GSM care starts with moisturizers and lubricants, then local hormones when needed. Energy devices have weaker evidence and are not first-line treatment.
Genitourinary syndrome of menopause (GSM) describes bothersome vulvovaginal, sexual, and some urinary symptoms linked to lower estrogen and androgen effects on the genitourinary tract. Dryness, burning, irritation, pain with sex, and recurrent urinary complaints are common and often underdiagnosed. Care is a clinical service, not a spa “rejuvenation.” The North American Menopause Society (now The Menopause Society, NAMS) states that first-line therapy for many women is nonhormone lubricants with sexual activity and regular long-acting vaginal moisturizers. For moderate to severe GSM, or symptoms that persist, several government-approved options have stronger evidence: low-dose vaginal estrogen, vaginal DHEA (prasterone), oral ospemifene, and systemic estrogen when bothersome vasomotor symptoms are also present.
The 2025 AUA/SUFU/AUGS guideline likewise supports offering local low-dose vaginal estrogen for dryness, irritation, and dyspareunia, and recommends moisturizers or lubricants alone or with other therapies. Evaluation should distinguish GSM from infection, vulvar dermatoses, pelvic floor pain, medication effects, and malignancy warning signs. Postmenopausal bleeding always requires evaluation, regardless of which GSM product you use.
Energy-based devices have weaker evidence. NAMS concluded there are insufficient placebo-controlled trials of laser and other energy-based therapies to draw efficacy and safety conclusions or to make treatment recommendations. The FDA has warned against using energy-based devices for “vaginal rejuvenation” or cosmetic vaginal procedures because of burns, scarring, pain with sex, and chronic pain. A cash-pay laser series is not equivalent to an FDA-approved vaginal estrogen, DHEA insert, or ospemifene prescription.
People with a history of estrogen-dependent breast cancer should start with nonhormonal care. ACOG allows consideration of low-dose vaginal estrogen after shared decision-making if nonhormonal measures fail; aromatase-inhibitor users need the gynecologist and oncologist in that discussion. Systemic menopausal hormone therapy is not required solely for local symptoms and has a different risk profile. Reasonable goals are less dryness and less pain with sex—not a guaranteed return of desire or a cosmetic change.
Write when dryness, pain, or urinary symptoms started and list all hormones, aromatase inhibitors, tamoxifen, and vaginal products. Do not ignore postmenopausal bleeding. Bring oncology records if you have a hormone-sensitive cancer history. Avoid a new over-the-counter steroid or “tightening” cream the day of the exam unless your clinician asked you to use it.
Moisturizers, lubricants, and most local prescriptions have no downtime. Mild irritation can occur when a product is started; persistent burning, rash, or bleeding should be reported. Device procedures, if you still choose them after counseling, have separate consent and recovery rules and are not required for standard GSM care.
Missed infection, dermatosis, or cancer is the main diagnostic harm. Local hormones can cause irritation or spotting; any postmenopausal bleeding needs evaluation. Systemic hormone therapy has different clot, stroke, and cancer considerations and is not required for local symptoms alone. Energy devices can burn or scar and lack strong GSM outcome data. Self-directed compounded hormones from a spa skip monitoring and oncology input.
The Menopause Society (NAMS): 2020 GSM Position Statement (PDF)
https://menopause.org/docs/default-source/default-document-library/2020-gsm-ps.pdfThe Menopause Society: Genitourinary Syndrome of Menopause (patient)
https://menopause.org/patient-education/menopause-topics/genitourinary-syndrome-of-menopauseAUA/SUFU/AUGS: Genitourinary Syndrome of Menopause Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopauseACOG: Urogenital Symptoms After Estrogen-Dependent Breast Cancer
https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer© 2026 Longevity Clinic Finder. All rights reserved.
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FDA: Warning on energy-based vaginal rejuvenation devices
https://www.fda.gov/medical-devices/safety-communications/fda-warns-against-use-energy-based-devices-perform-vaginal-rejuvenation-or-vaginal-cosmetic-procedures-fda-safety-communicationPerimenopausal and postmenopausal people with bothersome vulvovaginal, sexual, or selected urinary symptoms after examination. It is not appropriate as a cosmetic “rejuvenation” package, or as the only response to bleeding, a visible lesion, or untreated pelvic pain. Breast-cancer history needs oncology-informed shared decision-making before local hormones.
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