Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)

The American Urological Association (AUA), in collaboration with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and the American Urogynecologic Society (AUGS), has released the 2025 guideline on Genitourinary Syndrome of Menopause (GSM). GSM encompasses a range of symptoms and physical changes resulting from declining estrogen and androgen levels, affecting the urinary tract and female genital tract. ​American Urological Association+1American Urological Association+1American Urological Association+1American Urological Association+1

Key Highlights of the 2025 AUA/SUFU/AUGS Guideline on GSM:

1. Definition and Prevalence:

   • GSM refers to the collection of symptoms and signs associated with decreased estrogen and androgen levels, impacting the labia, clitoris, vagina, urethra, and bladder. ​American Urological Association

2. Diagnosis:

   • A comprehensive history and physical examination are essential. Physical findings may include labial and clitoral atrophy, decreased vaginal moisture, and urethral changes. ​ResearchGate+10AUAU+10American Urological Association+10American Urological Association

3. Treatment Recommendations:

   • Non-Hormonal Therapies: First-line treatments include vaginal moisturizers and lubricants to alleviate dryness and discomfort. ​American Urological Association+1Health Jade+1

   • Hormonal Therapies:

     • Topical Estrogen: Recommended for moderate to severe symptoms, topical estrogen has been shown to improve vaginal and urinary symptoms with minimal systemic absorption.

     • Vaginal DHEA: An alternative for those who cannot use estrogen; it helps in restoring vaginal tissue.

     • Systemic Hormone Therapy: Considered when GSM symptoms are part of a broader menopausal syndrome, but risks and benefits must be weighed.

4. Special Considerations:

   • In women with a history of estrogen-dependent cancers, non-hormonal therapies are preferred. If hormonal treatments are considered, consultation with an oncologist is advised. 

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