Menopause and GSM
What is Menopause?
Menopause is a natural transition in life, reflecting changes in hormone levels as the body moves beyond the reproductive years. It occurs when the ovaries gradually produce less oestrogen and progesterone, leading to the permanent end of menstrual periods. This transition usually happens between the ages of 45 and 55 and may be preceded by a phase called perimenopause, during which hormone levels fluctuate and symptoms such as hot flushes, night sweats, sleep disturbances, mood changes, and vaginal dryness can occur.
While menopause is a normal biological process, its symptoms can affect quality of life and may benefit from medical support and lifestyle management.
Menopause and GSM
What is GSM?
Genitourinary Syndrome of Menopause (GSM) is the medical term used to describe a group of symptoms that can develop because of this drop in oestrogen. These symptoms may include vaginal dryness, burning or irritation, pain during sex, reduced lubrication, urinary urgency, discomfort when passing urine, or repeated urinary infections. GSM1 is common, long-lasting, and tends to worsen over time if left untreated.
How GSM1 is connected to Menopause
Menopause and GSM1 are closely connected because the hormonal changes of menopause directly cause the tissue changes that lead to GSM1. While menopause itself is a normal life transition, GSM1 is a treatable medical condition — and addressing it early can greatly improve comfort, sexual health, and overall quality of life.
Menopause, intimacy, and feeling like yourself again
Many women are surprised to find that menopause doesn’t just affect periods or hot flushes, it can also change how your body feels during intimacy. As oestrogen levels fall, the tissues of the vagina and bladder can become thinner, drier, and less elastic. This can lead to discomfort, burning, pain during sex, or urinary symptoms, a group of changes known as GSM1.
The South African CLOSER study showed that these changes can have a real emotional impact. Many women avoided intimacy because sex had become uncomfortable or painful, and this often led to feeling less confident, less attractive, or emotionally distant from their partners. Importantly, most partners wanted to understand and support what was happening however, many women felt unsure or embarrassed to raise the topic.
The good news is that GSM1 is treatable. Women in the CLOSER study who received the right hormone treatment, particularly local oestrogen therapy as part of HRT2 care, reported meaningful improvements. Many felt more comfortable during sex, more confident in their bodies, and more connected to their partners again. Some even described feeling like their body was “working again.”
Menopause is a natural life transition, but ongoing discomfort is not something women need to accept as normal. With the right treatment and open conversations, intimacy, comfort, and confidence can be restored.
Decreased lubrication with sexual activity
Discomfort or pain with sexual activity
Post-coital bleeding
Decreased arousal, orgasms, desire
Irritation / burning / itching of vulva or vagina
Dysuria (painful urination)
Urinary frequency / urgency
GSM and Menopause
GSM1 vs Vaginal Atrophy
GSM1 uses the recommended, overarching term that includes vaginal atrophy plus associated symptoms in the external genital and lower urinary tract. These may include urinary urgency dysuria, recurrent urinary tract infections (UTIs3), and bladder dysfunction. GSM1 reflects the multifactorial and progressive nature of these symptoms and provides a more inclusive, accurate and less stigmatizing clinical framework.
Vaginal atrophy (also known as vulvovaginal atrophy or atrophic vaginitis) denotes the thinning, drying, and inflammation of vaginal tissue resulting from estrogen deficiency.
Clinically, it primarily refers to vaginal symptoms such as dryness, irritation, and painful intercourse.
GSM and Menopause
The Hidden Cost of Vaginal Discomfort
Vaginal atrophy is more than a physical condition- it’s a silent disruptor of intimacy and emotional connection for many postmenopausal women and their partners.
In a South African study of 400 individuals, 68% of women reported avoiding intimacy due to vaginal discomfort, and over half of all couples experienced a decline in sexual activity. These symptoms created emotional distance, with many partners feeling the strain.
Encouragingly, women who used local estrogen therapy reported feeling “happy their body was working again” and regained confidence as sexual partners.
The findings highlight the urgent need for greater awareness, open conversations, and access to effective treatments – because no woman should feel disconnected from her body or her relationship.
GSM and Menopause
The Hidden Impact of GSM1 on Intimacy in South African couples
Vaginal discomfort changes behaviour - often silently
Intimacy declines for both partners
Women experience a greater emotional burden
Put off having sex
Feeling emotionally distant
Treatment can restore confidence and well-being
