Last reviewed: October 2026
Vaginal dryness, pain during sex, burning when you pass urine, needing to go more often, and urinary tract infections (UTIs) that keep coming back are well known after menopause. Health practitioners call this group of symptoms genitourinary syndrome of menopause, or GSM. What is less well known is that the same symptoms can affect women who are nowhere near menopause.
Why do these symptoms happen?
The tissues of the vulva, vagina, urethra and bladder rely on oestrogen to stay thick, moist, stretchy and well supplied with blood. When hormone levels fall, these tissues can become thinner, drier and more easily irritated. Healthy vaginal bacteria can also change, making infections more likely.
The term GSM was introduced in 2014 to replace “vaginal atrophy” and cover genital, sexual and urinary symptoms. Evidence: strong that these symptoms are common after menopause and linked to low oestrogen.
A new proposal: “genitourinary syndrome”
In 2026, a group of researchers writing in the journal Maturitas proposed dropping “of menopause” and calling it simply genitourinary syndrome, with subtypes based on the cause. Their concern is that women who are not menopausal get overlooked.
This paper is a narrative review and a proposal. It does not present new research data, and the authors acknowledge there are no agreed diagnostic criteria for the new subtypes yet. It has not changed Australian practice. But it is a useful reminder that these symptoms can happen at any age.
Causes outside menopause
Breast cancer treatments and other hormone-blocking treatments. Some treatments for breast cancer lower oestrogen or block its effects, for example aromatase inhibitors. Medicines that temporarily switch off the ovaries, sometimes used for breast cancer, endometriosis or fibroids, can do the same. Evidence: strong.
Chemotherapy and pelvic radiotherapy. These can damage the ovaries and bring on early menopause, either temporarily or permanently. Evidence: strong.
Premature or early ovarian insufficiency. When the ovaries stop working normally before age 40, oestrogen levels fall and vaginal and urinary symptoms can follow. International guidelines recommend hormone treatment for most women with this condition, for overall health as well as symptoms. Evidence: strong.
Periods stopping due to low weight, stress or over-exercise. When the body is under-fuelled or under strain, the brain can turn down signals to the ovaries, lowering oestrogen. Evidence: moderate for low oestrogen in this situation.
Breastfeeding. While breastfeeding, the hormone prolactin is high, which keeps oestrogen low. A 2025 review of 65 studies found vaginal dryness and painful sex were very common in breastfeeding women in the months after birth. Some researchers call this “genitourinary syndrome of lactation”. For many women it improves once breastfeeding slows or stops. Evidence: emerging, as many of the studies were small or of mixed quality.
Some hormonal contraceptives. A few small studies suggest some hormonal contraceptives may lower natural hormone levels enough to cause vaginal dryness or pain with sex in some women. Evidence: emerging and uncertain. This is not a reason to stop your contraception without talking to your health practitioner first.
Some other medicines. Certain acne treatments taken by mouth, some antidepressants, some bladder medicines and some antihistamines can cause dryness or affect sexual function. Evidence: varies by medicine.
It’s not always thrush or “just stress”
Itching or burning is often put down to thrush or stress. Sometimes it is, but repeated thrush treatments that do not help can be a sign of something else.
Other causes that need checking include:
- infections, including UTIs and sexually transmitted infections
- skin conditions of the vulva, such as lichen sclerosus or dermatitis
- reactions to soaps, washes or other products
- pelvic floor muscle tension or pain.
Working out the cause may involve an examination or tests.
What can help
These symptoms are common, real and usually treatable. Options include:
- vaginal moisturisers used regularly, and lubricants during sex
- local (vaginal) hormone treatments, which act mainly on the tissues where they are applied
- pelvic floor physiotherapy, especially if there is pain or muscle tension
- treating the underlying cause where possible.
Evidence: strong for local oestrogen in women after menopause. Evidence for women who are not menopausal is more limited, so the right choice depends on the cause.
If you have had breast cancer, please talk with your treating team before using any hormone treatment, including local treatments. Non-hormonal options are a common starting point.
When to seek care promptly
See a health practitioner soon if you have:
- vaginal bleeding after sex, between periods, or after menopause
- fever, chills, back or side pain, or feeling unwell with urinary symptoms
- blood in your urine
- new pain, sores, lumps or skin changes on the vulva
- unusual or smelly vaginal discharge
- urinary symptoms while pregnant.
If you are very unwell, call 000.
The bottom line
Vaginal and urinary symptoms caused by low hormone levels are not only a menopause issue. They deserve to be taken seriously at any age. Talk with your health practitioner about what may be causing them and which options suit you.
Related reading: Menopausal hormone therapy: what it does well, and what the evidence really says.
References
- Perelmuter S, Osgood A, Munoz N, et al. Redefining genitourinary syndrome: a proposal to expand the GSM nomenclature to encompass the full spectrum of hypoestrogenic and hypoandrogenic urogenital disorders. Maturitas. 2026;212:109083. https://doi.org/10.1016/j.maturitas.2026.109083
- Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause. 2014;21(10):1063–1068. https://doi.org/10.1097/GME.0000000000000329
- Perelmuter S, Stokes C, Chapalamadugu M, et al. Postpartum and lactation-related genitourinary symptoms: a systematic review. Obstetrics & Gynecology. 2025;146(1):59–72. https://doi.org/10.1097/AOG.0000000000005940
- Panay N, Anderson RA, Bennie A, et al. Evidence-based guideline: premature ovarian insufficiency. Human Reproduction Open. 2024;2024(4):hoae065. https://doi.org/10.1093/hropen/hoae065
- The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976–992. https://doi.org/10.1097/GME.0000000000001609
- Australasian Menopause Society. Genitourinary syndrome of menopause (information sheet). https://hub.menopause.org.au/Play?pId=e3cb85a0-2da9-40a0-8974-057ee3b2bf30
This article is general information only and is not a substitute for individual medical advice. Talk to your health practitioner about your own situation.