Evidence-based treatments for GSM include: Hormone therapy Systemic hormone therapy is used to treat vasomotor symptoms of menopause (hot flashes and night sweats) and often will sufficiently treat GSM. However, for some women systemic HT will not be sufficient and local vaginal HT should be used. Low dose local hormone therapies include a variety of estrogen delivery options — vaginal creams, rings, tablets and inserts. The dose of hormones is very low and gets hormones just to the vulvovaginal tissues.Moisturizers and lubricantsMoisturizers and lubricants don’t treat the underlying issue — the lack of estrogen — or the existing tissue damage, but they can help keep you comfortable.Vaginal moisturizers are creams that you apply regularly, two or three times a week. You don’t use them during sex.Lubricants may help with vaginal dryness during sex. There are a number of options to choose from. Your best bet is to use a lubricant with:A pH level of 3.8 to 4.5 (this matches the pH of your vagina)An osmolality (a fancy word for how many particles are in the lube) lower than 1200 (too high and it actually pulls moisture out of the tissue). If the label doesn’t list this, it’s probably too high.As few ingredients as possible. The cleaner, the better!Pelvic floor physical therapists specialize in providing specialized physical therapy when there is pelvic floor dysfunction. GSM can result in pain during sex and consequently, vaginismus—the involuntary tightening of the pelvic floor muscles due to anticipatory anxiety and fear of penetration. Vaginismus is a common condition for women to experience.Pelvic floor physical therapy to improve vaginismus may involve increasing awareness of pelvic muscles, learning relaxation techniques, increasing vaginal elasticity and tone, and providing ways to stretch the vaginal opening. Pelvic floor physical therapy may be combined with the use of vaginal dilators. Vaginal dilators can help reduce the fear and anxiety of penetration by gradually stretching the vaginal tissue and promoting pelvic floor muscle relaxation.