What is GSM?

Genitourinary syndrome of menopause, also known as GSM, is a collection of symptoms caused by low levels of the hormone oestrogen in the body. Genitourinary means it relates to the parts of the body involved in having children and going for a wee. In women, these body parts include the vagina, uterus, cervix, ovaries, fallopian tubes, kidneys, bladder, ureters and urethra.1,2

People that may have a lower than usual level of oestrogen include those that have been through the menopause, had treatment for breast cancer, or are at high risk of breast cancer.2

Having lower than usual oestrogen levels can lead to a range of symptoms such as:3

  • Genital symptoms (relating to the reproductive system): dryness; a burning sensation; and irritation
  • Sexual symptoms: dryness and lack of lubrication; discomfort or pain; and impaired function
  • Toilet symptoms: urgency to go for a wee; pain or a burning sensation when urinating; and recurrent urinary tract infections

People with GSM may have some, or all, of these symptoms. The exact symptoms someone experiences will depend on the type of treatment they have and how long it is taken for, among other factors.4

Key facts about GSM 

  • Women treated for breast cancer are 5x more likely to have menopausal symptoms than women without breast cancer5
  • The common treatment for menopausal symptoms – hormonal therapy – often cannot be used in breast cancer survivors5
  • Many women don’t discuss their gynaecological worries with their medical team6

Why might hormone levels be affected by treatment for breast cancer?

Some treatments for breast cancer work by lowering the amount of oestrogen in the body. By doing this, they stop fuelling the cancer cells to grow and survive in the body.7

However, the lower levels of oestrogen may cause other effects in the body. It may affect the genital structures and lining of the vagina. This may affect your genital and sexual health and overall quality of life and wellbeing.4

If you are struggling with these issues, it’s important to talk to your doctor or healthcare team.

How can I lower my risk of GSM? Or reduce the severity of symptoms if I have it?

There are some ways you can potentially lower your risk of getting GSM and manage any symptoms you may have. Leading a healthy lifestyle is a way to improve your overall health – including your genitourinary health. Here are some tips to improve your overall health when living with menopause:4,8

  • Eat a healthy diet
  • Keep to a healthy weight – read more about healthy weight here9
  • Get regular moderate exercise
  • Keep vitamin D levels normal
  • Avoid alcohol and smoking
  • If you wish to, it’s fine to remain sexually active – this may improve blood and lymphatic vessel flow in the area and reduce symptoms
  • Get any underlying medical conditions treated

Medical therapies may be used to treat GSM. Some of these treatments are hormonal, but these may not be appropriate for people that have had, or are having, hormone treatment for their breast cancer. Vaginal lubricants and moisturisers may be offered. These can be used by most people with GSM, regardless of which treatment they had for their breast cancer, to help with symptoms. Talk to your medical team about which treatment might be best for you.4,8

Hormonal changes are a part of many people’s breast cancer journey – but everyone copes differently.4,10 By being aware of potential side effects of breast cancer treatment, such as GSM, and speaking with your doctor as soon as you notice anything unusual, you are in a better place to get the support you need to manage your symptoms.4,11

References

  1. American Cancer Society. Female Genitourinary System. Available from: https://www.cancer.org/cancer/understanding-cancer/anatomy-gallery/female-genitourinary-system.html [Accessed June 2025].
  2. Cleveland Clinic. Genitourinary syndrome of menopause in breast cancer survivors. Available from: https://consultqd.clevelandclinic.org/genitourinary-syndrome-of-menopause-in-breast-cancer-survivors [Accessed June 2025]
  3. 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.
  4. López DML. Management of genitourinary syndrome of menopause in breast cancer survivors: An update. World J Clin Oncol 2022;13(2):71–100.
  5. Cancer Australia. Cancer Australia guidelines. Management of menopausal symptoms in women with a history of breast cancer. November 2024. Available at: https://www.canceraustralia.gov.au/clinical-practice-guidelines/management-menopausal-symptoms-women-history-breast-cancer [Accessed June 2025].
  6. Sousa MS, et al. A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy. Ther Adv Med Oncol 2017;9(4):269–285.
  7. Cancer Research UK. Hormone therapy for breast cancer. Available from: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/hormone-therapy [Accessed June 2025].
  8. González AF, et al. Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients. Clin Transl Oncol 2025 Mar;27(3):909-934.
  9. NHS. Healthy weight. Available from: https://www.nhs.uk/live-well/healthy-weight/ [Accessed June 2025].
  10. CRUK. Coping and support when you have breast cancer. Available at: https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/coping-support [Accessed June 2025].
  11. Diez de los Rios de la Serna C, et al. Early Recognition and Management of Side Effects Related to Systemic Anticancer Therapy for Advanced Breast Cancer. Seminars in Oncology Nursing 2024:40(1);151553.