How to Manage Symptoms of GSM -The Role of Physiotherapy & Other Interventions

A multi-modal treatment approach

Because GSM reflects both tissue (hormonal) change and functional/structural change (muscle, connective tissue, nerves, vaginal/urethral tissue), the best outcomes come from combining interventions rather than relying on a single treatment.

Major management options include:

• Lifestyle and behavioural strategies (e.g., avoiding irritants, ensuring adequate hydration, bladder/bowel habit optimisation)
• Over-the-counter non-hormonal measures (vaginal lubricants, moisturisers)
• Local (vaginal) oestrogen therapy or other hormone therapies
• Pelvic floor muscle training and pelvic health physiotherapy
• Other specialist/gynaecologic interventions when needed (e.g., selective oestrogen receptor modulators, laser therapies)

How physiotherapy (pelvic floor) can assist

As a pelvic health physiotherapist, Jessica Dingle brings a unique role in this integrated management. Here are some key areas:

1. Pelvic Floor Muscle Training (PFMT): Recent evidence suggests that PFMT is feasible and beneficial in women with GSM symptoms. For example, a 12-week program of pelvic floor muscle training showed statistically significant improvements in symptoms and quality of life in a cohort of post-menopausal women.
2. Tissue health, muscle coordination and relaxation: Many women with GSM may have pelvic floor muscle tightness/overactivity (especially if pain with intercourse) or muscle weakness/support issues (if incontinence). A tailored assessment and treatment plan — including manual therapy, biofeedback, muscle re-education, relaxation, functional integration — can help restore muscle tone, improve circulation to the region, improve coordination and reduce dysfunction.
3. Bladder and bowel habit education: Since urinary symptoms are part of GSM, physiotherapists can help with bladder retraining, voiding habits, managing urgency/frequency, improving pelvic floor responsiveness in those contexts.
4. Sexual health and intimacy support: Because GSM often impacts sexual comfort (pain, dryness, penetration difficulties), you can provide strategies such as dilator training, guidance about safe lubrication and insertion techniques, pelvic floor relaxation specifically for intercourse, and collaborative care with a gynaecologist or sex-therapist.
5. Empowerment and self-management: One of the great benefits of physiotherapy is that women become active participants — learning exercise, lifestyle habits, proprioception, functional movement, posture/biomechanics (which also affect pelvic floor health) and feel less helpless. As one blog puts it: “Proactive management significantly improves quality of life”.

Where medical/other interventions fit

• Vaginal (local) oestrogen therapy remains first-line for moderate-to-severe GSM symptoms, particularly when dryness/atrophy is significant. The recent American Urological Association / Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction / American Urogynecologic Society guideline underscores this.
• Non-hormonal lubricants and moisturisers: Particularly suitable for women who cannot or prefer not to use hormones.
• Systemic hormone therapy or selective oestrogen receptor modulators may be considered in some cases (though beyond the scope of physiotherapy per se).
• Some emerging therapies (energy-based devices, lasers) are under investigation but currently have less robust evidence for long-term outcomes.

Why seeing a specialist pelvic health physiotherapist like Jessica Dingle is valuable

• We bring specialist training in pelvic floor anatomy, neuromuscular coordination, and women’s pelvic health — which many general physiotherapists may not emphasise.
• We provide a holistic view addressing both the musculoskeletal/pelvic floor component and the functional genital/urinary changes of GSM.
• We support  women to move from passive receipt of treatment (e.g., “just use this cream”) to active management (exercise, habits, self-care) which tends to yield longer-lasting benefit.
• By working collaboratively with the woman’s medical team, we help ensure that her pelvic floor function is optimised in conjunction with appropriate medical/hormonal therapy — offering a more comprehensive and effective intervention.

Key take-home messages

• If you have symptoms of vaginal dryness, burning, intercourse pain or urinary changes during or after menopause — these are not just “part of getting older” and they are treatable.
• Early intervention matters: waiting for symptoms to “get better on their own” is not the best approach because GSM tends to persist or worsen without treatment.
• A combination of approaches works best — and pelvic floor physiotherapy is a vital part of that combination.
• As your pelvic health physiotherapist, I can work with you to assess, plan and implement an individualised programme that complements your medical care, improves your comfort, confidence and quality of life — so you can focus on what matters, not just “getting through” menopause.

References

Mercier J, Dumoulin C, Carrier-Noreau G. Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when? Climacteric. 2023;26(4):302-308. doi:10.1080/13697137.2023.2194527.

Carrion–Perez L, et al. Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: a feasibility study. Maturitas. 2018;116:48-53. doi:10.1016/j.maturitas.2018.06.019.

The North American Menopause Society (NAMS). The 2020 GSM Position Statement. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609.

Simon JA, Nappi RE, Chedraui P, Clark AL, Gompel A, Nasreen SZ, Palacios S, Wolfman W. Genitourinary syndrome of menopause (GSM): recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024). Sexual Medicine Reviews. 2025 (in press). doi:10.1093/sxmrev/qeaf055.

Mayo Clinic Proceedings. Genitourinary syndrome of menopause: overview and management. Mayo Clin Proc. 2017;92(12):1842-1853. doi:10.1016/j.mayocp.2017.09.003.