{ "schemaVersion": 2, "eyebrow": "Menopause care", "title": "Genitourinary Syndrome of Menopause", "summary": "A practical approach to confirming GSM, excluding competing vulvovaginal and urinary pathology, selecting local therapies, and individualizing treatment for patients with breast cancer or systemic hormone contraindications.", "seoDescription": "Physician guide to diagnosis and treatment selection for genitourinary syndrome of menopause, including vaginal estrogen, nonhormonal options, cancer survivorship, and urinary symptoms.", "clinicalQuestion": "How should clinicians diagnose and treat GSM while accounting for urinary symptoms, cancer history, and hormone-related risk?", "specialty": "Obstetrics and Gynecology", "audience": "U.S. physicians and medical trainees", "tags": [ "genitourinary syndrome of menopause", "vaginal estrogen", "vulvovaginal atrophy", "dyspareunia", "recurrent urinary tract infection", "breast cancer survivorship", "ospemifene", "prasterone" ], "keyTakeaways": [ "Do not attribute bleeding, focal vulvar lesions, purulent discharge, or persistent urinary symptoms automatically to GSM; evaluate alternative gynecologic, dermatologic, infectious, and urinary causes before escalating therapy.", "For bothersome GSM, low-dose vaginal estrogen is minimally absorbed, does not require progestogen for endometrial protection in patients with an intact uterus, and can be considered when systemic menopausal hormone therapy is contraindicated. [9]", "Local vaginal estrogen can improve dysuria, urinary frequency, urgency, and recurrent urinary tract infections; systemic menopausal hormone therapy may worsen urinary incontinence. [14]", "In breast cancer survivors, start with nonhormonal moisturizers and lubricants; persistent moderate-to-severe symptoms require individualized discussion of vaginal estrogen or other options with attention to tumor biology and oncology treatment. [3][14][16]", "Do not offer vaginal laser or radiofrequency as established replacement therapy for GSM; randomized evidence remains limited, and sham-controlled trials have reported procedure-related adverse effects without a clear safety or efficacy advantage. [16][21]" ], "sections": [ { "id": "clinical-assessment", "eyebrow": "Diagnostic branch point", "heading": "Confirm GSM while identifying findings that require a different workup", "intro": "Treat empirically only when the clinical pattern is concordant and no alarm feature is present.", "paragraphs": [ "GSM is a clinical syndrome encompassing vulvovaginal and lower urinary tract symptoms associated with estrogen deficiency; the symptom cluster may include dryness, burning, irritation, dyspareunia, dysuria, urgency, and recurrent urinary tract infections. [10][16] At the first visit, document the dominant domain—penetrative pain, vulvar burning, urinary urgency/dysuria, recurrent culture-confirmed UTI, or mixed symptoms—because treatment response and competing diagnoses differ by domain.", "Perform a focused vulvar, vaginal, and pelvic examination when symptoms are new, severe, refractory, or accompanied by bleeding, discharge, focal pain, or a visible lesion. A lesion, erosive process, marked architectural change, purulent discharge, abnormal uterine bleeding, or a palpable pelvic mass should redirect evaluation toward vulvar dermatosis or neoplasia, vaginitis or sexually transmitted infection, cervical/endometrial pathology, pelvic floor dysfunction, or bladder disease rather than escalation of GSM therapy.", "For dysuria, urgency, or recurrent UTI, obtain urinalysis and urine culture when infection is clinically plausible; do not label persistent urinary symptoms as estrogen deficiency after a negative or discordant infectious evaluation without reassessing the pelvic examination and bladder differential. Urinary complaints during menopause have multiple contributors and are not all attributable solely to estrogen deficiency. [14]" ], "bullets": [ "Escalate abnormal uterine or postmenopausal bleeding to a bleeding evaluation before prescribing vaginal hormone therapy. [7]", "Biopsy or refer a persistent focal vulvar lesion, ulcer, pigment change, or unexplained architectural distortion rather than treating repeatedly as GSM.", "Review prior pelvic radiation, antiestrogen therapy, chemotherapy-induced menopause, endocrine therapy adherence, and sexual pain history; cancer treatments, tamoxifen, and