Genitourinary syndrome of menopause (GSM) is a long-term condition caused by the reduction of estrogen after menopause. It affects the vagina, vulva, and lower urinary tract, leading to symptoms such as dryness, discomfort during sex, urinary irritation, and tissue thinning. A recent clinical study published in Menopause (2026) examined how GSM differs between women who experience surgical menopause and those who undergo natural menopause. The findings suggest that surgical menopause is linked to more severe symptoms and more pronounced physical changes.
This blog provides a overview of that study, its methods, and its implications for women’s health.
GSM develops when estrogen levels drop, causing changes in hormone-sensitive tissues. These changes include reduced vaginal lubrication, thinning of the vaginal lining, decreased elasticity, and alterations in urinary tract function. Over time, these effects can lead to discomfort, pain during intercourse, urinary frequency, and increased vulnerability to infection.
The severity of GSM varies widely among women. Some experience mild symptoms, while others develop significant physical and emotional distress that affects sexual health and quality of life. Researchers have been interested in whether the type of menopause, natural or surgical, influences how severe these symptoms become.
The study by Özmen and colleagues (2026) examined 422 postmenopausal women attending a gynecology clinic in Türkiye. Of these, 218 had undergone surgical menopause due to removal of the uterus and ovaries, while 204 had natural menopause.
The researchers used a structured clinical scoring system to measure GSM severity. This system evaluated eight physical components:
Each category was scored from 0 to 3, producing a total score ranging from 0 to 22. Higher scores indicated more severe GSM changes.
In addition, participants were asked about symptoms such as dryness, pain during intercourse, urinary frequency, dysuria, postcoital bleeding, and reduced sexual desire.
The study found clear differences between the two groups.
Women with surgical menopause had higher total GSM scores than those with natural menopause. On average, their vaginal and urinary tract tissues showed more advanced signs of estrogen deficiency.
Several specific areas were more affected in the surgical menopause group:
In terms of symptoms, women with surgical menopause reported more frequent:
A statistical analysis showed that the total GSM score was independently associated with surgical menopause. In practical terms, as the GSM score increased, the likelihood of a woman belonging to the surgical menopause group also increased.
The researchers suggest that the difference is related to how menopause occurs. In natural menopause, estrogen levels decline gradually over time. In surgical menopause, especially when both ovaries are removed, estrogen levels drop suddenly.
This abrupt hormonal change may not give the body enough time to adapt. As a result, vaginal and urinary tissues may experience faster and more severe atrophy. The study supports the idea that estrogen deprivation has a more immediate and intense effect when it occurs suddenly.
Previous research has also suggested that women with surgical menopause often develop GSM symptoms earlier and with greater severity compared to those with natural menopause.
One of the important aspects of this study is the use of a structured GSM scoring system. Instead of relying only on symptoms reported by patients, clinicians also assessed physical signs during examination.
This combined approach helps provide a more complete understanding of GSM severity. The study suggests that the total GSM score may be a useful clinical tool for identifying women who need earlier or more intensive treatment.
For example, higher scores may indicate the need for early interventions such as:
The authors also emphasize that GSM should not be viewed as a normal part of aging alone, but as a treatable medical condition that can significantly affect quality of life.
The study highlights an important clinical message: GSM is often underdiagnosed and underreported. Many women may not discuss symptoms such as dryness or discomfort due to embarrassment or the belief that these changes are inevitable.
However, untreated GSM can have a strong impact on sexual health, urinary function, and emotional well-being. Recognizing the difference between surgical and natural menopause can help healthcare providers identify higher-risk patients earlier.
The findings also suggest that preserving ovarian function during gynecological surgery, when medically appropriate, may help reduce long-term GSM severity.
The study has several limitations. It was conducted at a single medical center and used a retrospective design, which means it analyzed existing patient data rather than following participants over time. This limits the ability to observe long-term changes.
In addition, some clinical factors such as pelvic floor health, surgical techniques, and patient-reported severity scales were not fully included. The scoring system also depends partly on clinician judgment, which may introduce variability.
Despite these limitations, the overall pattern of results was consistent and statistically significant.
This study provides strong evidence that surgical menopause is associated with more severe genitourinary syndrome of menopause compared with natural menopause. Women who undergo surgical removal of the ovaries appear to experience greater tissue changes and more frequent symptoms related to vaginal and urinary health.
The findings support the use of structured GSM scoring in clinical practice and highlight the importance of early assessment and treatment, especially in surgically menopausal women. Recognizing GSM as a multidimensional condition rather than a minor consequence of aging may improve care and quality of life for many patients.
Özmen, S., Balci, M. F., Atay, A. O., Ozdogar, O. N., & Onal Erdemir, D. (2026). Genitourinary syndrome of menopause in surgical versus natural menopause: standardized clinical scoring. Menopause.
This article is a rewritten educational summary based on a peer-reviewed medical study. It is intended for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Individual symptoms and medical decisions should always be discussed with a qualified healthcare professional.
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