Vaginal Dryness After Menopause (GSM) Support

Also called genitourinary syndrome of menopause, GSM, vaginal atrophy, vulvovaginal atrophy, atrophic vaginitis

Vaginal dryness, painful sex, and urinary symptoms after menopause are common and treatable. When a provider prescribes a vaginal preparation, Mixwell in Chino, CA prepares it.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

Speak with our pharmacist Send a prescription

Signs people notice

Vaginal dryness
Burning, itching, or irritation
Pain or discomfort during sex
Less natural lubrication during sex
Needing to urinate urgently or often
Burning with urination
Urinary tract infections that keep coming back

Clinical Overview

What is genitourinary syndrome of menopause?

Genitourinary syndrome of menopause, or GSM, is the name for vaginal, sexual, and urinary symptoms caused by lower estrogen after menopause. The term replaced vulvovaginal atrophy in 2014 because the changes affect the vulva, vagina, and urinary tract together [1].

Who has it

GSM affects roughly 27% to 84% of postmenopausal women and can impair health, sexual function, and quality of life. It is likely underdiagnosed and undertreated, and in most cases symptoms can be managed effectively [2].

Menopause also changes the bacteria that live in the vagina, which the CDC lists among the risk factors for urinary tract infections [5].

How it is treated

Options depend on how severe the symptoms are. They include over the counter vaginal lubricants and moisturizers, prescription vaginal estrogen, vaginal DHEA, systemic hormone therapy, and ospemifene, a tablet [2]. Long term studies on the uterine lining with vaginal estrogen, vaginal DHEA, and ospemifene are lacking, and there is not enough evidence to recommend vaginal laser treatments [2].

In November 2025 the FDA began removing boxed warnings about heart disease, breast cancer, and dementia from menopausal hormone therapy labels. In February 2026 it approved the first updated labels, including one for a vaginal estrogen product [3].

How Compounding Can Help

Most women with GSM do well on over the counter or FDA approved products [2]. A compounding pharmacy fills specific gaps when a prescriber orders it.

Estriol vaginal creams and suppositories, since estriol has no FDA approved product in the United States
Versions without an ingredient the patient reacts to, such as a preservative or fragrance
A strength or base the approved products do not offer
Suppository forms for patients who prefer them to a cream and applicator

Compounded hormones are not FDA reviewed, and a national review recommends reserving them for allergies to an ingredient in approved products or dosage needs those products cannot meet [6]. Your provider decides which option fits.

Common Formulas Prescribers Order for This

Non-sterile vaginal preparation — est...Estriol Vaginal (Ellage)Technical details Non-sterile combination vaginal prepa...Estriol / Estradiol Vaginal (Ellage® Anhydrous)Technical details Non-sterile combination vaginal prepa...Dehydroepiandrosterone (DHEA) / Estriol Vaginal (Ellage)Technical details Non-sterile compounded vaginal suppos...Estriol / Progesterone Vaginal SuppositoryTechnical details

Each formula is prepared only with a valid prescription. Your prescriber decides what is appropriate.

What to ask your provider

Could my symptoms be genitourinary syndrome of menopause?
Should I start with a lubricant or moisturizer before a prescription?
Is vaginal estrogen right for me, given my health history?
What did the FDA's labeling update change for the product you are recommending?
Is there a reason to use a compounded preparation rather than an approved one?
How long before I should expect to notice a difference, and when should we follow up?

Call (909) 378-7301

Common Questions

Is vaginal dryness after menopause common?

Very. Genitourinary syndrome of menopause affects roughly 27% to 84% of postmenopausal women, and it is often underdiagnosed. It is a physical change in the tissue caused by lower estrogen, and in most cases it can be treated effectively. Talk with your provider about options.

Did the FDA remove the boxed warning from vaginal estrogen?

In November 2025 the FDA began removing boxed warnings about heart disease, breast cancer, and dementia from menopausal hormone therapy labels. In February 2026 it approved the first six updated labels, including a vaginal estrogen product, with more expected. Ask your prescriber how the change applies to you.

What is estriol, and why is it compounded?

Estriol is a form of estrogen with no FDA approved product in the United States, so prescribers who want it order it from a compounding pharmacy. Compounded hormones are not FDA reviewed, and national guidance favors approved products unless a patient has an allergy or a dosage need they cannot meet.

Are compounded hormones safer than FDA approved hormones?

No. National reviews describe safety concerns with compounded hormone therapy, including limited regulation, dosing that can run high or low, and the absence of a label listing risks. Compounded preparations are not reviewed by the FDA. They exist for patients who cannot use an approved product, and that decision belongs to your prescriber.

Do I need a prescription for a compounded medication?

Yes. Every compounded preparation is made for one patient with a valid prescription from a licensed prescriber, such as a physician, nurse practitioner, dentist, or veterinarian. If you do not have one yet, ask your provider whether a compounded preparation fits your situation, and they can send the order to us.

References

Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063 to 1068.
The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976 to 992. doi:10.1097/GME.0000000000001609
U.S. Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. February 12, 2026. FDA news release
American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124 to e129. doi:10.1097/AOG.0000000000002631
Centers for Disease Control and Prevention. Urinary tract infection basics. CDC
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: National Academies Press; 2020. doi:10.17226/25791

Menopause & Perimenopause SupportMenopause and perimenopause bring cycle changes, hot flashes, and sleep trouble. When a provider prescribes...Read more

Compounded in Chino, CA. Delivered across California.

Chino
Chino Hills
Ontario
Pomona
Diamond Bar
Rancho Cucamonga
Eastvale

Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Mixwell is a state licensed, non sterile compounding pharmacy and a PCCA member, preparing each formula in a lab built to USP 795 and USP 800 standards. Compounded medications are not reviewed or approved by the FDA and are dispensed only with a valid prescription. We do not prepare sterile products or injectables. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products. Mixwell does not accept insurance. Call for pricing.

Call pharmacist Send Rx