aromatase inhibitors can intensify hypoestrogenic genital symptoms. [16]" ], "subsections": [], "table": { "caption": "Clinical pattern determines the next diagnostic step.", "columns": [ "Presentation", "Interpretation", "Next action" ], "rows": [ [ "Dryness, burning, dyspareunia with compatible examination", "GSM is likely when symptoms and examination are concordant. [10][16]", "Begin symptom-directed nonhormonal or local therapy; reassess response." ], [ "Dysuria, urgency, recurrent UTI symptoms", "May reflect GSM, infection, overactive bladder, or another urinary disorder; menopause alone does not explain all urinary symptoms. [14]", "Use urinalysis and culture when UTI is plausible; reassess if symptoms persist after infection is excluded or treated." ], [ "Bleeding, purulent discharge, focal lesion, ulcer, or mass", "Not a routine GSM presentation.", "Perform targeted gynecologic, infectious, dermatologic, or oncologic evaluation before attributing symptoms to GSM." ] ] } }, { "id": "initial-treatment", "eyebrow": "First-line management", "heading": "Match treatment intensity to symptom severity and treatment goals", "intro": "Choose a vaginal therapy for isolated GSM; do not use systemic therapy solely when local treatment meets the goal.", "paragraphs": [ "For mild symptoms or for patients avoiding hormones, use vaginal moisturizers on a regular schedule and lubricants with sexual activity. In breast cancer survivors, these nonhormonal options are generally the initial approach, but their benefit is typically mild and short term. [16] Reassess the specific symptom driving distress—dyspareunia, dryness, burning, or urinary symptoms—rather than continuing an ineffective product indefinitely.", "For persistent bothersome GSM, low-dose vaginal estrogen is an effective local option delivered as cream, tablet, insert, suppository, or local silicone ring. [7][9] Low-dose vaginal estrogen is minimally absorbed and does not require concomitant progesterone in patients with an intact uterus. [9] Verify that a vaginal ring is a local low-dose product rather than a systemically delivering ring before prescribing. [7]", "Use systemic menopausal hormone therapy only when there is a separate systemic indication, such as vasomotor symptoms or prevention of bone loss and fracture risk, and then account for uterine status and cardiovascular/thrombotic risk. [9] Estrogen alone in a patient with an intact uterus increases endometrial hyperplasia and cancer risk and should be paired with a progestin or an endometrial-protective SERM strategy when systemic therapy is used. [9] Oral formulations are associated with hypertriglyceridemia, venous thromboembolism, and elevated high-sensitivity C-reactive protein; observational data suggest transdermal estrogen may carry less venous thromboembolism and stroke risk than oral estrogen. [9]" ], "bullets": [ "For isolated vaginal symptoms, prefer a low-dose local vaginal product over systemic menopausal hormone therapy. [7][9]", "Ask at follow-up whether urinary urgency, dysuria, frequency, or culture-confirmed UTI burden has changed; localized vaginal estrogen has demonstrated benefit for these urinary manifestations. [14]", "If symptoms persist despite correct and consistent use, repeat the examination and reconsider pelvic floor, dermatologic, infectious, bladder, or pain-related contributors before changing treatment class." ], "subsections": [], "table": { "caption": "Therapy selection for GSM by clinical context.", "columns": [ "Clinical context", "Preferred next step", "Key limitation or safeguard" ], "rows": [ [ "Mild dryness or intercourse-related discomfort", "Regular vaginal moisturizer plus lubricant with sexual activity. [16]", "Expect primarily mild, short-term symptom relief. [16]" ], [ "Persistent bothersome isolated GSM", "Low-dose vaginal estrogen by cream, tablet, insert, suppository, or local ring. [7][9]", "Confirm local rather than systemic ring formulation. [7]" ], [ "Intact uterus receiving low-dose vaginal estrogen", "No concomitant progestogen is required. [9]", "Evaluate unexplained vaginal bleeding rather than assuming a local-treatment effect. [7]" ], [ "Systemic vasomotor symptoms plus GSM", "Consider systemic menopausal hormone therapy only after individualized risk assessment; add endometrial protection if uterus is intact. [9]", "Oral therapy has hepatic first-pass-associated metabolic and