The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause

Abstract

Purpose: Genitourinary syndrome of menopause (GSM) describes the symptoms and physical changes that result from declining estrogen and androgen concentrations in the genitourinary tract during the menopausal transition. There has not been a consensus reached about the number or type of symptoms needed to diagnose GSM, and the associated urinary symptoms are also linked with other common urologic conditions such as overactive bladder. This guideline provides information to clinicians regarding identification, diagnosis, counseling, and treatment for patients with GSM to optimize symptom control and quality of life while minimizing adverse events.

Materials and methods: The systematic review utilized in the creation of this guideline is based on research conducted by the Minnesota Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality and funded by the Patient Centered Outcomes Research Institute. The Evidence-based Practice Center extracted and synthesized effectiveness and/or harms outcomes from 68 publications. An additional 66 publications evaluating 46 non-hormonal interventions, were described in an evidence map.

Results: Clinicians diagnose GSM based on symptoms, with or without related physical findings, and after ruling out other etiologies or co-occurring pathologies. There is a large body of evidence examining the use of hormonal and non-hormonal treatment options to manage the symptoms of GSM; however, the local low-dose vaginal estrogen has the most robust evidence base.

Conclusions: The strategies defined in this document were derived from evidence-based and consensus-based processes. Given that there is insufficient information to recommend one hormonal therapy over another, this guideline is not meant to support a stepwise progression through different hormonal approaches. The clinician should make treatment decisions in the context of shared decision-making considering patient goals and preferences, using the evidence of efficacy and adverse events of each possible intervention as a guide.

Keywords: dryness; dyspareunia; genitourinary syndrome of menopause; recurrent UTI; shared decision-making; vaginal estrogen; vulvovaginal discomfort; irritation.