Why Do Women Suffer in Silence with Genitourinary Syndrome of Menopause?

Between half and two-thirds of postmenopausal women experience genitourinary syndrome of menopause (GSM), yet only about 25% seek treatment for their symptoms.^1,2 This striking gap between symptom prevalence and treatment-seeking behavior represents a significant quality of life issue for millions of women navigating menopause.

In this interview with Patient Care^© at The Menopause Society 2025 Annual Meeting in Orlando, Caroline Mitchell, MD, MPH, associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, discussed the barriers that prevent women from getting help for GSM symptoms. Mitchell identifies a troubling cycle: many women believe their symptoms are simply an inevitable part of aging that they must endure, remaining unaware that effective treatments exist. Compounding this problem, health care practtitioners often fail to ask about these symptoms during routine visits.

"I think we don't ask, and people don't tell," Mitchell explained, pointing to the dual nature of this communication breakdown. She notes that even when women intend to discuss their symptoms, GSM concerns often fall lower on the priority list during busy clinical appointments. The combination of patient embarrassment, lack of awareness about available treatments, and providers' failure to initiate these conversations creates a perfect storm of underdiagnosis and undertreatment.

Mitchell's insights underscore the need for both patient education about GSM treatment options and proactive screening by healthcare providers to ensure women receive the care they need for these common and treatable symptoms.

The following transcript was edited lightly for flow.

Patient Care: Between half and two thirds of post-menopausal women experience the symptoms, but only about a quarter seek treatment. What do we know about the reasons for that?

Mitchell: I think one reason is that in surveys where people have been asked, "Have you spoken with your doctor? And if not, why not?" a significant number of people say, "Well, I thought it was just something I had to deal with. This is just part of life." They are unaware that there are treatments available, that there are interventions that could change that experience. I also think we as providers don't always ask, and many people are not comfortable bringing it up, or it's like one of a list of things, and it seems lower on the list, or people are less comfortable. And so at the end of the visit when you're, you know, walking out of the door, and so it never gets mentioned. So I think we don't ask, and people don't tell.

References:

1. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-978. doi:10.1097/AOG.0b013e3181898cdb
2. Kingsberg SA, et al. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013;10(7):1790-1799. doi: 10.1111/jsm.12190