Treating the Symptoms of Menopause in Women -- Evidence Update for Patients

Vaginal dryness, vaginal itching and burning, uncomfortable or painful sex and uncomfortable or painful urination are symptoms of genitourinary syndrome of menopause, or GSM. A review of the evidence found that treatments may improve some symptoms.

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Findings

Research shows that some treatments for GSM may help to improve certain symptoms. These include over-the-counter vaginal moisturizers and vaginal estrogen, vaginal DHEA and oral ospemifene.

The evidence is lacking or uncertain on how well other treatments, such as oral DHEA, vaginal and oral testosterone, vaginal oxytocin, oral raloxifene and bazedoxifene and energy-based therapies, work to improve symptoms of GSM.

The research team could not say whether these treatments cause any harms.

GSM is a fairly new term that describes the symptoms caused by hormonal changes during and after menopause. It includes a wide variety of symptoms that affect quality of life for more than half of all women. While some women have mild symptoms, others have symptoms that are more severe. Symptoms may get worse over time and don’t usually go away without treatment.

A review of the research offers information about treatments that can improve symptoms of GSM. The research team rated how certain or confident they were about how well each treatment works to improve symptoms of GSM based on the studies reviewed. This information can help you and your clinician, like your doctor or nurse practitioner, consider the treatment options that are right for you.

What Are My Treatment Options?

Three types of treatment are available for GSM:

➤ Over-the-counter treatments like vaginal moisturizers

➤ Treatments prescribed by a clinician, such as vaginal estrogen, testosterone and dehydroepiandrosterone, or DHEA; vaginal oxytocin; and oral ospemifene, raloxifene and bazedoxifene

➤ Energy-based therapies that use devices like lasers or radiofrequency to deliver heat to vaginal tissues

How Well Do These Treatments Work?

The table that follows lists the treatments that the evidence showed may improve some symptoms of GSM.

Treatments That May Improve Some GSM Symptoms

Treatment	What it is	Evidence of effectiveness
Vaginal moisturizer	Available over the counter without a prescription A cream or gel that is applied to the vaginal area on a regular basis May contain ingredients like hyaluronic acid, lactic acid, polycarbophil and polyacrylic acid	May improve vaginal dryness Research couldn’t say for sure whether it improves painful sex Research didn’t look at vaginal discomfort or irritation or painful urination
Vaginal estrogen	Comes in a variety of forms including creams, suppositories, rings and tablets Brand names include Estrace^®, Estring^®, IMVEXXY^®, Premarin^®, Vagifem^® and Yuvafem^®	May improve vaginal dryness Research showed little to no improvement in painful urination and painful sex Research couldn’t say for sure whether it improves vaginal discomfort or irritation Vaginal estrogen ring may result in higher treatment satisfaction than the cream
Vaginal DHEA	A vaginal insert that is placed in the vagina using a disposable applicator Brand name is Intrarosa^®	May improve vaginal dryness May improve painful sex Research couldn’t say for sure whether it improves vaginal discomfort or irritation Research didn’t look at painful urination
Oral ospemifene	A pill taken by mouth that acts like estrogen in some parts of the body Brand name is Osphena^®	May improve vaginal dryness May improve painful sex Research showed little to no improvement in vaginal discomfort or irritation Research didn’t look at painful urination

The table that follows lists additional treatment options. For these treatments, evidence on whether they improve the symptoms of GSM is lacking or uncertain.

Treatments with No or Uncertain Evidence of Effectiveness

Treatment	What it is	Evidence of effectiveness
Vaginal testosterone	A cream or gel that is applied directly to the vaginal area Not approved by the US Food and Drug Administration, or FDA, for GSM	Research couldn’t say for sure if it improves vaginal dryness or painful sex Research didn’t look at vaginal discomfort or irritation or painful urination
Oral testosterone	A pill taken by mouth Not approved by the FDA for GSM	Research showed little to no improvement in vaginal dryness and painful sex Research didn’t look at vaginal discomfort or irritation or painful urination
Vaginal oxytocin	A gel applied directly inside the vagina with an applicator Not approved by the FDA for GSM	Research couldn’t say for sure if it improves vaginal dryness, vaginal discomfort or irritation, or painful sex Research didn’t look at painful urination
Oral raloxifene and bazedoxifene	A pill taken by mouth Brand names include Evista^® and Duavee^®	Raloxifene: Research showed little to no improvement in vaginal dryness, vaginal discomfort or irritation, painful urination, or painful sex Bazedoxifene: Research didn’t look at vaginal dryness, vaginal discomfort or irritation, painful urination, or painful sex
Energy-based therapies	Examples include a carbon dioxide, or CO₂, laser; an erbium-doped yttrium aluminum garnet laser; and radiofrequency Not approved by the FDA for GSM	Research showed little to no difference or can’t say for sure if the treatments improve vaginal dryness, vaginal discomfort or irritation, painful urination, or painful sex

Talking to Your Clinician About Treating GSM

You may want to talk with your clinician about your GSM symptoms, treatment goals and medical history. You may also want to consider the cost and availability of treatments. Some treatments are covered by insurance and others are not. Your clinician may suggest that you try over-the-counter treatments first.

After you start treatment, it is important for you and your clinician to check in about your symptoms. Watching for changes in your symptoms will help you understand how well the treatment works and if it causes any side effects. You can also talk with your clinician about whether you are happy with the treatments you’re using.

What Questions Should I Ask My Clinician?

Here are a few questions you may want to ask your clinician:

➤ Are treatments available that can help with my symptoms?

➤ Can I get the treatment over the counter, or does it require a prescription?

➤ Are any of these treatments more difficult to use than others?

➤ Given my medical history, do you have any concerns about me using hormonal treatments?

➤ What side effects of treatment should I know about?

➤ How long will it take for my symptoms to get better?

About the Evidence

The research team looked at evidence from 68 moderate- and high-quality studies comparing how well treatments worked to improve symptoms of GSM. All studies were published between 1983 and December 2023 and conducted in the United States.

Read the full systematic review at www.pcori.org/reviews-GSM

Download this Evidence Update

SOURCES

^{© 2011–2026 Patient-Centered Outcomes Research Institute. “Genitourinary Syndrome of Menopause (A Systematic Review).” Updated May 9, 2025.}^{https://www.pcori.org/research-results/2022/genitourinary-syndrome-menopause-systematic-review}

^{Danan ER, Diem S, Sowerby C, et al.}^{Genitourinary Syndrome of Menopause: A Systematic Review.}^{This systematic review was supported by PCORI through a research partnership with AHRQ. Rockville, MD: AHRQ Publication No. 24-EHC022; 2024. Washington, DC: PCORI Publication No. 2024-SR-02; 2024. doi:}^{https://doi.org/10.23970/AHRQEPCCER272}

^{The information in this publication is not intended to be a substitute for professional medical advice.}

Posted: June 29, 2026

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