This episode is part of our Head-to-Toe Menopause Series, and it tackles one of the most underdiagnosed and undertreated menopause conditions out there — GSM. This is a menopause symptom that’s incredibly common, highly treatable, and somehow still whispered about like it’s a secret.

If you’ve ever thought:

“Why does sex suddenly feel like sandpaper?”

“Why am I peeing all the time?”

“Why do I feel irritated down there for no reason?”

You’re not broken.

You’re not “just getting older.”

You may have Genitourinary Syndrome of Menopause (GSM) — and today, we’re talking all about it.

We break down:

• What GSM actually is (and why it replaced the outdated term “vaginal atrophy”)

• Why symptoms often persist and worsen without treatment

• How low estrogen changes vaginal, vulvar, and urinary tissue at a structural level

• Why this is about collagen, blood flow, pH, and microbiome — not “just dryness”

• Why GSM can affect sex, bladder control, UTIs, irritation, and pelvic floor health

• Why common doesn’t mean normal — and why we should be talking about this more

And then we get very clear about what actually helps.

We talk about:

• The difference between lubricants and vaginal moisturizers

• Why vaginal estrogen is not a lubricant — and why that matters

• Why low-dose vaginal estrogen is the gold standard for GSM

• What the research really says about systemic absorption and safety

• Vaginal estrogen vs DHEA — and why “not estrogen” doesn’t mean safer

• What ACOG, AUA, and menopause societies actually recommend

• When pelvic floor physical therapy can be a game changer

• Why lasers and energy-based devices deserve a cautious conversation

GSM is not:

• Rare

• A personal failure

• Something you just have to live with

It is:

• Common

• Progressive without treatment

• One of the most treatable menopause conditions we see

If you’re dealing with dryness, irritation, pain with sex, urinary urgency, or recurrent UTIs — bring it up.

If your clinician doesn’t ask, you can.

And if your symptoms are dismissed, it’s okay to get a second opinion.

Menopause symptoms don’t need to be miserable — and this one is especially fixable.