OMG: The Women's Health Brief

The Silence Around GSM

So much of women’s health is shrouded in silence, and GSM — Genitourinary Syndrome of Menopause — is one of the biggest gaps. It used to be called “vaginal atrophy,” and before that, unbelievably, the “senile vagina.” Thankfully, the terminology has moved on, but the lack of awareness hasn’t.

Many women don’t realise that GSM is not something you can “escape.” If you don’t replace estrogen in some form, you will experience it on some level — whether it’s mild or severe.

What GSM Covers

GSM isn’t just one symptom; it’s a cluster of vulvovaginal and urinary changes caused by the loss of estrogen. It can include:

• Vaginal dryness, burning, or itching
• Painful sex (dyspareunia)
• Recurrent urinary tract infections
• Urinary urgency and frequency, especially at night
• Thinning or shrinking of vulvar tissues, including the labia minora and majora
• Loss of elasticity and resilience in the vaginal walls

It can start early in perimenopause, or it might not show up until 10 or more years after menopause. This is why many women in their late 50s or 60s don’t even connect their symptoms to menopause.

My Story

For me, GSM first appeared as urinary frequency. It was one of my very first perimenopause symptoms. I was literally getting up every hour during the night — sometimes more than ten times. My doctor kept testing me for UTIs, all negative, and her patience wore thin. Mine wore out completely.

Today, it’s much improved. I still get up once a night to pee — sometimes not at all if I manage my fluid intake — but that’s manageable compared to those early days. A few years later, GSM returned in a different guise: intense vaginal itching.

Here’s the key point: not once during either phase did any doctor suggest it might be perimenopause or GSM. And not once did anyone mention vaginal estrogen.

It wasn’t until I heard it discussed on a podcast — I can’t recall if it was Kelly Casperson or Louise Newson — that I had the biggest OMG moment.

“Why had no one ever told me this before?”

How could something so safe and effective be so absent from the conversation?

Now I take both systemic HRT and vaginal estrogen. Some women need the vaginal treatment on top of systemic, and I’m one of them. Vaginal estrogen is incredibly safe — it stays local, doesn’t travel through the body, and can even be used by women who can’t take systemic HRT.

And here’s where the doctors who are really in the know — menopause specialists like Kelly Casperson, Rachel Rubin, and Louise Newson — make an important point: they argue that every woman could benefit from vaginal estrogen.

Kelly Casperson has one of the best analogies:

“Vaginal estrogen is like sunscreen. You don’t apply sunscreen once and expect to be protected forever. You use it consistently, because your skin needs it. Vaginal estrogen works the same way — it’s skincare for the vagina.”

Stories from Others

I’ve worked with clients who struggled with GSM too — and the misconceptions are striking:

• One thought it was caused by the fruit she ate in the morning affecting vaginal yeast.
• Another thought it was because she wasn’t having sex. (For the record: “use it or lose it” does not apply here.)
• Another couldn’t have sex at all because of the pain and dryness.

And on podcasts, I’ve heard even more stories:

• A woman in her 50s went to her doctor because sex was painful — and was told she was “too old for sex anyway.”
• Another went in with intense discomfort, only to be dismissed with, “It’s just aging, nothing can be done.”

This is gaslighting dressed up as medical advice — and it’s devastating.

My Reflection

For me, GSM has been one of the most disruptive physical symptoms of menopause. The itching, the frequency, the discomfort — they were relentless at times. But what made it worse was the silence around it.

The problem wasn’t just the symptoms themselves, but the fact that no one connected them to perimenopause, and no doctor ever mentioned vaginal estrogen as a solution. That silence meant I went without answers for far longer than I should have.

That’s why I wrote a whole post on [ Vaginal Estrogen], and why I’ll also be writing one on the labia minora — because these changes deserve open, honest discussion.

Because here’s the truth: GSM isn’t optional. If you don’t replace estrogen, you will experience it on some level. But with treatment, relief is possible — and it can be transformative.

---

Resources & Further Reading

📄 Websites & Guidelines

• NHS – Vaginal Estrogen
• British Menopause Society – GSM Guidance
• North American Menopause Society (NAMS) – GSM Resources

🎧 Podcasts & Multimedia

• You Are Not Broken — Kelly Casperson, MD
• The Dr Louise Newson Podcast — expert conversations on HRT and GSM episode with Rachel Rubin
• The Drive with Peter Attia — Rachel Rubin, MD on sexual health, GSM, and menopause

📝 Related Blog Posts

• [Vaginal Estrogen: The Simple Fix We’re Not Talking About]
• [When the Labia Minora Disappear: Why Vaginal Estrogen Matters]

---