Healthy Hooha

Below is the abstract I presented at the 2025 ISSWSH Annual Conference. It is the culmination of work by a taskforce I formed to advocate for terminology that more accurately reflects the diverse populations affected by low-hormone–related genitourinary symptoms, including but not limited to menopausal patients. It was then published in the Journal of Sexual Medicine.

Broadening Genitourinary Syndrome for More Accurate Diagnoses Across Diverse Populations

Authors: Aimee Osgood (Cloutier) A.A.S., Project Lead, Patient Advocate, Sara Perelmuter BSc, MPhil, Weill Cornell Medical College, New York, NY, Dr. Heather Quaile DNP, WHNP-BC, AFN-C, MSCP, CSC, IF, FAANP, Anna Myers, WHNP-BC, CUNP, CSC, IF, Jessica Bell, PA-C, MSCP, IF, Laura Goetz, SW/CSW, Patient Advocate, Dr Louise Newson BSc(Hons) MBChB(Hons) MCRP FRCGP DHealth, Physician and Menopause Specialist, Newson Health, Stratford-upon-Avon, UK, Jackie Piasta, MSN, WHNP-BC, MSCP, Rachel Pope MD, MPH, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

Maintaining genitourinary health is essential for overall quality of life. The term “Genitourinary Syndrome of Menopause” (GSM) was introduced to replace “vulvovaginal atrophy,” a term previously used only for postmenopausal women. However, GSM remains limited by its exclusive association with menopause, even though many individuals experience genitourinary symptoms due to a wide range of medical, hormonal, and physiological factors. This restrictive terminology excludes other affected groups and may lead to misdiagnosis or insufficient care. A broader, more inclusive term that accounts for the diverse causes and populations experiencing these symptoms, will enhance diagnostic accuracy and empower both healthcare providers and patients.

To propose updating the GSM terminology to encompass a wider range of individuals affected by genitourinary symptoms, promoting better diagnostic accuracy and equitable healthcare.

A comprehensive review of clinical studies and medical literature was conducted to assess the populations experiencing GSM-like symptoms. The review focused on individuals who are not postmenopausal but experience genitourinary symptoms. Data on symptoms, hormone levels, and treatment responses were analyzed to identify common patterns across these groups.

The review identified several distinct populations that experience genitourinary symptoms but are unrelated to menopause: 

1. Individuals using hormonal contraceptives experience symptoms due to lowered estrogen and testosterone levels. 

2. Transmasculine individuals on testosterone therapy or hormonal contraceptives frequently report atrophic changes in genital tissues.

3. Individuals using hormone-blocking therapies for breast cancer and endocrine treatments cause significant hypoestrogenic states. 

4. Individuals with endocrine Conditions such as Polycystic Ovary Syndrome (PCOS), Primary Ovarian Insufficiency (POI), anovulation, and treatments such as GnRH agonists for endometriosis. 

5. Individuals in postpartum and lactation phases experience symptoms due to elevated prolactin and decreased estrogen, disrupting normal hormonal regulation. 

6. Individuals using medications such as Acne medications, Antidepressants/SSRI’s, Anticholinergics, Chemotherapeutics, Antihypertensives disrupt normal hormone regulation.

7. Other conditions, including genetic disorders, chromosomal syndromes, stress, eating disorders, exercise and sports training disrupt normal hormone regulation.

Current terminology can contribute to delayed diagnosis or inappropriate care, especially among younger patients, individuals undergoing hormonal therapies, or those with non-menopausal endocrine conditions.

The term “Genitourinary Syndrome of Menopause” is too restrictive and fails to encompass the diverse populations affected by genitourinary symptoms. A broader and more inclusive term, such as Genitourinary Syndrome (GS), with subcategories to capture specific conditions, is proposed to improve diagnosis, treatment, and patient care. These subcategories would include: 

• GS of Perimenopause/Menopause
• GS of Postpartum & Lactation
• GS of Hormonal Contraceptives
• GS of Gender-Affirming Hormone Therapy
• GS of Cancer Treatment & Prevention
• GS of Endocrine Disorders (e.g., Endometriosis, PCOS, POI, anovulation, other Hypothalamic-pituitary-ovarian axis disorders, other)
• GS of Medications (e.g., Isotretinoin, Spironolactone and other acne medications, Antidepressants/SSRI’s, Anticholinergics, Chemotherapeutics, Antihypertensives, other)
• GS of Other Causes (e.g., genetic disorders, chromosomal syndromes, stress, eating disorders, sport training, other)

Adopting this inclusive terminology will reduce stigma, promote equitable healthcare, and ensure timely diagnosis and appropriate treatment for all affected individuals, regardless of age, hormonal status, or gender identity.