Genitourinary Syndrome of Menopause: A Recognized Clinical Diagnosis
Yes, genitourinary syndrome of menopause (GSM) is an established medical diagnosis that replaced the outdated terms "vulvovaginal atrophy" and "atrophic vaginitis" in 2014. 1, 2, 3
Definition and Clinical Significance
GSM describes a constellation of genital, sexual, and urinary symptoms caused by hypoestrogenism in postmenopausal women that are not attributable to other medical conditions. 2, 3 The terminology change was necessary because the older terms failed to capture the full spectrum of urogenital symptoms and did not explicitly link them to estrogen deficiency. 3
Core Symptom Categories
GSM encompasses three distinct but often overlapping symptom domains:
- Genital symptoms: vaginal dryness, burning, and irritation 3
- Sexual symptoms: lack of lubrication, dyspareunia (painful intercourse), and impaired sexual function 1, 3
- Urinary symptoms: urgency, dysuria, recurrent urinary tract infections, and increased urinary frequency 1, 3
Epidemiology and Clinical Impact
GSM affects 27% to 84% of postmenopausal women, making it an extremely common condition. 4 Despite its high prevalence, GSM remains chronically underdiagnosed and undertreated because women are often embarrassed to report symptoms and healthcare providers frequently fail to screen for it. 1, 5, 4
The condition is chronic and progressive, requiring early recognition and appropriate management to preserve urogenital health and quality of life. 2, 5
Diagnostic Recognition in Clinical Guidelines
Multiple authoritative sources explicitly recognize GSM as a distinct clinical entity:
- The American College of Obstetricians and Gynecologists provides specific treatment recommendations for GSM 6, 7
- The North American Menopause Society published a comprehensive 2020 position statement on GSM management 4
- The National Comprehensive Cancer Network includes GSM in their clinical guidelines 6, 7
- The ACR Appropriateness Criteria for postmenopausal pelvic pain specifically addresses vaginal atrophy (a component of GSM) as a recognized cause of perineal, vulvar, or vaginal pain 8
Clinical Pitfalls to Avoid
Do not dismiss these symptoms as "normal aging." While GSM is related to the natural decline in estrogen after menopause, it is a treatable medical condition that significantly impairs quality of life and sexual function. 5, 4
Do not wait for patients to volunteer symptoms. Active screening is essential because most women will not spontaneously report genitourinary symptoms due to embarrassment. 1, 5
Do not confuse GSM with other conditions. The diagnosis requires that symptoms are attributable to hypoestrogenism and not to other medical conditions such as lichen sclerosus, infections, or malignancy. 2
Treatment Framework
The recognition of GSM as a formal diagnosis has led to evidence-based treatment algorithms:
- First-line for mild symptoms: vaginal lubricants and moisturizers 6, 4
- First-line for moderate-to-severe symptoms: low-dose vaginal estrogen therapy, which is the gold standard treatment 6, 7, 4
- Alternative options: ospemifene (oral SERM), vaginal DHEA (prasterone), or systemic hormone therapy depending on contraindications and patient preference 6, 7, 4