The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.
Level 5 - mechanism / opinion, no new human data
Expert panel consensus statement and narrative literature review
PubMed 32852449 · doi:10.1097/GME.0000000000001609
What was done
An expert panel from The North American Menopause Society (NAMS) searched PubMed for medical literature published after their 2013 position statement regarding pharmacologic and nonpharmacologic treatments for genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA). The panel synthesized the evidence and updated consensus clinical recommendations, which were reviewed and approved by the NAMS Board of Trustees.
What was found
GSM affects an estimated 27% to 84% of postmenopausal women. Over-the-counter vaginal lubricants and moisturizers provide adequate relief for mild symptoms. For moderate-to-severe symptoms, low-dose vaginal estrogens, vaginal dehydroepiandrosterone (DHEA), systemic estrogen therapy, and ospemifene demonstrate clinical effectiveness. Concurrent progestogen therapy is not indicated when using low-dose vaginal estrogen, vaginal DHEA, or ospemifene, though endometrial safety has not been studied in clinical trials beyond 1 year. The abstract notes an absence of sufficient placebo-controlled evidence to support or recommend energy-based treatments (such as vaginal laser therapy) and insufficient data to confirm the safety of vaginal estrogen, DHEA, or ospemifene in women with breast cancer.
Why it matters
This statement provides standardized clinical guidance for diagnosing and managing GSM, delineating first-line nonhormonal therapies from prescription options based on symptom severity. It clarifies prescribing parameters, such as the lack of need for progestogens with low-dose local therapies, while cautioning against off-label energy-based devices.
Limits
The document is an expert consensus statement rather than a formal systematic review or meta-analysis. The abstract reports wide epidemiological ranges (27% to 84%) and does not provide pooled effect sizes, statistical measures, or exact study counts. Clinical trial evidence for endometrial safety is limited to one year or less, and safety data remain inadequate for women with breast cancer.
Cited by
- supports Vaginal estrogen cream or suppositories alone ameliorate sexual symptoms but do not provide systemic bone protection or reduce vasomotor symptoms.