GSM Treatment: The 2025 Guide to Relief from Vaginal Atrophy & Dryness

Introduction

For many women over 45, menopause brings more than hot flashes and night sweats. One of the lesser-discussed but deeply impactful conditions is Genitourinary Syndrome of Menopause (GSM), formerly known as vaginal atrophy.

GSM includes a constellation of symptoms stemming from estrogen decline and affects the vaginal and urinary systems.

While it’s a natural part of aging, GSM is treatable. And yet, many women don’t seek help—either because they’re unaware it’s a medical issue or they believe it’s untreatable. As a pharmacist, I’m committed to bridging that knowledge gap.

This comprehensive guide explores the best GSM treatments, non-hormonal options, natural remedies, and answers to frequently asked questions.

What Is GSM?

Genitourinary Syndrome of Menopause is a clinical term used to describe the vaginal and urinary symptoms associated with reduced estrogen levels in menopause. It affects vaginal health, bladder function, and sexual comfort.

Symptoms of GSM

Vaginal dryness
Burning or irritation
Painful intercourse (dyspareunia)
Recurrent urinary tract infections (UTIs)
Urgency and frequency of urination

These symptoms are progressive, meaning they typically worsen without intervention.

Causes

Estrogen plays a crucial role in maintaining the elasticity, thickness, and moisture of vaginal tissues. After menopause, estrogen production significantly drops, leading to thinning of the vaginal walls, decreased lubrication, and changes in urinary tract tissues. This estrogen deficiency is the primary driver behind GSM.

7 Best GSM Treatments

What works best depends on your symptoms and what feels right for you. Here are some of the most trusted, research-backed treatments for vaginal dryness in 2025:

1. Vaginal Estrogen

Vaginal estrogen therapy remains the gold standard for moderate to severe GSM treatment. It delivers low-dose estrogen directly to vaginal tissues, restoring thickness and lubrication while minimizing systemic absorption.

Creams (e.g., estradiol, conjugated estrogens): Applied daily initially, 2-3 times a week.
Rings (e.g., Estring): Inserted into the vagina every 90 days.
Tablets (e.g., Vagifem): Inserted daily for two weeks, then twice weekly.

These options effectively reverse vaginal atrophy with minimal systemic risk. Vaginal estrogen also reduces the risk of recurrent UTIs.

Note: These therapies are not suitable for women with a history of hormone-sensitive cancers without physician oversight.

2. Hyaluronic Acid Suppositories

Hyaluronic acid is a naturally occurring molecule known for its water-retaining properties. Hyaluronic acid suppositories help keep the vagina hydrated and support healing—without using hormones. That makes them a great choice if you’re looking for a non-hormonal way to ease dryness and discomfort.

Studies show they really can make a difference. Just be sure to choose a high-quality product from a pharmacy or a trusted online store.

3. MonaLisa Touch Laser Therapy

This GSM laser therapy uses fractional CO2 laser energy to stimulate collagen production and rejuvenate vaginal tissues. It is a non-hormonal outpatient procedure typically performed in 3 sessions over 12 weeks.

Benefits: Improved elasticity, moisture, and symptom relief
GSM laser therapy cost: Varies by region; typically $1,500 to $2,500 for a complete course

While more expensive, it’s a valuable option for women unable or unwilling to use hormones.

4. Vaginal Moisturizers

Unlike lubricants, vaginal moisturizers are used regularly, twice or thrice weekly, to maintain vaginal hydration. Look for products free from parabens, fragrances, and glycerin.

Best vaginal moisturizers for GSM treatment include brands with bioadhesive hyaluronic acid, vitamin E, or polycarbophil.
Products like Replens or Revaree are popular OTC options.

5. DHEA Vaginal Inserts

DHEA (dehydroepiandrosterone) inserts convert to estrogen and testosterone locally within the vaginal tissue. Prasterone (Intrarosa) is FDA-approved for GSM and offers hormonal benefits without significantly increasing serum hormone levels.

6. Ospemifene

This oral medication is a Selective Estrogen Receptor Modulator (SERM) approved for dyspareunia due to GSM. It improves vaginal tissue integrity systemically.

Ideal for women with GSM who prefer an oral option
Not suitable for those with a history of venous thromboembolism

7. Vaginal Lubricants for Intercourse

For immediate symptom relief during intercourse, water- or silicone-based lubricants can reduce pain and friction. These do not treat GSM but improve sexual comfort.

Read: Herbal Remedies for Menopause Symptoms

Natural Remedies for GSM

Some women prefer or require non-hormonal GSM options, especially those with contraindications to hormone therapy. Natural remedies can be a valuable part of a holistic approach.

Vitamin E Oil

Vitamin E oil applied vaginally may help improve tissue integrity and reduce dryness. It acts as an antioxidant and promotes healing. Use pharmaceutical-grade suppositories or oils specifically designed for vaginal use.

Pelvic Floor Therapy

Pelvic floor dysfunction can exacerbate GSM symptoms. Pelvic floor physical therapy improves blood flow, muscle tone, and urinary control. It’s beneficial for women experiencing urinary incontinence or painful intercourse.

Read: Vitamins to Increase Female Lubrication Naturally

Frequently Asked Questions

Can GSM come back after treatment?

Yes. GSM is a chronic condition. Stopping treatment often leads to the return of symptoms. Long-term maintenance therapy is typically required.

Are there GSM treatments without hormones?

Absolutely. Options like hyaluronic acid suppositories, vaginal moisturizers, Mona Lisa Touch laser, and pelvic floor therapy offer effective non-hormonal GSM options.

Can menopause cause UTIs?

Yes. When estrogen levels drop, it can change the lining and pH of the urinary tract, making it easier for infections to happen repeatedly. For many postmenopausal women, using a low-dose estrogen treatment right where it’s needed can help cut down on repeated UTIs.

Final Thoughts for You

GSM is common, progressive, and treatable. If you’re experiencing vaginal dryness, painful sex, or UTIs, you’re not alone—and you don’t have to suffer in silence.
Whether you’re seeking hormonal or non-hormonal GSM treatment, a wide array of effective options exist in 2025.
As a pharmacist, I encourage open conversations with your healthcare provider about what you’re experiencing. Relief is possible, and reclaiming your comfort, intimacy, and quality of life is well within reach.

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