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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Gynecology · Genitourinary Syndrome of Menopause

Mapping Your Symptoms and Finding Clarity

At a Glance

Genitourinary Syndrome of Menopause (GSM) causes vaginal pain, burning, and urinary issues due to low estrogen. Because GSM symptoms closely mimic urinary tract infections, women are often incorrectly prescribed antibiotics. An accurate medical diagnosis is essential to treat the root cause.

Identifying the symptoms of Genitourinary Syndrome of Menopause (GSM) can be tricky because they often “hide” behind other common issues. You might think you have a stubborn yeast infection or a series of never-ending bladder infections, but these can actually be signs of the progressive tissue changes associated with lower estrogen levels [1][2].

Mapping Your Symptoms

GSM is not just “vaginal dryness.” It is a collection of symptoms that affect both the genital and urinary tracts [3].

  • Vulvovaginal Signs: You may experience persistent burning, itching, and irritation [2]. These symptoms often lead to dyspareunia (pain during or after sexual activity), which can range from a mild “sandpaper” feeling to sharp, intense pain [4][1].
  • Urinary Signs: Because the bladder and urethra are also sensitive to estrogen, you might experience dysuria (painful urination), a frequent and sudden urgency to go, and nocturia (waking up multiple times at night to urinate) [4][2].

The UTI Confusion and Antibiotic Risk

One of the most common reasons GSM is missed is that its urinary symptoms almost perfectly mimic a Urinary Tract Infection (UTI) [3]. When the tissues of the urethra thin out, they become easily irritated, causing that familiar burning and “need to go” feeling [2].

Many women are prescribed repeated courses of antibiotics for these symptoms without a urine culture (a lab test to prove bacteria are actually present) [5]. Overusing antibiotics when there is no infection is risky—it can lead to antibiotic resistance and won’t fix the underlying tissue thinning [5][6]. In many cases, treating the GSM with vaginal estrogen is actually more effective at stopping these “phantom” UTIs than antibiotics ever were [7].

What Else Could It Be?

It is important to ensure your symptoms aren’t caused by other conditions that require different treatments. During an exam, your doctor should rule out:

Condition Key Differences from GSM
Lichen Sclerosus (LS) Characterized by ivory-white patches, a “shiny” or “parchment-like” skin texture, and visible changes to the structure of the vulva (like the labia minora appearing to shrink) [8][9].
Desquamative Inflammatory Vaginitis (DIV) Presents with a heavy, purulent (pus-like) yellow or green discharge and significant redness and inflammation, rather than the thin, pale tissue seen in GSM [10][11].
Vulvodynia Defined as chronic vulvar pain or burning that often occurs without visible tissue changes; the pain is frequently “provoked” or triggered by light touch [11].

The Importance of the Right Label

Getting an accurate diagnosis matters because GSM is progressive [12]. While some other conditions might flare up and settle down, the tissue atrophy in GSM typically continues to worsen if the estrogen deficiency isn’t addressed [13]. By distinguishing GSM from its “mimics,” you and your doctor can choose a targeted plan that actually treats the root cause rather than just chasing symptoms [14][15].

Common questions in this guide

Why does Genitourinary Syndrome of Menopause feel like a UTI?
When estrogen levels drop, the tissues of the urethra thin out and become easily irritated. This causes burning and a sudden urge to urinate, which perfectly mimics the symptoms of a urinary tract infection (UTI).
Should I take antibiotics for my urinary symptoms during menopause?
You should only take antibiotics if a laboratory urine culture confirms a bacterial infection. Taking antibiotics for urinary symptoms that are actually caused by menopausal tissue thinning won't fix the problem and can lead to antibiotic resistance.
How is GSM different from Lichen Sclerosus?
While both conditions cause vaginal discomfort, Lichen Sclerosus typically presents with ivory-white patches, a shiny skin texture, and visible structural changes to the vulva. Your doctor can identify these distinct differences during a physical exam.
Will GSM symptoms go away on their own?
No, Genitourinary Syndrome of Menopause is a progressive condition. This means the tissue atrophy and associated symptoms will typically continue to worsen over time if the underlying estrogen deficiency is not treated.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can we perform a urine culture to confirm if my symptoms are actually a bacterial infection before I start another course of antibiotics?
  2. 2.Do you see any ivory-white patches or changes to my labial structure that might suggest Lichen Sclerosus instead of GSM?
  3. 3.Is it possible to check the pH or perform a microscopy (swab) of my vaginal discharge to rule out Desquamative Inflammatory Vaginitis (DIV)?
  4. 4.Based on my exam, do I have specific trigger points for pain (suggestive of Vulvodynia) or is the discomfort more generalized due to tissue thinning?

