Caroline Mitchell, MD, Describes Toll of Genitourinary Syndrome of Menopause on QoL

Genitourinary syndrome of menopause affects up to 60% of postmenopausal women, yet it remains one of the most undertreated conditions in women's health, according to Caroline Mitchell, MD, MPH, Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School. Patient Care spoke with Mitchell during The Menopause Society 2025 Annual Meeting, October 21-25, in Orlando, FL. She explained that, unlike hot flashes that fade with time, GSM symptoms are chronic and progressive, worsening as women move further from their menopausal transition. The impact extends far beyond physical discomfort, affecting sexual function, intimate relationships, and overall quality of life in ways comparable to chronic pulmonary disease.

Despite this significant burden, only about 25% of affected women seek treatment. Many suffer in silence due to embarrassment, misconceptions about treatment safety, or the belief that these symptoms are simply an inevitable part of aging. Meanwhile, primary care clinicians—often the first and only point of contact for these patients—may lack confidence in recognizing and managing GSM, leading to missed opportunities for intervention.

The landscape of GSM treatment has evolved considerably in recent years. Evidence now clearly demonstrates the safety of low-dose vaginal estrogen, even in breast cancer survivors. Research has debunked longstanding myths about sexual activity and vaginal health, while sham-controlled studies have challenged the efficacy of expensive energy-based treatments like fractional laser therapy. Yet translating this evidence into clinical practice remains a challenge, particularly in primary care settings where most women receive their healthcare.

In this interview, Dr. Caroline Mitchell, an expert in menopause and vulvovaginal health, discusses the fundamentals of GSM and its profound impact on women's lives, setting the foundation for understanding why improved recognition and treatment of this condition is critical.