The assessment and management of genitourinary syndrome of menopause in primary care.

BACKGROUND: Genitourinary syndrome of menopause (GSM) encompasses a range of anatomical and functional changes affecting the vulva, vagina, bladder and pelvic floor due to oestrogen deficiency. GSM affects up to 50% of postmenopausal individuals yet remains underdiagnosed and undertreated because of stigma and lack of awareness. OBJECTIVE: This article outlines the pathophysiology, assessment and management of GSM, emphasising trauma-informed care and culturally sensitive communication. First- line treatments include lifestyle modifications, genital skin care, lubricants, vaginal moisturisers and pelvic floor muscle training (PFMT). Topical hormonal therapies, including vaginal oestrogens and dehydroepiandrosterone (DHEA) are effective and safe, including for breast cancer survivors, with appropriate consultation. DISCUSSION: General practitioners have a pivotal role in initiating conversations, acknowledging symptoms and providing trauma-informed, evidence-based education and care to improve quality of life and reduce inadequate management of symptoms.