New guidelines for managing genitourinary syndrome of menopause
Panel discussion will highlight AUA’s guidelines for diagnosis and treatment.
Genitourinary syndrome of menopause (GSM) presents with a complex spectrum of symptoms and physical changes in women due to declining estrogen and androgen concentrations in the genitourinary tract as a result of menopause, oral contraceptive use or medical interventions that impact the production of these hormones. It’s estimated to affect 50% to 70% of women in menopause to some degree, yet it remains consistently underdiagnosed and undertreated.
“As urologists, GSM has not been high enough on our radar to be comfortable employing treatment because of many unknowns,” said Melissa R. Kaufman, MD, PhD, FACS, the Patricia and Rodes Hart Endowed Chair in urologic surgery and professor of urology at Vanderbilt Medical Center. However, new AUA Guidelines: Genitourinary Syndrome of Menopause, promise to create order from confusion by promoting consistent and effective evidence-based interventions for diagnosing, evaluating the severity of symptoms and treating patients with symptoms of GSM.
In “Case-Based Guidelines Panel Discussion: Genitourinary Syndrome of Menopause” during the Plenary: Monday Morning session on April 28, Dr. Kaufman and fellow panelists Gulia Ippolito, MD, MS; Charles R. Powell, MD; and Una Lee, MD, will introduce the guidelines by employing a case-based format of patients with symptoms of GSM urologists are likely to similarly encounter in their office, with a focus on post-menopausal women.
The AUA developed the new GSM guidelines in conjunction with the American Urogynecologic Society, the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, the Patient-Center Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality.
“We’ve only been using the term ‘Genitourinary Syndrome of Menopause’ for about a decade. When we interrogated the literature, we didn’t always find strong randomized controlled trials because the data is heterogeneous,” Dr. Kaufman said.
Consequently, the guidelines were developed using a set of criteria commonly employed in the literature in a systematic review and reinforced with clinical principles and expert opinions. The result is a comprehensive set of graded evidence focusing on shared decision-making, considering patients’ values and preferences.
In the session, panelists will discuss screening patients for symptoms of GSM, hormonal interventions including low-dose vaginal estrogen and other types of hormonal treatments, non-hormonal interventions, such as laser therapies, educating patients about GSM, best practices for follow-up, and treatment recommendations for patients with GSM who have been undergone treatment for breast and endometrial cancer.
“We provide direct statements and guidelines on how clinicians should approach these patients, which often relies on multidisciplinary decision-making,” Dr. Kaufman said.
The session will also address conditions that often accompany GSM, including pelvic floor dysfunction, urinary tract infections and overactive bladder.
Be prepared to come away inspired to embrace the opportunity the new guidelines offer for diagnosing, evaluating and treating patients with GSM and enhancing their treatment satisfaction and overall quality of life.
“It’s transformational for the AUA to have embarked upon this tremendous initiative, and I am absolutely convinced it will be an incredible service for many patients,” Dr. Kaufman said.
