Genitourinary syndrome of menopause in surgical versus natural menopause: standardized clinical scoring

To compare genitourinary syndrome of menopause (GSM) symptoms and objective examination findings between women with surgical and natural menopause, and to evaluate the association between menopausal type and GSM severity.

This retrospective, single-center cross-sectional study included 422 postmenopausal women (218 surgical, 204 natural menopause). GSM was assessed using a standardized eight-component examination score (elasticity, lubrication, tissue integrity, introitus, labia, urethra, rugae, color; total score 0-22) and structured symptom inquiry. Group comparisons were performed with non-parametric and χ2 tests. Multivariable logistic regression analysis was used to explore the association between menopausal type and GSM-related findings.

Women with surgical menopause had significantly higher total GSM scores and more pronounced impairment in lubrication, tissue integrity, introitus, labial, and urethral components. Genital dryness, dyspareunia, reduced sexual desire, postcoital bleeding, dysuria, and urinary frequency were also more common in this group. In regression analysis, total GSM score was found to be independently associated with surgical menopause (adjusted odds ratio: 1.08, 95% CI: 1.04-1.12).

Surgical menopause is associated with a more severe GSM phenotype. The total GSM score may serve as a practical tool to assess symptom severity and support timely clinical management. Routine assessment of GSM, particularly in surgically menopausal women, should be integrated into gynecological care to improve quality of life.