Genitourinary Syndrome of Menopause (GSM)
Genitourinary syndrome of menopause (GSM) refers to the vaginal dryness, irritation, and urinary symptoms that can develop as estrogen declines around menopause. IM Care Family NP evaluates and manages GSM via telehealth for New York State residents, as part of comprehensive women's urologic and hormonal health care.
Common Symptoms
Vaginal dryness, burning, or irritation
Pain with intercourse (dyspareunia)
Urinary urgency, frequency, or recurrent UTIs
Vaginal itching or discomfort with daily activities
What May Contribute
Declining estrogen levels during and after menopause
Certain medications (e.g., aromatase inhibitors, some hormonal therapies)
Postpartum or breastfeeding-related low estrogen states
Other causes of vulvovaginal irritation, which should be ruled out
This is general information, not a diagnosis — many different conditions can cause similar symptoms.
How We Evaluate
Detailed symptom history and menopausal status
Review of medications that may affect estrogen levels
Referral for a pelvic examination when needed to confirm findings and rule out other causes
Hormone-related lab testing when clinically indicated
Treatment Options We May Discuss
Vaginal moisturizers and lubricants (non-hormonal, first-line)
Low-dose vaginal estrogen therapy, when appropriate
Systemic hormone therapy for patients with broader menopausal symptoms, when appropriate
Referral to pelvic floor physical therapy or gynecology for persistent symptoms
Can This Be Managed by Telehealth?
Many GSM visits — symptom review, starting vaginal moisturizers, and discussing hormonal treatment options — can be managed by telehealth. A pelvic exam is sometimes needed to confirm the diagnosis or rule out other causes of similar symptoms, in which case we'll refer you for one.
Frequently Asked Questions
Real questions patients ask us about this condition.
Is GSM the same as vaginal dryness?
Vaginal dryness is one symptom of GSM, which also includes urinary symptoms and vulvovaginal irritation related to declining estrogen.
Can GSM be treated without hormones?
Yes, non-hormonal vaginal moisturizers and lubricants are a reasonable first step for many patients, though hormonal options are often more effective for persistent symptoms.
Is vaginal estrogen safe?
Low-dose vaginal estrogen is generally considered to have minimal systemic absorption and is an option for many patients, but it should be discussed individually based on your health history.
Can telehealth help with menopause-related vaginal symptoms?
Yes, an initial evaluation and treatment discussion can often be done by telehealth, with a referral for a physical exam recommended if symptoms don't improve or the diagnosis is unclear.
When to Seek Urgent Care
Contact urgent care, an emergency room, or call 911 right away if you experience:
• Vaginal bleeding after menopause
• Severe pelvic pain
• Signs of infection (fever, foul-smelling discharge)
• New or worsening vulvar lesions or sores
Ready to Talk to a Provider?
Schedule a consultation with Inga Melnikova, DNP, FNP-C to discuss your symptoms and next steps.
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