You can talk about the hot flashes. You have probably joked about the brain fog, the 3 a.m. wake-ups, or the way your jeans fit differently now. Those have become almost sayable.
But there is another change that arrived around the same time, and this one you have told no one. Maybe it’s the sudden, urgent dash to the bathroom that did not used to happen. The little leak when you laugh, or sneeze, or lift something. The recurring urinary tract infections that keep coming back for no clear reason. The dryness and discomfort that have made intimacy feel like something to avoid rather than enjoy.
You have wondered if something is wrong with you. You have probably not said the words out loud, not to your friends, maybe not even to your doctor.
If there’s one thing I’d want you to know, it’s this: it’s not your fault, and it’s not something you simply have to live with in silence.
It has a name
For years this cluster of changes was filed under a cold, narrow term, “vaginal atrophy”, that described one part of it and captured none of the experience. In 2014, a panel of menopause and sexual-health specialists agreed on a better name: genitourinary syndrome of menopause, or GSM[1][2].
The longer name matters, because it finally says the true scope. This is not only about vaginal dryness. The same drop in estrogen that changes everything else in perimenopause also affects the tissues of the vulva, the vagina, the urethra, and the bladder, all of which are rich in estrogen receptors. As estrogen falls, those tissues become thinner, drier, and less elastic, and the whole system becomes more easily irritated and more prone to infection[1][2].
So the urgency, the leaks, the recurring UTIs, the dryness, the discomfort during sex. These are not separate problems you happen to have all at once. They are one syndrome, with one underlying cause.
How common is “nobody talks about it”
What makes the silence so striking is that GSM is not a fringe experience. Depending on how it is defined and how long it has been since menopause, studies estimate it affects anywhere from 27 to 84 percent of postmenopausal women[2][3].
And yet almost no one names it. In the VIVA survey of 3,520 postmenopausal women, only about 4 percent could identify vaginal atrophy as the cause of their symptoms[7]. The rest assumed it was aging, or poor hygiene, or something uniquely, embarrassingly wrong with them. Most never raised it with a doctor. Many who did were waved off.
Read that again. A large share of women, by some estimates the majority, go through this. Almost none of them know what it is. That is not a coincidence; it is what happens when a symptom carries shame. The silence is not a sign that it is rare. The silence is the symptom.
Why it does not just “pass”
There is one more difference that matters, and it is the reason this one deserves your attention more than most.
Many perimenopause symptoms eventually settle. Hot flashes, for most women, fade with time. GSM does not work that way. Because it is driven by the ongoing absence of estrogen in those tissues, it tends to be chronic and progressive. It often stays, and frequently worsens, the longer it goes unaddressed[2][5].
This is not said to frighten you. It is said because it flips the usual advice on its head. With a lot of midlife symptoms, “wait and see” is reasonable. With this one, waiting quietly in the hope that it passes is the one approach least likely to help.
The part that brings relief: there are real options
If the hard part of this article is naming the problem, here is the part worth holding onto. GSM is one of the more treatable changes of menopause, and the options are well established[4][5][6].
Doctors generally start with the gentlest tools. Non-hormonal vaginal moisturizers and lubricants are considered a sensible first step and can make a real difference for dryness and comfort[4][5]. When more is needed, low-dose vaginal estrogen, delivered locally, in very small amounts, right where the tissue needs it, is widely regarded as the gold-standard treatment. It works directly on the affected tissues, and research has even found it lowers the rate of recurring urinary tract infections[3][5].
The point of naming these is not to tell you what to take. It is to tell you the conversation is worth having, because there is something real on the other side of it. This is exactly the kind of change a doctor who understands menopause can help with, and “I’m fine” is not the only possible answer.
How to actually bring it up
The hardest part, for most women, is the first sentence. So borrow one. At your next appointment, you can simply say:
“Since menopause I’ve noticed changes in my bladder and during sex, and I’ve read this might be genitourinary syndrome of menopause. Can we talk about it?”
That one sentence does three things. It names the symptom without you having to find the words in the moment. It signals that you have done your reading and expect to be taken seriously. And it gives the conversation somewhere to go.
If your doctor brushes it off, that is information about the doctor, not about whether your concern is valid. You are allowed to ask again, or to ask someone else.
Why we are saying this out loud
We could have written another piece about hot flashes. It would have been easier, and more of you would have shared it without a second thought.
But SecondSpring exists for the whole of this stage, including the parts that are harder to say. A symptom this common should not be the one nobody mentions. Naming it is not oversharing, it is how the shame loses its grip, and how the woman reading this realizes she was never the only one.
If you recognized yourself in any of this, you are in very good, very large company. Save this. Send it to a friend who would never bring it up first. And, when you are ready, bring it to someone who can actually help.
Sources
- Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. American Urological Association, 2025. Link
- Genitourinary Syndrome of Menopause. StatPearls, NCBI Bookshelf (NBK559297). Link
- Genitourinary syndrome of menopause: a systematic review on prevalence and treatment. 2021. Link
- Genitourinary syndrome of menopause: Common problem, effective treatments. Cleveland Clinic Journal of Medicine, 2018;85(5):390. Link
- Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. Mayo Clinic Proceedings, 2017. Link
- Cedars-Sinai. What You Should Know About Genitourinary Syndrome of Menopause. Link
- Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA), results from an international survey. Climacteric, 2012;15(1):36–44. (n=3,520 postmenopausal women, 7 countries, source of the “4% could name the cause” figure. Western cohort; no Philippine data.) Link