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‘Common’ Isn’t ‘Normal’: The Silent Struggle of Genitourinary Syndrome of Menopause
By Dr. Natalie Perkins
Founder PAUZ Health, Women’s Health Advocate, Menopause Warrior
You’ve probably heard some version of this: “It’s just a bit dry,” “I leak when I laugh,” or “It’s normal at our age.” Those statements are everywhere — in waiting rooms, group chats, and the quiet corners of exam rooms. But let’s be blunt: common does not equal acceptable — and it certainly doesn’t mean that nothing can be done.
During perimenopause and after menopause, many people experience a constellation of genital and urinary changes grouped under the medical term Genitourinary Syndrome of Menopause (GSM). The umbrella includes symptoms such as vaginal and vulvar dryness, itching, pain with sex (dyspareunia), urinary urgency or incontinence, and recurrent urinary tract infections (UTIs). These symptoms are driven by hypoestrogenic changes in the vulvovaginal and lower urinary tract tissues and are highly prevalent — affecting a large share of postmenopausal people. Estimates vary (because studies and definitions vary), but reviews place prevalence broadly at 80+% — many women experience symptoms that matter to their quality of life.
Here’s the hard truth: GSM doesn’t reliably get better on its own. Left unaddressed, tissue thinning and inflammation often progress, sexual pain can worsen, urinary symptoms can increase in frequency and severity, and risk of complications such as recurrent UTIs and incontinence can rise. That’s why calling symptoms “just a part of aging” is dangerous — it delays care and may leave people suffering needlessly.
The real health consequences
GSM isn’t only about discomfort or awkward sex. It can:
- Reduce libido and intimacy, affecting relationships and mental health
- Increase urinary frequency, urgency, and recurrent UTIs — which can lead to antibiotic exposure and, in older adults, serious complications
- Cause stress and impact work, self-image, and daily functioning.
And yet, despite how common it is, many people never seek help. Research and clinical reports repeatedly show that up to three-quarters of of affected women with GSM don’t get treatment — either because they don’t recognize symptoms as treatable, feel embarrassed, or have been told it’s “just normal.”
Effective options exist — and they work
The encouraging news: there are evidence-based treatments that improve symptoms, restore tissue health, and lower urinary risks when used appropriately.
- Low-dose vaginal estrogen (creams, rings, or tablets): Has a robust evidence base for reducing dryness, improving tissue quality, and relieving dyspareunia. It acts locally, with minimal systemic absorption when used as directed
- Intravaginal DHEA (prasterone): An effective local therapy shown in randomized trials to reduce vaginal pain and improve signs of atrophy. It’s FDA- approved for dyspareunia related to GSM
- Pelvic floor therapy and tailored rehabilitation: Help with urinary symptoms, pelvic pain, and sexual function in many people when combined with medical treatment and education. While research is growing, clinical practice increasingly recognizes pelvic floor specialists as essential partners in GSM care
Treatment is not one-size-fits-all: At PAUZ we take a personalized, whole-person approach — matching medical therapies with pelvic health, behavioral strategies, and the emotional support people need to regain comfort and confidence.
Real stories — what recovery can look like
“Anna,” 54 — She’d been avoiding intimacy for two years because sex felt like sandpaper. After a pelvic exam and discussion, she began low-dose vaginal estrogen and short-term pelvic floor therapy. Within 8–12 weeks she reported less pain, better sleep, and that sex was comfortable again
“Maya,” 62 — Recurrent UTIs had become her norm. Testing and pelvic health assessment revealed GSM contributing to recurrent infections. With intravaginal DHEA and bladder-health counseling, her UTI frequency dropped and she needed far fewer courses of antibiotics
“Janel,” 49 — Leaking when she sneezed made her give up long walks. Pelvic floor training combined with lifestyle changes and targeted pelvic rehab restored her confidence and allowed her to get back to the park with her dog
These stories are what we see when we stop accepting “it’s normal” and start treating the cause.
*Names have been changed to honour confidentiality
How to take action (and what to ask)
If you’re experiencing symptoms, don’t shrug them off. Here’s a short checklist to bring to your clinician:
- Book an appointment specific for this issue: We often shy away and burry this in an appointment for other things. Support your clinicians with sufficient time by booking an appointment specific for your GSM concerns
- Prepare: Be ready to describe symptoms precisely — when they started, how they affect intimacy and daily life, and any urinary complaints
- Ask about local treatments (vaginal estrogen, prasterone) and pelvic floor therapy
- Ask about targeted evaluation and prevention (if you’ve had recurrent UTIs or new urinary urgency): Prescriptions for antibiotics routinely may lead to antibiotic resistance, which can result in major risks to your health
What you deserve
“Common” is a statistic. “Normal” is a standard of health. GSM may be common, but it does not have to be your future. Effective, evidence-based options exist, and compassionate pelvic health care can restore comfort, function, and intimacy.
If you’re ready to stop normalizing pain and start getting help that recognizes your life — and your goals — PAUZ is here. We combine medical expertise, pelvic health specialists, and personalized plans so you don’t have to accept suffering as part of the status quo.
Want to learn more or get a personalized plan?
Visit PAUZ.health or sign up for our newsletter to get practical guides, recipes and real stories of recovery.
You don’t need to do this alone.
Key source & further reading:
Systematic reviews on GSM and its treatment (NAMS position statement; randomized trials on intravaginal DHEA/prasterone; pelvic floor therapy reviews)
The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020, Sep;27(9):976-992. doi: 10.1097/GME.0000000000001609. PMID: 32852449
