repeat UTIs. There's a name for the whole cluster now, and naming it is the first step to feeling less alone with it.
What is GSM (genitourinary syndrome of menopause)?
It's called genitourinary syndrome of menopause, or GSM. In 2014 a group of experts (including the organization now known as The Menopause Society) adopted the term to replace the older, narrower phrase "vaginal atrophy." The new name reflects reality: as estrogen declines, the tissues of the vulva, vagina, and lower urinary tract all change together. So this isn't only about sex. It's also about why you might suddenly feel like you need to pee constantly, or keep getting urinary tract infections you never used to get.
First, let's say the quiet part out loud: this is normal, it's not your fault, and it's not something you "just have to live with." GSM affects a large share of women after menopause, and unlike hot flashes, it tends to be progressive rather than fading on its own. It also tends to go unmentioned. Surveys consistently show most women never bring it up with a clinician, often out of embarrassment or the assumption that nothing can be done. Plenty can be done.
Symptoms of GSM
Here's what GSM can look like:
- Vaginal dryness, itching, or a raw or burning feeling
- Pain or discomfort with sex (the medical term is dyspareunia)
- Light spotting after intercourse
- Urinary urgency, frequency, or discomfort
- Recurrent urinary tract infections
A quick word on us, since it matters here: Menova sells no hormones and is not a medical provider. We don't prescribe, diagnose, or have a product to push on you. Our only goal is to help you walk into a clinician's office knowing the right questions to ask.
So let's talk options, starting with the non-hormonal ones that many women reach for first.
Non-hormonal relief: moisturizers vs. lubricants
Vaginal moisturizers and lubricants are different tools, and the distinction is worth knowing. Lubricants are used in the moment, during sex, to reduce friction and pain; they're short-acting and come in water-, silicone-, or oil-based versions. Moisturizers work differently: they cling to the vaginal tissue to help it hold moisture and are used on a regular schedule, often every one to three days, whether or not you're having sex. Mayo Clinic and Cleveland Clinic both describe these as reasonable first-line, over-the-counter steps for milder symptoms. Some products use hyaluronic acid, a moisture-binding ingredient, as a non-hormonal moisturizing option. If one product irritates you, it's fine to try another; ingredient sensitivity varies a lot from person to person.
Local vaginal estrogen is not systemic HRT
Now for a point of confusion that trips up a lot of smart women: local vaginal estrogen is not the same thing as systemic hormone therapy (HRT). This is a big deal, so it's worth slowing down on.
When people say they're "avoiding hormones," they're usually thinking of systemic HRT (pills or patches) that raises estrogen levels throughout the body. Local vaginal estrogen is a low-dose product (a cream, tablet, insert, or ring) applied right where the symptoms are. Multiple sources, including The Menopause Society and the 2025 AUA/SUFU/AUGS guideline on GSM, note that it works locally with minimal absorption into the bloodstream, so circulating estrogen stays in the normal postmenopausal range. The guideline calls local low-dose vaginal estrogen the option with the most robust evidence for GSM symptoms, and there's compelling evidence it can also help prevent recurrent UTIs in postmenopausal women.
The regulatory picture recently shifted, too. In November 2025, the FDA announced it was removing the long-standing boxed warning from low-dose vaginal estrogen products. That warning had been based largely on older studies of systemic hormones, not these local low-dose forms, and experts had argued for years that it discouraged a safe, effective treatment. The Menopause Society publicly agreed with the FDA's decision. (Harvard Health and the FDA both covered the change.)
None of this means local vaginal estrogen is automatically right for you. Whether it's appropriate, especially with a personal history of certain cancers, is a conversation for you and a licensed clinician. There are also other prescription routes, like vaginal DHEA inserts and an oral medication called ospemifene, both FDA-approved for painful sex due to GSM. The point isn't to crown a winner; it's to know the menu exists.
If symptoms are nagging at you, it may help to spend two minutes with Menova's free self-check to organize what you're noticing before an appointment. Then bring it up. You deserve a clinician who treats this as the common, treatable thing it is.
The Menopause Society · AUA/SUFU/AUGS 2025 Guideline · Harvard Health · Mayo Clinic
Some non-hormonal products many women find helpful for day-to-day comfort (these are Amazon affiliate links — Menova may earn a small commission at no extra cost to you; we sell no hormones and suggest these as comfort options, not medical treatment):
This article is general education, not medical advice. It is not a diagnosis and not a recommendation of any specific drug or dose for you. Please talk with a licensed clinician about your symptoms and what options make sense for your health history.