Vaginal moisturizers & lubricants
Regular-use moisturizers for daily comfort and lubricants for intimacy. Simple, available without a prescription, and genuinely effective for milder symptoms, alone or alongside other treatments.
Genitourinary syndrome of menopause, or GSM, is the medical name for what declining estrogen does to the vagina, vulva, urethra, and bladder. Dryness. Burning. Pain with intimacy. Urinary urgency. Infections that keep coming back. Roughly half of postmenopausal women experience it,1 and most are never told it has a name, let alone a treatment.
It is also one of the most treatable conditions in this practice. The tissue changes behind GSM respond directly to low-dose vaginal estrogen and other targeted therapies, and improvement is the rule, not the exception.
Medically reviewed by Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S., board-certified urogynecologist · Last reviewed August 2026
Fellowship-Trained
Most patients assume these symptoms are simply what menopause is. They are not something you have to live with.
Estrogen maintains the thickness, elasticity, blood flow, and healthy bacterial balance of the vaginal and lower urinary tract tissue. When estrogen declines, in menopause, after surgical removal of the ovaries, during breast cancer treatment, or with prolonged breastfeeding, that tissue thins and dries. The vagina, vulva, urethra, and bladder all share this estrogen-dependent tissue, which is why one hormonal change produces symptoms across all of them.
Before 2014, this condition went by names like vaginal atrophy or atrophic vaginitis. The medical community adopted “genitourinary syndrome of menopause” because the old names captured only part of the picture. The urinary symptoms, the urgency, the burning, the recurring infections, are the part most often missed, and the part a urogynecology practice is specifically built to treat.
Unlike hot flashes, which typically fade with time, GSM is progressive.2 Without treatment, the tissue changes continue. With treatment, they reverse.
Most GSM treatment happens right where the problem is: at the tissue itself. The mainstays are low-dose therapies applied vaginally, which restore the tissue directly with minimal absorption into the rest of the body. Here is the toolbox, in the order we typically work through it.
Regular-use moisturizers for daily comfort and lubricants for intimacy. Simple, available without a prescription, and genuinely effective for milder symptoms, alone or alongside other treatments.
The cornerstone of GSM treatment: a cream, tablet, insert, or ring that delivers a small dose of estrogen directly to the vaginal tissue. It restores thickness, elasticity, and moisture, and it is the recommended therapy for reducing recurrent urinary tract infections in postmenopausal women.3 Because the dose is low and local, very little reaches the bloodstream. This is not the systemic hormone therapy you may have read warnings about.
A nightly vaginal insert that the tissue converts to estrogen and testosterone locally. An effective option for dryness and painful intercourse, particularly for patients who prefer an alternative to estrogen.
A once-daily oral medication that acts selectively on vaginal tissue. An option for moderate to severe painful intercourse when vaginal therapies are not preferred.
GSM often travels with pelvic floor muscle dysfunction, and treating the tissue without treating the muscle produces partial results. Where indicated, PT is part of the plan.
Supplements, herbal products, and over-the-counter “hormone-balancing” regimens are heavily marketed for these symptoms. The clinical evidence does not support them, and we will tell you that directly rather than let you spend months and money finding out.
An unhurried first visit with Dr. Johnson. Time to be listened to. In-office evaluation, no separate facility.
Dr. Johnson has read your intake before you walk in. The conversation starts with what these symptoms are doing to your life, your sleep, your relationship, your confidence.
A gentle, explained-at-every-step exam of the vulvar and vaginal tissue. Nothing happens without your full awareness and consent.
GSM symptoms can mimic infections, skin conditions like lichen sclerosus, and other disorders. A specialist evaluation makes sure the diagnosis is right before the treatment starts.
Every option explained: what it is, how long until you feel a difference, and what it means for your week. Most patients notice meaningful improvement within six weeks, with full effect over two to three months.
No, and this is the single most important thing to understand about GSM treatment. The warnings you remember came from studies of systemic hormone therapy, pills and patches that raise hormone levels throughout the body. Low-dose vaginal estrogen works locally, at the tissue, with minimal absorption into the bloodstream. Professional guidelines treat it as a distinct therapy with a distinct safety profile. For the overwhelming majority of my patients, it is a safe, effective, long-term treatment. If you have a history of breast cancer, we have that conversation individually, often in coordination with your oncologist.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
Often, everything. The urethra and bladder depend on estrogen just as vaginal tissue does. When estrogen declines, the tissue thins and the protective bacterial balance shifts, and infections that used to be rare become a cycle. Current urology and urogynecology guidelines recommend low-dose vaginal estrogen specifically to reduce recurrent UTIs in postmenopausal women. If you are on your third or fourth infection this year and no one has examined the underlying tissue, that is the missing piece.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
No. Pain with intimacy is one of the most common GSM symptoms and one of the most responsive to treatment. Restoring the tissue with local therapy, sometimes alongside pelvic floor physical therapy, returns comfort for most patients. The patients who tell me they wish they had come in years earlier are usually the ones who came in for this.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
Most patients notice improvement within about six weeks, with full benefit over two to three months. GSM is a chronic condition: the estrogen decline that causes it does not reverse on its own, so symptoms typically return if treatment stops. Most patients stay on a low maintenance dose long-term, with periodic follow-up visits to review symptoms, the treatment itself, and whether it still earns its place. Nothing here is set-and-forget.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
Yes, in nearly all cases. GSM is a medical condition, not a cosmetic concern, and evaluation and prescription treatment are covered under standard medical benefits, including Medicare. Our team verifies your specific coverage before your first visit. The insurance page has the current accepted-plan list.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
Yes. Vaginal atrophy, atrophic vaginitis, and urogenital atrophy are the older names for the same condition. The medical community adopted genitourinary syndrome of menopause in 2014 because the old terms described only the vaginal changes and left out the urinary side: the urgency, the burning, the recurring infections. If a clinician has told you that you have vaginal atrophy, this page describes your condition, and everything on it applies to you.
— Lisa L. Johnson, M.D., F.A.C.O.G., U.R.P.S.
Most new patients are seen within five business days. Your first visit with Dr. Johnson is unhurried, and you will leave with a written plan, and a name for what has been happening, which for many patients is half the relief.
We see patients from across Chicagoland's southwest suburbs at our Oak Lawn, Oak Brook, and Orland Park offices.