What causes vaginal atrophy (GSM)?

The causes behind GSM symptoms

Where to find the causes

Published guidance files vaginal atrophy, also called genitourinary syndrome of menopause (GSM), under menopause. For the specific causes, read the cause section of the Cleveland Clinic page on vaginal atrophy, then ask your clinician which of them fits your own timeline.

Reading the cause sections side by side

A good cause question has two parts. What changed in the body, and why did it change then? Those are separate questions, and a source can answer one well and skim the other.

Read the cause section of each source on its own. Check whether two sources name the same causes in the same order, and whether either one leans on a single study. The MedlinePlus menopause overview gives the general menopause background, so you can see which symptoms the guidance groups together before you read about any one of them.

Then read the sexual health material from a medical society. The Menopause Society's sexual health topic page is one place to find it. A cause that shows up in all three places is stronger than one that shows up in a single place.

Taking the cause question to a clinician

Bring the cause question to a clinician along with your own timeline. Notes on when symptoms started, what else changed around then, and which medicines you take make the answer specific to you instead of general.

Questions worth asking:

• Which cause is most likely in my case, and what makes you say so?
• Is there another explanation we should rule out?
• What would change your answer?

If a clinician gives you one explanation with no alternatives, asking for a second opinion is reasonable.

What a source comparison cannot tell you

Comparing published guidance on causes of GSM side by side does not diagnose a cause for you. Discuss symptoms and treatment decisions with a licensed clinician who knows your history.