Karyn S. Eilber, MD, discusses updates on management of genitourinary syndrome of menopause

As genitourinary syndrome of menopause (GSM) gains overdue clinical attention, the AUA/SUFU/AUGS 2025 Guidelines on Genitourinary Syndrome of Menopause (GSM) bring a renewed focus on individualized, evidence-based care. With a strong emphasis on shared decision-making, the guidelines challenge clinicians to prioritize patient comfort and autonomy while staying grounded in science. In this Q&A, Karyn S. Eilber, MD, reflects on how these new recommendations reshape conversations around GSM therapies—from the cautious stance on energy-based devices to updated perspectives on local hormone treatments, even for patients with complex health histories. The discussion also highlights the critical need to expand education and access to care for underserved populations. Eilber is chair of the Cedars-Sinai Medical Group department of surgery and professor of urology, and associate professor of obstetrics & gynecology at Cedars-Sinai Medical Center in Los Angeles, California.

Contemporary OB/GYN: The 2025 GSM guidelines highlight the importance of shared decision-making and patient-centered care. What do you think this emphasis signals to physicians about how GSM treatment discussions should evolve?

Karyn S. Eilber, MD: On a broader level, the emphasis on shared decision-making reinforces that the best treatment of any condition is not only what addresses the main issue that a patient is having, but the patient is also comfortable and accepting of the proposed treatment plan. Similarly, the physician needs to respect a patient’s wishes while providing safe and effective treatment options.

Contemporary OB/GYN: With the guidelines cautioning against energy-based treatments like CO₂ lasers due to insufficient evidence, how should physicians respond to patient interest in these increasingly marketed therapies?

Eilber: There are many conditions/diseases that have treatments which are successful but not backed by hard scientific evidence. This is where expert opinion and physician experience come into play. While there isn’t a large amount of data specifically for CO2 lasers and GSM, CO2 lasers have been used successfully in dermatology for decades and are known to increase collagen and improve elasticity. Both the face and vagina are lined with an epithelium, so it makes sense to treat the vaginal epithelium with energy-based treatments that have a good track record in dermatology.

Contemporary OB/GYN: Several recommendations support the use of local low-dose vaginal estrogen and vaginal DHEA, even in complex populations such as those with a history of breast cancer. What does this suggest about how clinicians should be approaching treatment conversations and risk-benefit assessments moving forward?

Eilber: It’s been known for a while that low-dose vaginal estrogen isn’t absorbed into the body in a significant amount, and most oncologists support use of low-dose vaginal estrogen. Almost ten years ago, the American College of Obstetrics and Gynecologists (ACOG) published their consensus on the treatment of genitourinary symptoms in women with estrogen-dependent breast cancer and included both vaginal estrogen and DHEA.

Contemporary OB/GYN: The guideline underscores the need to reach underserved and marginalized populations with GSM. What steps can the broader physician community take to improve identification, education, and access to care for these patients?

Eilber: Education, education, education! Unfortunately, as a society, we have not done a great job of educating women about their specific health needs in general. Health education needs to include basics like how your hormones fluctuate during your cycle, guidelines for cervical cancer screening, how to do a breast exam, etc. Many well-educated women don’t even know that the uterus has nothing to do with their hormones. Education is power, and fortunately, we have public education in this country, but improving female health education needs to be a priority.

For a full breakdown of the guideline, click here