Summary
This BMS Consensus Statement provides guidance on Genitourinary Syndrome of Menopause (GSM), a chronic and progressive condition due to estrogen deficiency, most commonly associated with the menopause. There is a potential negative impact on all urogenital tissue quality including the vulva, vagina, bladder and urethra. Symptoms may not become apparent for several years after the menopause and therefore any association is lost, with women accepting symptoms as a normal part of the aging process. There may be reluctance to discuss symptoms with a clinician, and this is likely to be linked with under diagnosis and under treatment1. GSM has been described as a silent epidemic with lack of awareness affecting an accurate diagnosis and access to treatment2-4. Whilst vaginal estrogen (also referred to as local estrogen) therapy is the best-known treatment, newer drugs and interventions are now available.
Terminology
Changing terminology has failed to improve recognition and treatment of GSM. Previously referred to as urogenital atrophy or vulvovaginal atrophy, the updated NICE menopause guideline 2024 refers to this combination of atrophic changes and symptoms as ‘genitourinary symptoms of the menopause’. Genitourinary Syndrome of Menopause (GSM) is now the internationally accepted term however, reflecting the impact of fluctuating or low levels of estrogen on urogenital tissue quality.
Author: Paula Briggs in collaboration with the medical advisory council of the British Menopause Society
Reviewed: November 2025