Age Distribution of Genitourinary Syndrome of Menopause
Genitourinary Syndrome of Menopause (GSM) affects more than half of postmenopausal women and becomes increasingly prevalent with advancing age after menopause, with symptoms typically emerging within the first few years following the median age of menopause (51 years) and affecting 27-84% of postmenopausal women. 1, 2, 3
Peak Age of Presentation
GSM symptoms typically begin in the early postmenopausal years (ages 51-60), as estrogen levels decline following the median age of menopause at 51 years in the United States 4, 1
The prevalence increases progressively with time since menopause, affecting 44-57% of middle-aged and postmenopausal women aged 40-60 years and up to 75% of elderly women aged 75 years and older 5
Unlike vasomotor symptoms (hot flashes) that often resolve spontaneously over time, GSM symptoms are progressive and persist throughout a woman's remaining life without treatment, making it more prevalent in older postmenopausal women 1, 6
Age-Related Prevalence Patterns
The condition affects 27-84% of postmenopausal women overall, with the wide range reflecting differences in symptom severity, willingness to report symptoms, and study methodology 2, 3
Symptoms may begin during perimenopause (typically starting in the mid-to-late 40s) as ovarian estrogen production begins to decline years before complete cessation of menses 4
For women with premature ovarian insufficiency (before age 40) or early menopause (ages 40-44), GSM symptoms can begin at significantly younger ages than the typical postmenopausal population 7
Clinical Implications by Age
Women under 60 or within 10 years of menopause represent the optimal window for initiating hormone therapy if GSM symptoms are severe, as the risk-benefit profile is most favorable in this age group 8, 4
Women over 65 years have the highest prevalence of GSM but face greater risks from systemic hormone therapy, making low-dose vaginal estrogen preparations the preferred treatment approach in this age group 8
The progressive nature of GSM means that without treatment, symptoms worsen with advancing age, distinguishing it from other menopausal symptoms that may improve spontaneously 1, 6
Common Pitfalls to Avoid
Do not assume GSM only affects elderly women—symptoms can begin in perimenopause and early postmenopause (ages 45-55) 4, 3
Do not overlook GSM in younger women with iatrogenic menopause from chemotherapy, radiation, or surgical menopause, as they experience GSM at significantly younger ages 4
Do not dismiss GSM symptoms as a normal part of aging that requires no treatment—effective therapies exist and significantly improve quality of life and sexual function 1, 9