Genitourinary Syndrome of Menopause and Lower Urinary Tract Symptoms: A Primary Care Approach

Authors

• Michelle A. Johnson, University of LynchburgFollow

Specialty

Urology, Gynecology

Advisor

Elijah Salzer, DMSc, PA-C, NYSAFE, C-EFM

Abstract

This literature synthesis reviewed current evidence on the pathophysiology, diagnosis, and management of genitourinary syndrome of menopause (GSM)-related lower urinary tract symptoms (LUTS) in postmenopausal persons and considered the implications for primary care providers. GSM is a chronic, progressive condition caused by estrogen deficiency that affects vaginal, urethral, and bladder tissues. An estimated 50% to 70% of postmenopausal persons experience symptoms, including urinary urgency, frequency, incontinence, and recurrent urinary tract infections (rUTIs). Despite its prevalence and impact on quality of life, GSM remains substantially underdiagnosed; fewer than half of symptomatic persons seek treatment, and clinicians often fail to screen proactively for urogenital complaints. Low-dose vaginal estrogen therapy (LET) remains the most effective evidence-based intervention for GSM-related LUTS, demonstrating minimal systemic absorption and no elevated risk of endometrial or breast cancer. Conversely, systemic hormone therapy may exacerbate or trigger urinary incontinence, reinforcing the clinical necessity of local administration. Emerging microbiome research provides a plausible biological framework, showing that estrogen deficiency is associated with the loss of Lactobacillus predominance in both vaginal and urinary microbiomes. However, these findings remain mechanistic rather than practice-changing. Non-hormonal approaches, including pelvic floor muscle training (PFMT), vaginal moisturizers, and behavioral strategies, serve as effective first-line or adjunctive options. To bridge the screening gap, a brief, validated two-question prompt targeting concurrent vaginal and urinary symptoms is introduced for routine postmenopausal wellness visits. Future research should further define the long-term safety of local estrogen therapy, prospectively validate brief case-finding tools, explore urobiome-targeted therapies, and standardize outcome measures for GSM.

Recommended Citation

Johnson MA. Genitourinary Syndrome of Menopause and Lower Urinary Tract Symptoms: A Primary Care Approach. University of Lynchburg Doctoral Project Assignment Repository. 2026; 8(3).