Is There Evidence of Diagnostic and Treatment Gaps for LUTS in Post-Menopausal Women With Genitourinary Syndrome of the Menopause? ICI-RS 2025.

AIMS: This report, from the International Consultation on Incontinence-Research Society, aims to evaluate the existing evidence and identify diagnostic and treatment gaps for Lower Urinary Tract Symptoms (LUTS) in post-menopausal women with Genitourinary Syndrome of Menopause (GSM).

METHODS

An overview on the current literature, including pathophysiology, diagnosis and management of GSM associated LUTS, including incontinence, overactive bladder, underactive bladder and recurrent urinary tract infections (rUTIs).

RESULTS

Significant gaps in the literature were identified. GSM is underdiagnosed and the interplay between hormonal changes in the postmenopausal period on LUTS remains poorly understood. Diagnostic methods for rUTIs lack sensitivity and the role of the urinary microbiome is emerging. Current treatments, including topical oestrogens and systemic hormone therapy, lack long-term efficacy data on LUTS. Evidence for regenerative medicine techniques remain limited by low-quality studies and short-term follow up.

CONCLUSION

There is lack of high-quality evidence, which hinders the optimal management of LUTS in post-menopausal women with GSM. The panel proposes targeted research questions, focusing on the hormonal impact on the lower urinary tract, advancing diagnostics and robust clinical trials for existing and novel therapies, to bridge current gaps in the literature and improve patient care.