thrombotic tradeoffs. [9]" ], [ "Urinary urgency, dysuria, frequency, or recurrent UTI associated with GSM", "Consider localized vaginal estrogen after appropriate urinary assessment. [14]", "Do not assume all urinary symptoms are caused by estrogen deficiency. [14]" ] ] } }, { "id": "nonestrogen-options", "eyebrow": "When local estrogen is unsuitable", "heading": "Use prasterone or ospemifene selectively, not as interchangeable substitutes", "intro": "Alternative agents are most useful when local estrogen is ineffective, unsuitable, unavailable, or unacceptable.", "paragraphs": [ "Vaginal prasterone (dehydroepiandrosterone) is an alternative pharmacologic option when nonhormonal products or vaginal estrogen are ineffective or unsuitable. [14] It may be particularly relevant when a patient cannot tolerate a local estrogen formulation, but treatment selection in cancer survivors remains individualized because robust safety data in gynecologic cancer survivors are limited. [14]", "Oral ospemifene is a selective estrogen receptor modulator and the only FDA-approved oral treatment for GSM. [17] It may be useful when local therapy cannot be tolerated or accessed, including situations such as post-radiation vaginal stenosis, but its systemic exposure and limited safety data in gynecologic cancer survivors require a different risk discussion from low-dose vaginal estrogen. [14]", "Avoid presenting energy-based vaginal devices as equivalent to established medical therapies. CO2 laser and radiofrequency have been studied, including randomized sham-controlled trials, but evidence remains uncertain; in breast cancer survivor trials, pain during treatment was common and one trial reported adverse effects in 37% of laser-treated participants versus 27% of sham-treated participants, without differences in incidence or severity. [16][21]" ], "bullets": [ "Consider vaginal prasterone when nonhormonal therapy and vaginal estrogen are ineffective or unsuitable. [14]", "Consider oral ospemifene when a patient cannot use or obtain local treatment, while recognizing its systemic SERM exposure. [14][17]", "Reserve laser or radiofrequency for research-oriented or carefully counseled settings, not as routine first-line or replacement treatment. [16][21]" ], "subsections": [], "table": { "caption": "Nonestrogen and device-based options have distinct practical roles.", "columns": [ "Option", "Potential role", "Decision-limiting issue" ], "rows": [ [ "Vaginal prasterone", "Alternative when nonhormonal therapy or vaginal estrogen is ineffective or unsuitable. [14]", "Safety evidence is limited in gynecologic cancer survivors. [14]" ], [ "Oral ospemifene", "Oral FDA-approved GSM treatment when local therapy is not tolerated or accessible. [14][17]", "Systemic SERM exposure and limited cancer-survivor safety data require individualized selection. [14]" ], [ "CO2 laser or radiofrequency", "Not established as routine therapy. [16][21]", "Sham-controlled evidence and procedure-related adverse effects do not support substituting it for established treatments. [16][21]" ] ] } }, { "id": "cancer-survivorship", "eyebrow": "High-stakes context", "heading": "Individualize GSM therapy in breast cancer survivors and patients with systemic hormone contraindications", "intro": "Separate local GSM treatment decisions from systemic hormone therapy decisions.", "paragraphs": [ "Breast cancer survivors often have more severe vulvovaginal atrophy and symptom burden than postmenopausal women without breast cancer; chemotherapy, tamoxifen, and aromatase inhibitors can worsen the hypoestrogenic genital environment. [16] Ask whether symptoms threaten sexual function, sleep, urinary health, or adherence to adjuvant endocrine therapy, because the severity of functional impact determines whether limited nonhormonal relief is acceptable.", "Begin with nonhormonal moisturizers and lubricants in breast cancer survivors. [16] For persistent moderate-to-severe GSM, vaginal estrogen may be considered after individualized assessment and, when appropriate, discussion with the oncology team; decisions should account for cancer type, tumor biology, current endocrine therapy, symptom severity, and patient priorities. [3][14]", "Do not extrapolate the low systemic absorption of local therapy to systemic menopausal hormone therapy. In patients with an intact uterus, systemic estrogen requires endometrial protection; oral