Treatment patterns for genitourinary syndrome of menopause: a TriNetX analysis

Genitourinary syndrome of menopause (GSM) is a highly prevalent, underdiagnosed condition that can significantly impair quality of life (QoL). This study evaluates real-world treatment trends for GSM to better understand current management practices and highlight ongoing gaps in care. The background is in a different font than the rest of the abstract.

We queried the TriNetX database for patients with a diagnosis of postmenopausal atrophic vaginitis (ICD N95.2) and treatment information from 2004-2024. A combination of RxNorm and International Classification of Diseases-10 (ICD) codes was used to classify disease and treatment type, including topical estrogen (RxNorm 4083, 4099), Ospemifene (RxNorm 1370971), Prasterone (RxNorm 3143), and hormone replacement therapy (HRT, ICD Z79.890). Demographic information about the patients' age and sex was collected.

Overall, there were 2,867,232 cases of GSM identified. 71.22% (n = 2,042,024) of the cohort did not receive any treatment. Of patients undergoing treatment, the majority underwent a single intervention (n = 740,922, 89.79%). Of single medical therapy cases, topical estrogen (n = 656,825; 88.64%) was most common, followed by HRT (n = 78,855; 10.64%), Prasterone (n = 3691; 0.50%), and lastly Ospemifene (n = 1551; 0.21%). Very few patients underwent multiple interventions (n = 31,339; 9.1%), the majority of which were prescribed topical estrogen with HRT (n = 70,392; 83.52%).

Most women diagnosed with GSM did not receive treatment. Among those treated, topical estrogen was the predominant therapy. Newer therapies were underutilized, though it is unclear whether this is due to provider familiarity, patient preference, or access. Further research is warranted to elucidate the underlying reasons for undertreatment in this population.