id: genitourinary-syndrome-menopause
title: "Genitourinary syndrome of menopause"
kind: symptom
summary: >-
  Genitourinary syndrome of menopause (GSM; also called vaginal atrophy or
  vulvovaginal atrophy) encompasses genital, urinary, and sexual symptoms
  associated with menopause. The AUA/SUFU/AUGS 2025 guideline reports
  symptom-based diagnosis, shared decision-making, and local (vaginal) estrogen
  as a first-line therapy. For mild symptoms, The Menopause Society's 2020
  position statement reports that non-prescription nonhormone therapies provide
  sufficient relief for most women. For moderate-to-severe GSM, low-dose
  vaginal estrogens, vaginal dehydroepiandrosterone (DHEA), systemic estrogen
  therapy, and ospemifene are reported as effective treatments. The 2025
  guideline reports that patients using local estrogen, vaginal DHEA, or
  ospemifene do not require endometrial surveillance, as limited data suggest
  these treatments do not increase the risk of endometrial hyperplasia or
  cancer. This entry summarizes what the literature reports for navigation and
  is not medical advice.
evidence_strength: moderate
status: published
sources:
  - url: https://www.auajournals.org/doi/10.1097/JU.0000000000004589
    title: "AUA / SUFU / AUGS — 2025 Guideline on Genitourinary Syndrome of Menopause"
    publisher: American Urological Association / SUFU / AUGS (Journal of Urology)
    date: "2025"
    note: "First-line local estrogen; no endometrial surveillance required (limited data)."
  - url: https://menopause.org/wp-content/uploads/default-document-library/2020-gsm-ps.pdf
    title: "The Menopause Society — 2020 Genitourinary Syndrome of Menopause Position Statement (Menopause, 2020)"
    publisher: The Menopause Society (Menopause journal)
    date: "2020"
    note: "Mild symptoms: non-prescription relief; moderate-severe: vaginal estrogens, DHEA, systemic estrogen, ospemifene."
signals:
  - sig-20260710-gsm-first-line-local-estrogen
  - sig-20260710-gsm-mild-nonprescription
  - sig-20260710-gsm-moderate-severe-treatments
  - sig-20260710-gsm-no-endometrial-surveillance
confidence: high
first_seen: "2026-07-10"
last_updated: "2026-07-10"
notes: >-
  Maps to entities.yml `genitourinary-syndrome-menopause` (kind: symptom). The
  signals' site_hint labels GSM as a "topic", but the canonical entity
  registers it as a symptom; kind follows the entity per profile — discrepancy
  flagged. Two independent bodies (AUA/SUFU/AUGS 2025 and The Menopause Society
  2020) concur on local vaginal estrogen as first-line and on the moderate-to-
  severe treatment set, so confidence is high. evidence_strength: moderate —
  sources are society/urology guidelines; the endometrial-surveillance safety
  claim rests on explicitly "limited data" per the 2025 guideline. Local
  vaginal estrogen is also catalogued as its own intervention entry
  (`vaginal-estrogen`), kept distinct from this symptom entry per profile.