Urinary manifestations of genitourinary syndrome of menopause: a review of the pathophysiology, clinical presentation, and management.

The term genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy or atrophic vaginitis, was introduced in 2014 by the North American Menopause Society (NAMS) and International Society for the Study of Women's Sexual Health (ISSWSH) to highlight a broader scope of urogenital symptoms associated with menopause. While the majority of studies focus on vulvovaginal symptoms and sexual dysfunction, a large proportion of women also present with one or more urinary complaints related to urogenital atrophy, such as urinary frequency, urgency, nocturia, dysuria, urinary incontinence, or recurrent urinary infections. Population-based studies show that despite its prevalence, the condition is underdiagnosed and undertreated. The cornerstone of GSM treatment is local estrogen therapy, while other therapeutic options for GSM also show promise in improving urinary symptoms, including intravaginal dehydroepiandrosterone (DHEA) and ospemifene. While vaginal energy-based devices remain experimental, limited data also suggest some benefit. Treating GSM has significant personal and societal cost implications. The purpose of this review is to synthesize the current literature on pathophysiology, diagnosis, and treatment modalities of this complex condition, with a focus on the urinary manifestations of GSM. A summary of various international guidelines on the management of GSM is also provided to help guide clinicians treating this condition.