GSM: Counseling Points to Discuss with Women Fearful of Vaginal Estrogen

Authors: Singhal D* and Bachmann GA

DOI: 10.23880/whsj-16000242

Volume 9, Issue 1

Abstract

Genitourinary syndrome of menopause (GSM), affecting both peri and postmenopausal women, is characterized by chronic, and often progressive symptoms that include vulvovaginal atrophy, dyspareunia, dryness, and urinary discomfort. Despite the prevalence and impact of these symptoms, many women remain untreated due to persistent fears about the safety of vaginal estrogen and other interventions as well as not reporting these symptoms to their health care provider. This review addresses the clinical dilemma faced by providers when counseling women who are hesitant to initiate hormone-based therapies. Although concerns about breast cancer, endometrial pathology, and thromboembolic events persist, robust evidence demonstrates that low-dose vaginal estrogen is safe, minimally absorbed systemically, and highly effective in restoring genitourinary tissue integrity and relieving symptoms. Topical preparations offer targeted delivery with favorable safety profiles. For women with contraindications or a preference to non-hormonal options, ospemifene provides a systemic alternative. This review synthesizes the comparative efficacy and safety data, highlights evidence-based counseling strategies, and offers practical guidance for addressing misconceptions that contribute to treatment refusal by women. By confronting misinformation and normalizing GSM treatment, clinicians can help restore quality of life for millions of women living with symptoms of GSM.

Keywords: GSM; Tissue Integrity; Vaginal Estrogen

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