Patients with genitourinary syndrome of menopause (GSM) who are already receiving systemic estrogen therapy may still experience persistent local genitourinary symptoms. This clinical scenario calls for a specific management step beyond systemic treatment alone.
Genitourinary syndrome of menopause (GSM) with ongoing local atrophic symptoms in a patient currently receiving systemic estrogen therapy — a situation where systemic therapy alone does not fully address local genitourinary needs.
The protocol addresses what to add alongside existing systemic estrogen therapy. A concurrent locally-directed vaginal intervention is considered — the complete options, guidance, and sequencing are detailed in the full structured protocol.
DOI: 10.1097/JU.0000000000004589
In patients with GSM who are on systemic estrogen therapy, clinicians should offer the option of local low-dose vaginal estrogen or vaginal dehydroepiandrosterone (DHEA).
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