In May 2025, the American Urological Association (AUA) released new clinical guidelines addressing Genitourinary Syndrome of Menopause (GSM)—a condition that affects nearly half of postmenopausal women but remains significantly underdiagnosed and undertreated. These new guidelines mark a critical step toward improving women’s health, especially for those over the age of 40. 

What Is Genitourinary Syndrome of Menopause?

Genitourinary Syndrome of Menopause refers to a collection of symptoms resulting from the decline in estrogen and other sex hormones that occurs during and after menopause. These hormonal changes can cause thinning and dryness of the vaginal and vulvar tissues, reduced elasticity, and urinary tract symptoms. Common symptoms include:

• Vaginal dryness, irritation, or burning

• Pain during sexual intercourse (dyspareunia)

• Urinary urgency or frequency
• Recurrent urinary tract infections (UTIs)
• Vaginal discharge or discomfort
• Pain with sensitive vaginal medical examinations

Unlike hot flashes, which often resolve over time, GSM symptoms tend to persist and may worsen without treatment.

Why the New AUA Guidelines Matter

The 2025 guidelines represent an evidence-based effort to raise awareness and standardize the diagnosis and management of GSM. The guidelines emphasize that GSM is a chronic and progressive condition that can significantly affect quality of life, sexual health, and urinary function. Most importantly, they call for proactive screening and discussion of symptoms within primary care settings—an area where these conversations have too often been overlooked.

Until recently, many women have suffered in silence due to stigma, lack of knowledge, or the misconception that these symptoms are an unavoidable part of aging. The new guidelines empower primary care physicians to break that cycle by taking a more active role in identifying and treating GSM early.

Why This Matters for Women 40 and Over

Women are living longer, healthier lives, but menopause and its effects remain under-discussed. GSM can impact not only physical comfort but also intimate relationships, mental health, and overall well-being. The guidelines send a clear message: these symptoms are treatable, and women deserve compassionate, evidence-based care.

Primary care providers are uniquely positioned to offer that care—often seeing women regularly for preventive visits, chronic disease management, or wellness counseling. By normalizing conversations about GSM, clinicians can reduce stigma, improve quality of life, and prevent complications like UTIs or sexual dysfunction.

How This Is Going to Change Care in Primary Care Practices

1. Questions Start the Conversation
   Women rarely bring up GSM symptoms unless asked. The AUA encourages clinicians to screen routinely for vaginal and urinary symptoms in women over 40, especially those who are postmenopausal or undergoing hormone suppression for medical reasons. A simple, nonjudgmental question like, “Have you noticed any changes in your vaginal or urinary health?” can open the door to meaningful dialogue.
2. Individualized Treatment Options
   The guidelines outline a stepped approach to management based on symptom severity and patient preferences:

• First-line therapy: Non-hormonal options such as vaginal moisturizers and lubricants.

• Second-line therapy: Local vaginal estrogen therapy (e.g., creams, tablets, or rings), which has been shown to be both safe and effective—even for many women with a history of hormone-sensitive cancers, under proper supervision.

• Emerging therapies: Options like vaginal DHEA or laser therapy are mentioned, though evidence is still evolving.

3. Long-Term Management
   Because GSM is a chronic condition, ongoing evaluation and treatment adjustments are essential. The guidelines recommend regular follow-up to assess symptom control, side effects, and patient satisfaction.
4. Multidisciplinary Coordination
   While gynecologists and urologists play a key role in complex cases, primary care remains the front line for recognizing and managing GSM. Coordination among providers ensures that care is holistic and tailored to each woman’s unique health history and lifestyle.

The AUA’s 2025 guidelines on Genitourinary Syndrome of Menopause are a welcome advancement for women’s health and a powerful reminder of the essential role primary care plays in addressing menopause-related concerns. If you’re a woman over 40 and experiencing any symptoms of GSM, know that you are not alone—and help is available. Talk with your healthcare provider about your symptoms, treatment options, and what support is right for you. Your comfort and well-being matter—at every stage of life.

Reference: 

Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589. https://www.auajournals.org/doi/10.1097/JU.0000000000004589