AUA Releases GSM Guideline: Scope, Recommendations, and Care Domains

The American Urological Association (AUA) recently released its Guideline on Genitourinary Syndrome of Menopause.

In the AUA’s press release, the document is described as addressing evaluation and treatment for women who present to a clinician with symptoms and signs of genitourinary syndrome of menopause. The announcement also frames the guideline as a reference focused on identification, diagnosis, counseling, and treatment for patients with GSM.

The press release defines genitourinary syndrome of menopause (GSM) as a spectrum of symptoms and physical changes that result from declining estrogen and androgen concentrations in the genitourinary tract during perimenopause and after menopause. In that framing, GSM is presented as an umbrella term spanning vulvovaginal, urinary, and sexual symptom domains, along with associated physical changes. The release also notes that since the term GSM was introduced in 2014, there has not been consensus on the number or type of symptoms needed to diagnose GSM or a requirement to identify concurrent physical signs. Overall, the announcement emphasizes a multi-domain clinical presentation tied to menopausal hormonal changes.

The press release describes the document as containing 26 recommendations. It lists several areas covered by the guideline, including screening, evaluation, and physical examination of patients presenting with GSM symptoms and signs. The release also describes evidence-based hormonal and nonhormonal treatment options, along with a framework that addresses surveillance for patients who undergo hormonal-based treatment and follow-up for patients who undergo any therapy intended to alleviate symptoms. In the organization’s summary, the recommendation set spans identification, evaluation, treatment selection categories, and longitudinal monitoring elements within a single guideline scope.

On development and organizational context, the AUA states that the guideline was produced in partnership with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and the American Urogynecologic Society (AUGS), and that it was endorsed by the International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS).

Within the treatment domains listed in the AUA materials, local, low-dose vaginal estrogen is cited as one example among the hormonal and nonhormonal options described. The announcement characterizes the guideline as evidence- and consensus-based, developed with SUFU and AUGS and endorsed by ISSWSH and The Menopause Society (TMS).

Key Takeaways:

• The AUA reported releasing a 2025 guideline on Apr 28, 2025, describing it as covering evaluation and treatment for patients presenting with GSM symptoms and signs.
• The press release defines GSM as a hormone-associated spectrum of symptoms and physical changes across vulvovaginal, urinary, and sexual domains during perimenopause and after menopause.
• The AUA materials describe a set of recommendations that cover screening/evaluation and focused exam, hormonal and nonhormonal options (including local, low-dose vaginal estrogen), and surveillance/follow-up, with development and endorsements involving SUFU, AUGS, ISSWSH, and TMS.

FAQs:

1. What is genitourinary syndrome of menopause (GSM)?
In its press materials, the American Urological Association (AUA) defines GSM as a spectrum of symptoms and physical changes resulting from declining estrogen and androgen concentrations in the genitourinary tract during perimenopause and after menopause. Rather than a single symptom entity, GSM is described as an umbrella term encompassing vulvovaginal, urinary, and sexual domains, along with associated physical findings. The AUA notes that since the term was introduced in 2014, there has been no universal agreement on the exact number or combination of symptoms required for diagnosis, nor on whether specific physical signs must be present. The guideline therefore frames GSM as a multidimensional, hormone-associated clinical presentation that requires individualized evaluation.

2. What do the latest guidelines recommend for the evaluation and diagnosis of GSM?
The guideline, released April 28, 2025, includes 26 recommendations addressing identification, evaluation, counseling, and treatment of patients presenting with GSM symptoms and signs. According to the AUA’s summary, this includes screening approaches, focused clinical history, and physical examination for women reporting genitourinary symptoms in the menopausal transition or postmenopausal period. The document positions evaluation as a structured but patient-centered process, recognizing the broad symptom range across vulvovaginal, urinary, and sexual domains. By consolidating diagnostic and management elements within one framework, the guideline aims to support clinicians in systematically identifying GSM in routine practice.

3. What treatment options are available for GSM?
The AUA materials describe both hormonal and nonhormonal treatment pathways as part of an evidence- and consensus-based framework. Among the hormonal options referenced is local, low-dose vaginal estrogen, cited as one example within the broader therapeutic landscape. The guideline also encompasses nonhormonal strategies, reflecting the need for individualized treatment selection based on symptom profile, patient preference, comorbidities, and risk considerations. Rather than promoting a single first-line solution for all patients, the recommendations span categories of therapy, reinforcing that GSM management may require tailored approaches across symptom domains.

4. How does the AUA guideline address follow-up and professional collaboration in GSM care?
Beyond initial treatment selection, the AUA describes a structured approach to surveillance and follow-up. This includes monitoring patients who initiate hormonal-based therapies and reassessing those undergoing any intervention intended to alleviate GSM symptoms. The guideline’s development reflects a multidisciplinary effort: it was produced in partnership with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and the American Urogynecologic Society (AUGS), and endorsed by the International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS). This collaborative context underscores the guideline’s cross-specialty relevance and its positioning as a comprehensive reference for clinicians managing GSM.