The role of hormone therapy in urogenital health after menopause

Best Pract Res Clin Endocrinol Metab. 2021 Dec;35(6):101595. doi: 10.1016/j.beem.2021.101595. Epub 2021 Oct 12.


Menopause represents an endocrine challenge to urogenital health, as oestrogens deprivation and androgens decline significantly contributes to age-related involution of vulvovaginal tissues and lower urinary tract. Genitourinary syndrome of menopause (GSM) is a clinical entity including the chronic and progressive condition of vulvovaginal atrophy (VVA) and encompassing both anatomical and functional consequences of menopause. The term GSM describes genital, sexual and urinary symptoms with a detrimental impact on quality of life (QOL). Several treatment options are available, but many barriers are still present to adequately diagnose and treat GSM. This review aims to present current evidences about epidemiology, aetiology, diagnosis and treatment of GSM, with a focus on prescription medications [low-dose local oestrogen therapy (LET), prasterone (DHEA) and the SERM ospemifene] for urogenital symptoms in healthy postmenopausal women and in special populations, including women with premature ovarian insufficiency (POI) and breast cancer survivors (BCS).

Keywords: breast cancer survivors (BCS); genitourinary syndrome of menopause (GSM); local oestrogen therapy (LET); ospemifene; prasterone (DHEA); vulvovaginal atrophy (VVA).

Publication types

  • Review

MeSH terms

  • Atrophy / pathology
  • Estrogens
  • Female
  • Female Urogenital Diseases* / drug therapy
  • Female Urogenital Diseases* / epidemiology
  • Female Urogenital Diseases* / etiology
  • Humans
  • Menopause
  • Quality of Life*
  • Vagina / pathology


  • Estrogens