Advances in the pharmacological management of genitourinary syndrome of menopause

INTRODUCTION: Genitourinary syndrome of menopause (GSM) results from climacteric estrogens drop and leads to bothersome and progressive genital and lower urinary tract symptoms. Given the high frequency of GSM in the female population and the impact on quality of life, it is crucial to find a safe and effective treatment. Pharmacological therapies aim to modulate the hormonal system and to restore tissue morphology and function to a premenopausal state. AREAS COVERED: We analyzed the scientific evidence indexed in PubMed, Google Scholar and Medscape concerning the main pharmacological treatments, which include systemic and topical therapies. The aim of this review was to evaluate the efficacy of each treatment in the management of genital and urinary symptoms, as well as sexual dysfunction, associated with GSM. EXPERT OPINION: Despite the availability of several pharmacological options, GSM management remains a complex and highly individualized clinical challenge. Current evidence supports the efficacy of local therapies and selective estrogen receptor modulators (SERMs) in improving genital, urinary and sexual symptoms. Future perspectives should focus on a multimodal, personalized approach integrating pharmacological treatments with innovative therapies, guided by shared decision-making to optimize long-term outcomes and quality of life.