Questions For You

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References

References (15)
  1. 1

    The Genitourinary Syndrome of Menopause: An Overview of the Recent Data.

    Angelou K, Grigoriadis T, Diakosavvas M, et al.

    Cureus 2020; (12(4)):e7586 doi:10.7759/cureus.7586.

    PMID: 32399320
  2. 2

    Genitourinary syndrome of menopause: in their own words-development of a new patient-reported outcome measure.

    Kling JM, Faubion SS

    Menopause (New York, N.Y.) 2019; (26(4)):335-336 doi:10.1097/GME.0000000000001309.

    PMID: 30724847
  3. 3

    Genitourinary syndrome of menopause (GSM): recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).

    Simon JA, Nappi RE, Chedraui P, et al.

    Sexual medicine reviews 2026; (14(1)) doi:10.1093/sxmrev/qeaf055.

    PMID: 40981832
  4. 4

    Laser treatment for genitourinary syndrome of menopause: Scientific Impact Paper No. 72 (July 2022): Scientific Impact Paper No. 72 (July 2022).

    Phillips C, Hillard T, Salvatore S, et al.

    BJOG : an international journal of obstetrics and gynaecology 2022; (129(12)):e89-e94 doi:10.1111/1471-0528.17195.

    PMID: 35892242
  5. 5

    Underdiagnosed and overmedicated: Investigating the management of urinary tract infection and vaginal estrogen use in a large cohort of postmenopausal women.

    Nahum R, Machtinger R, Oberman B, et al.

    Maturitas 2025; (205()):108806 doi:10.1016/j.maturitas.2025.108806.

    PMID: 41406900
  6. 6

    Vaginal Estrogen Utilization Among Medicare Beneficiaries With Genitourinary Syndrome of Menopause.

    Gallo K, Zhang CA, Burton C, et al.

    JAMA network open 2025; (8(12)):e2549822 doi:10.1001/jamanetworkopen.2025.49822.

    PMID: 41400949
  7. 7

    Efficacy and safety of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause: A randomized double-blind placebo-controlled trial.

    Muiños Fernández N, Martínez Salamanca JI, Pardo González de Quevedo JI, et al.

    Maturitas 2024; (190()):108128 doi:10.1016/j.maturitas.2024.108128.

    PMID: 39388913
  8. 8

    Advances in the pathogenesis of vulvar lichen sclerosus.

    Xie X, Wu K

    Molecular biology reports 2024; (51(1)):396 doi:10.1007/s11033-024-09318-7.

    PMID: 38453810
  9. 9

    Vulvar Lichen Sclerosus et Atrophicus.

    Nair PA

    Journal of mid-life health 2017; (8(2)):55-62 doi:10.4103/jmh.JMH_13_17.

    PMID: 28706405
  10. 10

    Evaluation and Management of Vaginitis.

    Marnach ML, Wygant JN, Casey PM

    Mayo Clinic proceedings 2022; (97(2)):347-358 doi:10.1016/j.mayocp.2021.09.022.

    PMID: 35120697
  11. 11

    Assessment and Treatment of Vaginitis.

    Mitchell CM

    Obstetrics and gynecology 2024; (144(6)):765-781 doi:10.1097/AOG.0000000000005673.

    PMID: 38991218
  12. 12

    Women harmed by vaginal laser for treatment of GSM-the latest casualties of fear and confusion surrounding hormone therapy.

    Kaunitz AM, Pinkerton JV, Manson JE

    Menopause (New York, N.Y.) 2019; (26(4)):338-340 doi:10.1097/GME.0000000000001313.

    PMID: 30789455
  13. 13

    Genitourinary syndrome of menopause: effects on related factors, quality of life, and self-care power.

    Karakoç H, Uçtu AK, Özerdoğan N

    Przeglad menopauzalny = Menopause review 2019; (18(1)):15-22 doi:10.5114/pm.2019.84152.

    PMID: 31114453
  14. 14

    Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy.

    Pérez-López FR, Vieira-Baptista P, Phillips N, et al.

    Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2021; (37(8)):740-745 doi:10.1080/09513590.2021.1931100.

    PMID: 34036849
  15. 15

    Treating Genitourinary Syndrome of Menopause in Postmenopausal Women with a History of Breast Cancer.

    Ferguson D, Pederson H, Kling JM

    Drugs & aging 2026; (43(3)):211-221 doi:10.1007/s40266-026-01287-9.

    PMID: 41758440

This page provides educational information about symptoms of Genitourinary Syndrome of Menopause and its common misdiagnoses. Always consult your gynecologist or healthcare provider for an accurate diagnosis and personalized treatment plan.

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