Non-hormonal treatments offer relief for genitourinary syndrome of menopause

In a recent interview with Contemporary OB/GYN, Deslyn Hobson, MD, from Corewell Health, and Elizabeth Evans, MD, from UT Health San Antonio, discussed the negative impacts of genitourinary syndrome of menopause and now non-hormonal therapies may be used to manage this condition.

Symptoms of genitourinary syndrome of menopause include vaginal dryness and vaginal irritation. Among women unwilling or unable to treat the condition with estrogen, products such as ospemifene work in the same tissues as estrogen to alleviate these symptoms.

Contemporary OB/GYN:

How does genitourinary syndrome of menopause impact women’s quality of life?

Deslyn Hobson, MD:

It impacts the woman’s quality of life by, it causes vaginal dryness, s and vaginal irritation, and then it affects your sexual function. So, sex becomes painful, it becomes uncomfortable. Your vagina feels dry and irritated, so makes sometimes, for some people, sitting a bit uncomfortable. So, that’s how it impacts your quality of life.

Elizabeth Evans, MD:

And more and more women are postmenopausal age, and we’re finding women notice these symptoms earlier and earlier. As urogynecologists, we also see that they’ve got urinary symptoms. They’re often related, like urinary tract infections, urgency, frequency, but can also be part of the same syndrome.

Contemporary OB/GYN:

How can nonestrogen therapies improve symptoms among impacted patients?

Evans:

A lot of the therapies we have, you know, our always go to product is estrogen, but there are women who can’t, or don’t want to, have an intolerance to estrogen. So, there are non-estrogen products that we can use instead that are going to help a lot of alleviate a lot of these symptoms. There’s various therapies that we’re going to talk about. So, for instance, ospemifene is a selective estrogen receptor modulator, and it’s actually going to work on the same tissues that estrogen would, but in a different manner. So, in some people thinking that’s a little safer than estrogen for certain populations of patients, by rebuilding the tissue and actually affecting those symptoms that alleviate in that way.

Contemporary OB/GYN:

What is the significance of this relationship?

Hobson:

Just like Dr Evans said, it’s a cheaper cost, so the vaginal estrogen therapies are more expensive for some people. I mean, the cost can range up to $400 or $500 versus the non-estrogen which are available over the counter. Some of them you don’t need a prescription for. So, I think that’s good if you have certain conditions that prevent you from taking vaginal estrogen, that would be also a significant factor for some people as well. So cost and prevailing medical conditions.

Contemporary OB/GYN:

What additional steps can clinicians take to support patients with genitourinary syndrome of menopause?

Evans:

I think the thing that we most notice is that although tons of women have these symptoms, so many are not treated. So, I think just recognition and appreciating the patient’s symptoms so that we say, “Yes, this is something that is important to you, and it’s a huge problem,” and we need to address it either with estrogen or not estrogen options, depending on what the patient desires, and doing shared decision making.

Hobson:

Right. And I think you can add like simple questions, such as, “Are you experiencing any vaginal dryness? If you’re sexually active, are you experiencing any problems with sexual activities?” And that can lead to another conversation and refer you to someone who’s willing to treat those symptoms.

Contemporary OB/GYN:

Is there anything you would like to add?

Evans:

So I mentioned the ospemifene is one option, but there’s a range all the way from non, you know, sort of hormonally based versus all the way to moisturizers and lubricants. There’s also a fair amount of data on vaginal DHEA, testosterone, which is not FDA approved for women, there are a lot of good studies on that as well. And then 2 of the common moisturizers, hyaluronic acid and replens, which is a polycarbrophile product, those can also be really helpful and do have some evidence that shows that they’re helpful in alleviating symptoms.

Hobson:

And I just wanted to add to add to, when you asked about the significance of having non hormonal therapies, there are some women out there who just don’t want to take any sort of hormones whatsoever, and we have to respect them and respect patient autonomy. So, I think these, this is where the non-hormonal therapies come into play, because then, especially if they’re getting a benefit from them. So, that’s another way where they’re significant for some of the patients.

No relevant disclosures

Reference

Evans E, Hobson D. Nonestrogen therapies for the genitourinary syndrome of menopause. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.