Benefits, Harms, and Costs
- 1The effects of estrogen deficiency on urogenital tissues include signs and symptoms of vulvovaginal atrophy, urinary urgency, dysuria, and recurrent urinary tract infection (high).
- 2Genitourinary syndrome of menopause is common and impairs quality of life, sexual function, and partner relationships (high).
- 3Without treatment, this syndrome will evolve chronically in most women and progress to functional and structural urogenital tissue changes that can be difficult to reverse even with treatment (high).
- 1Women entering menopause should be educated about the progressive impact of estrogen deficiency on urogenital health and the many options available for symptom relief (strong, high).
- 2Menopausal women should be comprehensively screened for genitourinary syndrome of menopause symptoms on an ongoing basis, as symptoms can present insidiously and become bothersome long after the menopausal transition (strong, high).
- 3First-line management options for genitourinary syndrome of menopause may include vaginal lubricants and/or vaginal moisturizers, particularly if patient concerns are limited to vaginal dryness or dyspareunia (strong, high).
- 4Second-line therapy for genitourinary syndrome of menopause is vaginal estrogen, administered either as a cream, tablet, or sustained-release ring (strong, high). Clinically significant systemic hormone absorption does not occur with low-dose therapy, so concomitant progestogen therapy is not needed (strong, high).
- 5Other second-line pharmacotherapy for atrophic vaginal symptoms includes the oral selective estrogen receptor modulator, ospemifene, and vaginal dehydroepiandrosterone ovules (strong, high).
- 6Long-term use of intravaginal laser therapy to manage genitourinary syndrome of menopause or stress urinary incontinence remains experimental and should be conducted only within the protocols of well-executed clinical trials designed to establish its safety and efficacy (strong, very low).
ABBREVIATIONS:CEE (conjugated equine estrogens), DHEA (dehydroepiandrosterone), GSM (genitourinary syndrome of menopause), UTI (urinary tract infection), DEFINITION (Genitourinary syndrome of menopause is a term recently adopted to comprehensively describe the effects of estrogen deficiency on the urogenital tissues. It includes the symptoms and signs of vulvovaginal atrophy, dyspareunia related to atrophy/dryness, overactive bladder, dysuria and recurrent urinary tract infections.)
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This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that health care providers provide patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and inclusivity: The SOGC recognizes the importance to be fully inclusive and when context is appropriate, gender-neutral language will be used. In other circumstances, we continue to use gendered language because of our mission to advance women's health. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person's needs.