A newly released guideline from the American Urological Association (AUA), developed in collaboration with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and the American Urogynecologic Society (AUGS), is bringing national attention to the diagnosis and treatment of Genitourinary Syndrome of Menopause (GSM). With growing visibility across clinical and popular media platforms, the guideline offers timely, evidence-based direction on a condition that remains both underdiagnosed and undertreated.
A Comprehensive, Patient-Centered Approach to GSM
GSM encompasses a range of symptoms and physical changes stemming from the natural decline in estrogen and androgen levels during menopause. While vulvovaginal dryness and pain with sex are among the most recognized features, GSM can also manifest with urinary symptoms like dysuria, urgency, frequency, and recurrent urinary tract infections—placing it firmly within the purview of urologic care.
The 2025 AUA/SUFU/AUGS guideline outlines an evidence-informed, multidisciplinary approach to evaluating, diagnosing, and managing GSM. Among the key takeaways:
- Shared decision-making is emphasized across all stages of care, with an individualized approach to treatment selection.
- Vaginal estrogen is recommended for the treatment of GSM symptoms and to reduce the frequency of recurrent urinary tract infections.
- DHEA (prasterone) is supported for the treatment of moderate-to-severe dyspareunia.
- Non-hormonal therapies like lubricants and moisturizers are recommended for symptom relief and as adjuncts to hormonal treatments.
- Energy-based treatments (e.g., CO₂ or Er:YAG laser) are not currently supported by evidence and are considered investigational outside of clinical trials.
- The guideline includes expert guidance on care for breast cancer survivors and others with complex hormone-related histories, offering clinicians a framework for risk-sensitive, patient-centered care.
Despite the condition’s high prevalence, affecting up to 87% of postmenopausal individuals, many patients do not initiate discussions about GSM symptoms with their clinicians. The guideline highlights the critical role providers can play in identifying GSM and improving patients’ quality of life through proactive, informed engagement.
Voices from UNC Urology: Leading with Clinical Insight
While UNC Urology faculty were not part of the panel that developed the GSM guideline, the topic resonates deeply with clinical providers across the department. As interest in the guideline continues to build among clinicians and patients alike, UNC Urology is preparing to contribute to the broader conversation.
“The new guidelines for genitourinary syndrome of menopause (GSM) represent an important step forward in improving quality of life for those affected, offering evidence-based, patient-centered approaches to care. These recommendations help reduce stigma, promote awareness, and ensure more consistent, effective treatment options.”
Kristy Borawski, MD
UNC Urology Vice Chair of Education,
Urology Residency Program Director,
Professor of Urology
UNC Urology’s Expanding Leadership in National Guidelines and Diagnostic Excellence
While UNC Urology faculty were not panelists on the GSM guideline, the department continues to play a central role in shaping national standards of care through its contributions to the American Urological Association (AUA) and its broader Quality agenda. Faculty members serve in influential leadership positions across AUA committees focused on clinical guidelines, quality improvement, and data-driven performance measurement.
This work aligns closely with the AUA’s commitment to advancing diagnostic excellence—a national priority that emphasizes timely, accurate, and patient-centered diagnosis across urologic conditions. UNC Urology has been deeply involved in these efforts, helping to develop frameworks that promote evidence-based care, address disparities, and translate research into meaningful improvements for patients.
Through ongoing leadership in AUA guideline development and quality initiatives, UNC Urology remains at the forefront of efforts to elevate the standards by which care is delivered, ensuring patients in North Carolina and beyond benefit from the most current, rigorous, and equitable approaches to urologic health.