Vaginal health: Pharmacist highlights GSM and the simple cure

Genitourinary syndrome of menopause (GSM) is a condition that affects a broad slice of women during perimenopause and after, but it remains widely under discussed. Researchers and clinicians note that estrogen decline can alter the pelvic tissues, urinary tract and surrounding structures, leading to dryness, irritation and pain. A new wave of attention is being led by pharmacist Laura Dowling, known to thousands as the Fabulous Pharmacist and founder of fabÜ health. Dowling’s work, including her book Love Your Vulva, centers on breaking taboos around intimate health and equipping women with practical guidance for managing GSM and related changes.

Her approach gained renewed attention after recounting a clinic anecdote involving a patient in her seventies who had endured repeated vaginal discomfort for years. In a private chat at the pharmacy, the woman described severe vaginal dryness that caused pain with wiping, making it painful to sit or ride a bicycle, and ending an active sex life with her partner. Dowling asked questions that led to a different diagnosis; the patient did not have thrush, she had advanced dryness. The woman ultimately received estrogen therapy in addition to local vaginal treatments. Within three weeks she reported relief from pain, and after four months she and her husband resumed intimacy. Dowling notes that, since that moment, she has repeatedly heard from the patient’s husband, who sends holiday cards to the pharmacist.

GSM is not a single disease but a spectrum of changes that can affect the vulva, vagina, urethra and bladder. The condition is most common when estrogen levels decline as part of the aging process, but the onset and intensity vary widely from one woman to another. In Dowling’s framing, understanding GSM is essential because its symptoms—vaginal dryness, burning, itching, pain during sex, and urinary urgency or frequency—can be persistent and disabling if ignored.

To put the scale in context, estimates cited in patient-facing materials and physician education notes suggest that roughly 80% of women experience some form of GSM during or after the transition to menopause. The condition can affect appearance and function: thinning or loss of elasticity in vulvar and vaginal tissues, reduced lubrication, and changes in the pelvic floor. The impact is not limited to physical comfort; it can influence mood, sexual relationships and self-image. Dowling argues that the problem is amplified when women feel invisible in healthcare settings, particularly older patients who fear being dismissed because of age.

The central message in Love Your Vulva is that GSM is highly treatable. Local vaginal estrogen therapy—through pessaries, creams or rings—has the strongest evidence base for restoring moisture and tissue elasticity with minimal systemic absorption. For women who cannot or prefer not to use hormones, non-hormonal options such as vaginal moisturisers and lubricants can provide meaningful relief. Consistency matters: symptoms often return if treatment is stopped, so ongoing management is key.

GSM reflects a broader understanding of estrogen as the master regulator of the female body. Estrogen receptors exist in many tissues beyond the reproductive system, including urinary and pelvic structures, skin and brain. When estrogen levels wane, tissues that rely on these receptors can become thinner, drier and more fragile. The perimenopausal transition can also bring a range of physical and psychological symptoms, from joint aches and fatigue to mood changes and cognitive fluctuations. While many resources describe these broader effects, Dowling’s emphasis is on the pelvic region and its intimate health, an area often neglected in conversations about aging.

Understanding GSM means recognizing a spectrum of symptoms. In some women, vaginal dryness and irritation are the principal issues; others experience urinary symptoms such as urgency, frequency or infections. In clinical guidance, doctors describe changes to the vulvar and vaginal mucosa, the vaginal opening and canal, and the surrounding tissues. The scope includes the urethra and pelvic floor muscles, which can influence continence and overall pelvic health. The syndrome’s variability means that care plans are often individualized, combining lifestyle adjustments, moisturisers, lubricants and, when appropriate, hormonal therapies.

Managing GSM begins with non-hormonal strategies, which Dowling frames as the first line of defense for many patients. Regular use of vaginal moisturisers—applied consistently rather than just before sexual activity—can improve tissue hydration and elasticity. Water-based products are commonly recommended, with certain formulations containing ingredients such as sodium hyaluronate or glycerol to support moisture. Lubricants, used during sexual activity, come in water-based, silicone-based and oil-based varieties, each with pros and cons regarding longevity, compatibility with condoms and sex toys, and potential residue on fabrics.

Lifestyle adjustments also play a role. Dowling highlights avoiding irritants such as scented soaps, bubble baths, and perfumed liners that can disrupt the vaginal ecosystem. Regular sexual activity or vaginal stimulation is suggested to promote blood flow and tissue health, though comfort and choice should guide each person’s behavior. These non-hormonal measures are often used in combination with targeted hormonal therapies when symptoms are moderate to severe.

When non-hormonal options are insufficient, local vaginal estrogen therapies are considered the gold standard. Pessaries, creams or gels containing estrogen aim to restore moisture and elasticity with low systemic exposure. In certain cases, other hormonal options such as dehydroepiandrosterone (DHEA) vaginal pessaries or even systemic hormone replacement therapy may be discussed, depending on a patient’s overall health profile and preferences. The field has also seen a rise in private offerings like vaginal laser therapy, which doctors describe as an option for select patients, though its adoption and long-term efficacy vary by clinic.

Beyond treatments, Dowling’s work stresses education and empowerment for women across age groups. The author argues that aging should not erase a person’s sense of comfort, confidence or sexual well-being. The narrative in Love Your Vulva centers on real patients and lived experiences to counter stigma and encourage dialogue between patients and health-care providers.

The practical takeaway, according to Dowling, is that GSM can be managed with a combination of targeted therapies and daily health practices. For women in nursing homes or other settings where access to care may be more complex, consistent use of vaginal estrogen under medical supervision can reduce urinary infections and related delirium, contributing to better overall well-being. The emphasis remains on open communication, timely examinations and adherence to treatment plans tailored to each individual’s needs.

Love Your Vulva is available in bookstores, and Dowling notes the importance of making information accessible so that more women can recognize GSM symptoms early and seek appropriate care. By reframing intimate health as a normal and important part of overall wellness, the book and Dowling’s broader advocacy aim to reduce shame and create a healthier dialogue around women’s health across the lifespan.