systemic formulations also carry first-pass-associated hypertriglyceridemia and venous thromboembolism tradeoffs. [9] In patients with prior spontaneous coronary artery dissection, reassess the indication for systemic hormone therapy and discontinue it unless there is a compelling reason to continue; recurrent GSM after stopping systemic therapy can prompt coordinated consideration of local treatment. [6]" ], "bullets": [ "Document the specific breast cancer treatment—tamoxifen, aromatase inhibitor, chemotherapy, radiation, or none—before selecting hormonal therapy. [16]", "Use shared decision-making for persistent symptoms in hormone-sensitive cancer survivors; involve oncology when the decision could affect endocrine therapy or perceived recurrence risk. [3][14]", "Distinguish local low-dose vaginal therapy from systemic estrogen products at every medication reconciliation. [7][9]" ], "subsections": [], "table": { "caption": "Escalation framework for GSM in breast cancer survivorship.", "columns": [ "Clinical scenario", "Management direction", "Required decision point" ], "rows": [ [ "Mild symptoms", "Moisturizer and lubricant first. [16]", "Assess whether relief is sufficient and whether symptoms affect endocrine therapy adherence." ], [ "Persistent moderate-to-severe symptoms", "Consider vaginal estrogen after individualized assessment; consider oncology discussion when appropriate. [3][14]", "Account for tumor biology, endocrine therapy, severity, and patient priorities. [14]" ], [ "Local estrogen ineffective or unsuitable", "Consider vaginal prasterone or oral ospemifene selectively. [14][17]", "Discuss limited cancer-survivor safety data, particularly for gynecologic cancer survivors. [14]" ], [ "Considering systemic menopausal hormone therapy", "Treat as a separate systemic-risk decision, not a default escalation for local GSM. [9]", "Assess uterine status and cardiovascular/thrombotic risks; provide endometrial protection if uterus is intact. [9]" ] ] } }, { "id": "monitoring-and-escalation", "eyebrow": "Follow-up", "heading": "Monitor symptom-specific benefit and investigate nonresponse", "intro": "The endpoint is functional improvement, not normalization of examination findings alone.", "paragraphs": [ "At follow-up, measure the outcome that prompted treatment: pain with penetration, dryness/burning, urinary urgency or dysuria, frequency of culture-confirmed UTI, and ability to continue cancer-directed endocrine therapy. For urinary presentations, improvement with localized estrogen supports a GSM contribution, but persistent symptoms still warrant reassessment because urinary symptoms have multifactorial causes. [14]", "Re-examine patients with persistent pain, recurrent bleeding, new discharge, lesion development, or no meaningful benefit after an adequate treatment trial. Nonresponse should trigger reconsideration of vulvar dermatoses, infection, pelvic floor dysfunction, painful bladder conditions, structural disease, medication effects, or malignancy rather than serial empiric treatment changes.", "For patients receiving systemic menopausal hormone therapy for an independent indication, reassess route and ongoing indication periodically. Transdermal treatment may be preferable to oral therapy for patients with moderate cardiovascular risk because available observational evidence suggests lower venous thromboembolism and stroke risk, although large randomized comparisons are lacking. [9]" ], "bullets": [ "Stop and evaluate new unexplained vaginal bleeding before further hormonal escalation. [7]", "Repeat urinalysis and culture for recurrent dysuria or UTI-like symptoms when infection remains plausible.", "Refer persistent focal vulvar findings for diagnostic evaluation rather than repeated treatment for presumed GSM." ], "subsections": [], "table": { "caption": "Failure of symptom-directed treatment should change the diagnostic plan.", "columns": [ "Follow-up finding", "Interpretation", "Next step" ], "rows": [ [ "Meaningful improvement in vaginal and/or urinary symptoms", "Current treatment is addressing a GSM component. [14]", "Continue the effective strategy and monitor symptom-specific function." ], [ "Persistent urinary symptoms despite treatment", "GSM may be incomplete or not the principal cause; urinary symptoms are multifactorial. [14]", "Reassess with urinalysis/culture when indicated and evaluate alternative bladder or pelvic