Perimenopause vaginal dryness is part of a medical syndrome called GSM — Genitourinary Syndrome of Menopause — that also affects your bladder, urethra, sexual function and tissue health. Unlike hot flashes, GSM does not improve on its own. It progressively worsens without treatment. The 2025 AUA guideline — the most comprehensive ever produced — confirms safe, effective treatments exist, from local vaginal oestrogen to pelvic floor physiotherapy. Most women are never offered