After menopause, a woman who presents with a burning sensation like a urinary tract infection (UTI) may well have genitourinary syndrome of menopause (GSM), formally called vulvovaginal atrophy or atrophic vaginitis.

Women often will tell their doctors they have a UTI because that what it feels like, and they are often treated for a UTI and receive antibiotics, even though a culture turns up no bacteria.

The cause of the pain during urination can occur not as the result of a bacterial infection but because the skin on the vagina is thin and cracked. For many of these women, urination is like lemon juice on a paper cut.

Other symptoms of genitourinary syndrome of menopause include incontinence, decreased arousal and painful sex.

All of the symptoms of GSM are related to a drop in circulating estrogen after menopause. There are estrogen receptors in the vagina, vulva and musculature of the pelvic floor. Decreased circulating estrogen can lead to vaginal dryness and decreased lubrication during sexual activity.

Surveys find from 45% to 63% of postmenopausal women report vulvovaginal symptoms, most commonly vaginal dryness.

In the absence of vasomotor symptoms, the ideal treatment is topical vaginal estrogen, which is available by prescription and can restore local estrogen levels. This is different from systemic hormone replacement therapy and doesn’t result in a sustained increase in serum estrogen levels.

Women who prefer to avoid estrogen can use hyaluronic acid-based moisturizers, which are sold under a variety of brand names. Endogenous hyaluronic acid is present in the vaginal lining and other tissues and has a unique ability to retain water.

As a urogynecologist, my advice is to keep GSM in mind in postmenopausal women. Any postmenopausal woman with complaints of vaginal dryness, pain with intercourse, urinary symptoms or frequent urinary tract infections should get a vaginal exam for hypoestrogenism.

Ryan Stewart, D.O.,is a urogynecologist with Norton Urogynecology Center.