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Genitourinary syndrome of menopause

moderate Evidence strength  ·  Status: published  ·  Source agreement: high

What the literature reports

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.

Citations

• AUA / SUFU / AUGS — 2025 Guideline on Genitourinary Syndrome of Menopause — American Urological Association / SUFU / AUGS (Journal of Urology) (2025)
  First-line local estrogen; no endometrial surveillance required (limited data).
• The Menopause Society — 2020 Genitourinary Syndrome of Menopause Position Statement (Menopause, 2020) — The Menopause Society (Menopause journal) (2020)
  Mild symptoms: non-prescription relief; moderate-severe: vaginal estrogens, DHEA, systemic estrogen, ospemifene.

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.

Provenance

This entry is resolved from per-source signals; the raw claims are the audit trail behind it.

• Machine record: /data/sites/genitourinary-syndrome-menopause.yml (schema-valid, verbatim)
• 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
• First recorded 2026-07-10 · last updated 2026-07-10

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