causes." ], [ "Persistent focal pain, lesion, discharge, or bleeding", "Features are not explained adequately by uncomplicated GSM.", "Repeat examination and pursue targeted gynecologic, dermatologic, infectious, or oncologic evaluation." ], [ "No benefit from correctly used nonhormonal therapy", "Symptom burden may require local pharmacologic therapy or an alternate diagnosis.", "Consider low-dose vaginal estrogen when appropriate, or selective alternatives such as prasterone or ospemifene. [9][14][17]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Genitourinary syndrome of menopause among breast cancer ...", "detail": "gocm.bmj.com", "url": "https://gocm.bmj.com/content/gocm/5/3/e000089.reviewer-comments.pdf", "authors": "gocm.bmj.com", "host": "gocm.bmj.com" }, { "number": 2, "title": "BMJ Open is committed to open peer review. 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Genitourinary Syndrome of Menopause: A Systematic Review - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK609623", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 23, "title": "The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause | Journal of Urology", "detail": "www.auajournals.org", "url": "https://www.auajournals.org/doi/full/10.1097/JU.0000000000004589", "authors": "www.auajournals.org", "host": "www.auajournals.org" }, { "number": 24, "title": "References - Genitourinary Syndrome of Menopause: A Systematic Review - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK609636", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Genitourinary syndrome of menopause among breast cancer ...", "detail": "gocm.bmj.com", "url": "https://gocm.bmj.com/content/gocm/5/3/e000089.reviewer-comments.pdf", "authors": "gocm.bmj.com", "host": "gocm.bmj.com", "snippet": "narrative review authored by the reviewer. While the review provides a comprehensive summary, our manuscript prioritizes referencing original data and consensus guidelines to maintain objectivity and comply with journal recommendations on referencing style and citation balance. Additionally, we have", "score": 0.5654673 }, { "number": 2, "title": "BMJ Open is committed to open peer review. As ...", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/bmjopen/15/11/e104711.draft-revisions.pdf", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "The National Institute of Health and Care Excellence (NICE) Guideline. JAMA internal medicine 2016, 176, 1205–1206 Portman, D.J.; Gass, M.L.S. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The ", "score": 0.50476116 }, { "number": 3, "title": "a randomised clinical trial protocol comparing multimod", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/bmjopen/15/11/e104711.full.pdf", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "The National Institute of Health and Care Excellence (NICE) Guideline. JAMA Intern Med 2016;176:1205–6. 8 Portman DJ, Gass MLS, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society fo", "score": 0.5019781 }, { "number": 4, "title": "Genitourinary syndrome of menopause induced by breast ...", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/15/11/e104711", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "by M Torres-Lacomba · 2025 — Genitourinary syndrome of menopause (GSM) is a prevalent condition among breast cancer survivors, often exacerbated by oncological treatments.", "score": 0.3397405 }, { "number": 5, "title": "An empowerment model for managing menopause - The Lancet", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2823%2902799-X/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "## What is menopause?\n\n02799-X/asset/1e0ac215-de21-413c-90b4-7108c5fa5cf4/main.assets/gr2.jpg)\n\n## Predicting the onset of menopause\n\n## What symptoms are caused by menopause?