WHAT IS GSM?

Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause is serious; it is not "just a little vaginal dryness."
Every day in our practice, we witness the life-saving impact of low-dose local vaginal estrogen.
In as little as 6-12 weeks our patients experience clear clinical benefits, including fewer urinary tract (UTI) and vaginal infections, reduced antibiotic use, and a lower risk of serious complications from UTIs, such as urosepsis. They report less urgency and bladder pain, improved sexual function, and a restored quality of life.

Vaginal estrogen is the single most effective therapy in our toolkit for treating GSM - regardless of a woman's stage of life

Recurrent UTIs kill our mothers, grandmothers, and wives, and the sad truth is that so many of them are preventable. Local vaginal hormone therapy is a critical preventative treatment and can save the lives of our loved ones.

The true risk lies in not treating GSM.

Every person deserves access to safe, effective treatment for GSM, whether or not you are our patient.
Please use the resources below to advocate for yourself or your loved ones. For the clinicians, take a look at these resources and learn how to prescribe this critical preventative medication.

A clinician examining a patient in a pelvic health clinic

Symptoms of Genitourinary Syndrome of Menopause(GSM) & Genitourinary Syndrome of Lactation (GSL)

Recurrent UTIs
Decreased lubrication
Urinary frequency or urgency
Vaginal dryness, itching, or burning
Urinary incontinence
Diminished orgasm or arousal
Pain with urination
Pain with sex

What does the Medical Research say about GSM?

UTI Reduction
Local vaginal hormones reduce the risk of UTIs by more than 50%
(Tan-Kim et al. 2023)
Vaginal estrogen saves money
Using preventative local vaginal estrogen therapy could save Medicare patients $1,226 to $4,888 annually.
(Houston et al. 2025)
Genitourinary Syndrome of Lactation
Postpartum, breastfeeding people may also experience GSM-like symptoms that can be treated with local vaginal hormones.
(Perelmuter et al. 2024)
The risks of not treating GSM outweigh the risks of therapy
Historical misinterpretation of data has scared many clinicians. We need to look at the data analytically
(Levy and Simon 2024)
Estrogen isn't the only answer
Vaginal DHEA, a precursor to both estrogen and androgens, is another option that can help relieve GSM symptoms.
(Rubin et al. 2025)
No systemic absorption
Local vaginal hormones do not absorb into the bloodstream or change whole-body estrogen levels.
(Mitchell et al. 2022)
Breast Cancer
Local vaginal hormones are safe for breast cancer survivors and those currently undergoing breast cancer treatment.
(Beste et al. 2025)(Meaidi et al 2024)
Cardiovascular Health
Local vaginal hormones do not increase the risk of cardiovascular events or stroke. In fact, it decreases the risk.
(Hendrix 2023)(McVicker 2024)

MonaLisa Touch: A Non-Hormonal Option

Available at Ovation

Vaginal estrogen is our first-line therapy for GSM, and for most women it is enough. But some women cannot use hormones, some prefer not to, and some remain symptomatic even on a well-managed regimen.

For those women, we offer MonaLisa Touch & V-Revive. A fractional CO2 laser treatment performed in our office. It can be used on its own, or alongside vaginal estrogen as part of a broader treatment plan.

Treatment takes about 3–4 minutes, requires no sedation, and is generally painless, although you may feel a mild vibration during treatment. A typical course is three sessions spaced six weeks apart, followed by one annual maintenance treatment.

MonaLisa Touch may be worth discussing if you:

Cannot use vaginal estrogen, or have been advised against it
Have a personal history of breast or other hormone-sensitive cancer
Prefer a non-hormonal approach
Are already using vaginal estrogen but still have dryness, irritation, or pain with intimacy
Have tried moisturizers and lubricants without adequate relief

Educational Resources about GSM

The removal of black box warning for vaginal estrogen represents a pivotal advancement in women's health, helping eliminate a significant barrier to appropriate and effective treatment.

Read the FDA Notice here

Consider bringing this notice to your clinician.

Read the AUA guidelines here

Consider bringing these guidelines to your clinician.

Read the TMS/NAMS position statement here

The Menopause Society (TMS - formerly NAMS) also supports the use of local vaginal hormones for the treatment of GSM.
This position statement also discusses systemic hormone therapy.

Below is a "prescriber guide" for local vaginal hormone options that has improved access for countless people around the country. This guide gives prescribers information on how to diagnose and prescribe treatment for GSM.

Download and print this guide, then bring it with you to your next appointment.

Southeast Urogyn

Prescriber's Pocket Guide to Local Vaginal Hormones

Symptoms ofGenitourinary Syndrome of Menopause (GSM)Genitourinary Syndrome of Lactation (GSL)

Recurrent UTIs
Urinary frequency or urgency
Urinary incontinence
Pain with urination

Vaginal dryness, itching, or burning
Decreased lubrication
Diminished orgasm or arousal
Pain with sex

Prescription Options

Form	Generic	Brand(* if generic exists)	Instructions
Cream	Estradiol 0.01%Conjugated estrogens 0.625mg	Estrace*Premarin	1 gram vaginally nightly for 2 weeks, then 1 gram 2x/week thereafter. Use topically around urethra and vestibule. Rub into vaginal walls for less mess.
Vaginal Estradiol Insert	Estradiol 10mcg	YuvafemVagifemImvexxy	1 insert vaginally nightly for 2 weeks, then 2x/week thereafter.
Vaginal DHEA Insert	DHEA/Prasterone 6.5mg	Intrarosa	1 insert vaginally nightly. DHEA converts to estrogen and testosterone, helps vestibular pain.
Vaginal Ring	Estradiol 2mg ring	Estring	Insert ring vaginally. Replace every 3 months.