Revitalizing research in genitourinary syndrome of menopause.

Genitourinary syndrome of menopause is defined as the collection of signs and symptoms of the genitourinary tract from menopause, previously known as vulvovaginal atrophy. The Food and Drug Administration has approved select hormonal and nonhormonal treatment for vaginal atrophy, including systemic estrogen, vaginal estrogen, estrogen receptor modulators, and dehydroepiandrosterone. These medications can increase the risk of thromboembolic disease and malignancy; furthermore, the cost of the medications have been increasing. Energy-based therapy such as the fractional CO2 laser energy or nonablative photothermal Erbium:YAG-laser has emerged as an alternative treatment option for genitourinary syndrome of menopause. However, in July of 2018, the Food and Drug Administration released a statement cautioning women against vaginal rejuvenation devices and highlighted the paucity of long-term clinical research in this field. This statement may result in patients' hesitation to seek care for genitourinary syndrome of menopause. These recent events should be a call to action to urge physicians to address the barriers that exist in the treatment of genitourinary syndrome of menopause because of limited clinical research, cost of treatment, and fear.