\n\n### Vasomotor symptoms\n\n### Muscle and joint pains\n\n### Sleep disturbance\n\n### Genitourinary symptoms\n\n### Other symptoms\n\n", "score": 0.07311853 }, { "number": 6, "title": "Spontaneous Coronary Artery Dissection: Current State of ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/cir.0000000000000564", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Patients who experience SCAD while receiving HT should have their indications for HT reassessed, and unless there are compelling reasons to continue, HT should be discontinued. Indications for initiation of exogenous HT include premature and early surgical menopause, severe vasomotor symptoms that c", "score": 0.14053692 }, { "number": 7, "title": "Menopause Hormone Therapy After Spontaneous Coronary Artery Dissection: A Gap in the Literature", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacadv.2026.102641", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Establish the symptoms: Next, a provider must clarify if a patient is experiencing VMS or genitourinary symptoms. If the patient is experiencing genitourinary syndrome of menopause, including vaginal dryness, dyspareunia, or recurrent urinary tract infections, vaginal estrogen and vaginal dehydroepi", "score": 0.71113056 }, { "number": 8, "title": "Should This Patient Receive Hormone Therapy for Her ...", "detail": "annals.org", "url": "https://annals.org/doi/10.7326/M17-3320", "authors": "annals.org", "host": "annals.org", "snippet": "Genitourinary syndrome of menopause is common. there is a 2-fold increased risk for VTE and a complicated story on breast cancer risk.", "score": 0.4622066 }, { "number": 9, "title": "Improving Cardiovascular Clinical Competencies for the Menopausal Transition: A Focus on Cardiometabolic Health in Midlife", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacadv.2025.101791", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Low-dose vaginal estrogen therapies for treatment of genitourinary syndrome of menopause are minimally absorbed and do not require concomitant progesterone therapy in those with an intact uterus. Additionally, it can be considered in some women in whom systemic MHT is contraindicated.78 There are lo", "score": 0.41577685 }, { "number": 10, "title": "CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1743609521008304", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Need help with access?\n\n## Section snippets\n\n### INTRODUCTION\n\nGenitourinary Syndrome of Menopause (GSM) is a condition encompassing changes resulting from loss of oestrogen production on the female genitourinary tract.\n\nThe nomenclature was proposed in 2014 during a consensus conference of experts,", "score": 0.6607204 }, { "number": 11, "title": "CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1743609521008304", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Original Research & Reviews Female Sexual Function CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or G", "score": 0.5325473 }, { "number": 12, "title": "Revitalizing research in genitourinary syndrome of menopause", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002937818322798", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "* D.J. Portman _et al._ ### 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 ### J Sex Med (2014) ### Laser therapy for the genitourinary syndrome of menopause:", "score": 0.47139415 }, { "number": 13, "title": "The 2020 genitourinary syndrome of menopause position... : Menopause", "detail": "journals.lww.com", "url": "https://journals.lww.com/menopausejournal/fulltext/2020/09000/the_2020_genitourinary_syndrome_of_menopause.5.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. This position statement was developed by The North American Menopause Society (NAMS) consisting of representatives of the NAMS Board of Trustees and other experts in women's health: Stephanie S. ", "score": 0.4272061 }, { "number": 14, "title": "Menopausal hormone therapy and comprehensive ...", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.71188", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "Urinary symptoms during menopause result from multiple factors, and existing evidence does not clearly link all complaints solely to estrogen deficiency. Although systemic MHT might aggravate urinary incontinence, localized vaginal estrogen treatment has been effective in alleviating dysuria, urinar", "score": 0.6191726 }, { "number": 15, "title": "Genitourinary syndrome of menopause (GSM)", "detail": "academic.oup.com", "url": "https://academic.oup.com/smr/article/14/1/qeaf055/8261468", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by JA Simon · 2026 · Cited by 20 — Recently, vaginal estrogen has been suggested as first-line therapy for the prevention of these rUTIs.50 Therefore, for urinary symptoms, which are more likely", "score": 0.5993685 }, { "number": 16, "title": "Laser and radiofrequency for treating genitourinary syndrome of menopause in breast cancer survivors: A systematic review of randomized controlled trial - Serquiz - 2026 - International Journal of Gynecology & Obstetrics - Wiley Online Library", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.70665", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "Given the controversy surrounding estrogen-based treatments, non-hormonal therapies like lubricants and vaginal moisturizers are typically the first-line choice.6 However, these options offer only mild efficacy, usually providing short-term relief without addressing urogenital aging.7, 8 Currently, ", "score": 0.5792344 }, { "number": 17, "title": "Genitourinary Syndrome of Menopause - Marino - 2021", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13277", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Ospemifene (Osphena) is an SERM and the only FDA-approved treatment for GSM that is taken orally. Ospemifene has proven efficacy for improving", "score": 0.56258565 }, { "number": 18, "title": "Impact of Vaginal Estradiol on the Genitourinary Syndrome of ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article/82/4/e710/8373761", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Vaginal estradiol is safe and effective for treatment of the genitourinary syndrome of menopause (GSM) 25% or less receive treatment", "score": 0.53881395 }, { "number": 19, "title": "Physical methods for the treatment of genitourinary syndrome ...", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13561", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "Dec 22, 2020 — Laser and radiofrequency therapy could be promising and safe non-estrogenic therapeutic options for genitourinary syndrome of menopause for", "score": 0.5005133 }, { "number": 20, "title": "FDA Boxed Warning Removal on Menopause Hormone ...", "detail": "agsjournals.onlinelibrary.wiley.com", "url": "https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70256", "authors": "agsjournals.onlinelibrary.wiley.com", "host": "agsjournals.onlinelibrary.wiley.com", "snippet": "Local low-dose vaginal estrogen, in particular, is endorsed by guidelines as the first-line treatment for treating GSM [5]. We urge our", "score": 0.42405477 }, { "number": 21, "title": "The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause", "detail": "www.auajournals.org", "url": "https://www.auajournals.org/doi/10.1097/JU.0000000000004589", "authors": "www.auajournals.org", "host": "www.auajournals.org", "snippet": "40. . A systematic review of randomised clinical trials—the safety of vaginal hormones and selective estrogen receptor modulators for the treatment of genitourinary menopausal symptoms in breast cancer survivors. Post Reprod Health.2023; 29(4):222-231. doi: 10.1177/20533691231208473Crossref, Medline", "score": 0.72814995 }, { "number": 22, "title": "Abbreviations and Acronyms - Genitourinary Syndrome of Menopause: A Systematic Review - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK609623", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Danan ER, Diem S, Sowerby C, et al. Genitourinary Syndrome of Menopause: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Jul. (Comparative Effectiveness Review, No. 272.)\n\nCover of Genitourinary Syndrome of Menopause: A Systematic Review\n\n## Geni", "score": 0.5849357 }, { "number": 23, "title": "The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause | Journal of Urology", "detail": "www.auajournals.org", "url": "https://www.auajournals.org/doi/full/10.1097/JU.0000000000004589", "authors": "www.auajournals.org", "host": "www.auajournals.org", "snippet": "Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee. function in postmenopausal women: a randomized controlled trial. doi: 10.1016/j.maturitas.2012.11.012 Crossref, Medline, Google Scholar. . Endometrial safety of lo", "score": 0.56690645 }, { "number": 24, "title": "References - Genitourinary Syndrome of Menopause: A Systematic Review - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK609636", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Danan ER, Diem S, Sowerby C, et al. Genitourinary Syndrome of Menopause: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Jul. (Comparative Effectiveness Review, No. 272.)\n\nCover of Genitourinary Syndrome of Menopause: A Systematic Review\n\n## Geni", "score": 0.5407062 } ], "publishedAt": "2026-08-24T17:57:23.359555+00:00", "updatedAt": "2026-08-24T17:57:23.359555+00:00", "readingMinutes": 6, "slug": "genitourinary-syndrome-of-menopause" }