Understanding Genitourinary Syndrome of Menopause (GSM)
By Dr. Miranda Hoskins, ND – Flow Functional Healthcare
Menopause marks a significant transition in a woman’s life — and while many expect hot flashes and mood changes, fewer conversations happen around the vaginal and urinary symptoms that also accompany this change. These issues are common, natural, and highly treatable, yet often go unspoken.
At Flow Functional Healthcare, we believe in breaking the silence around these changes to empower women with knowledge and support. Let’s dive into what you need to know.
What is Genitourinary Syndrome of Menopause (GSM)?
As estrogen levels decline during perimenopause and menopause, many women experience changes grouped under the term Genitourinary Syndrome of Menopause (GSM). One key feature of GSM is vulvovaginal atrophy — thinning and drying of the vaginal tissues — but GSM impacts more than just comfort.
Common symptoms include:
Vaginal dryness, irritation, and itching
Pain with intercourse (dyspareunia)
Increased frequency of urinary tract infections (UTIs) and vaginal infections
Frequent urination or urgency
Stress incontinence (leaking urine during physical activities)
Low libido and decreased sexual sensation
These symptoms result from a combination of lower estrogen levels affecting the vaginal tissue, urinary tract, pelvic floor muscles, and even mood.
Why These Symptoms Happen
Estrogen plays a critical role in maintaining the health of vaginal and urinary tissues, supporting the bladder, and helping maintain a protective vaginal microbiome. When estrogen drops:
Tissues become thinner, less lubricated, and more fragile
The microbiome shifts, increasing infection risk
The pelvic floor weakens, leading to urinary symptoms
Libido and sexual satisfaction can decline due to both physical and emotional factors
Treatment Options: Conventional and Naturopathic Approaches
The good news? GSM and vulvovaginal atrophy are highly treatable. Options include:
Vaginal Moisturizers and Lubricants
Moisturizers (used regularly) help hydrate tissues and improve flexibility
Lubricants (used as needed) reduce discomfort during intimacy.
Check out our favourite ND-owned lube and moisturizer company here.
Local Vaginal Estrogen Therapy
A low-dose treatment that restores tissue health with minimal systemic absorption, offering significant symptom relief with a strong safety profile.
Our Nurse Practitioner, Michelle can prescribe vaginal estrogen when appropriate.
Pelvic Floor Physiotherapy
Strengthens muscles to improve urinary control, reduce leakage, and increase sexual comfort.
Naturopathic Support
Adaptogens (like ashwagandha) for mood and stress
Vitamin E to improve vaginal dryness
Probiotics to restore healthy vaginal flora and lower infection risk
Cognitive Behavioral Therapy (CBT) and Sex Therapy
Address emotional and relational aspects of sexual health, helping women reconnect with themselves and their partners.
You Are Not Alone
If you're experiencing symptoms of GSM, know that support is available. No woman should have to suffer in silence. At Flow Functional Healthcare, we are here to help you navigate this stage of life with compassionate, evidence-based care.
Connect with us to learn more about treatment options that can help you feel comfortable, confident, and empowered again.
We Are Flow
A multidisciplinary functional health care clinic focused on whole family health using natural and complementary therapies. We work on finding the root cause of health issues and help people thrive.