Untreated Genitourinary Symptoms of Menopause Linked to Severe Risks

Untreated genitourinary symptoms of menopause (GSM) have been linked to serious health complications, including recurrent urinary tract infections (UTIs) and abnormal Pap smear results. This was highlighted in research presented at the American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting held in Minneapolis. The study, led by Ruben Fernandez Ibanez, a final-year medical student at the University of Alcala in Spain, synthesizes data from three studies involving over 800 women conducted over a 15-year period.

According to the study, untreated GSM can lead to three primary complications: false abnormal Pap smears, recurrent UTIs that may progress to severe infections, and vulvovaginal obliteration. "By identifying the risks associated with untreated GSM, this research underscores the need for early diagnosis and sustained, lifelong management to prevent serious and potentially life-threatening complications," Ibanez stated.

Dr. Monica Christmas, an associate professor at the University of Chicago Medicine and director of the Menopause Program, emphasized the importance of treating GSM even for individuals not sexually active. She noted that recurrent UTIs, particularly in nursing home populations, contribute to higher morbidity and mortality rates. "A number of risk-reducing interventions should be in place, one of which can be local low-dose vaginal estrogen therapy," she advised.

The findings indicate that the absence of hormone therapy is associated with a higher incidence of recurrent UTIs, which in some cases progressed to systemic complications, including severe sepsis. The authors noted that patients receiving hormone therapy rarely experienced such outcomes, suggesting that estrogen therapy plays a protective role in reducing infections and preventing severe complications.

The poster highlighted that more than 500 patients over the age of 40 initially had abnormal Pap results; however, following local vaginal estrogen therapy, over 90% of these patients experienced full cytological resolution within four to six months. This underscores the notion that estrogen deficiency-induced cellular atrophy can mimic dysplasia, leading to false diagnoses of malignancy.

Dr. Christmas cautioned that while the study presents significant findings, it lacks detailed information regarding the nature of the abnormal Pap smears. "In older people with vaginal atrophy, you often can’t get enough cervical cells, and it will come back insufficient," she explained, suggesting that a brief treatment of vaginal estrogen could aid in obtaining adequate samples for assessment.

Moreover, the authors reported cases of vulvovaginal obliteration in patients aged 62 to 92, with total obliteration resulting in complications such as urinary retention and renal insufficiency. While immediate relief was achievable through interlabial fusion release procedures, long-term success required combined treatment with hormone therapy and gradual use of dilators.

The study did not address potential confounders present in nursing home populations, such as incontinence and immobility, which could influence outcomes. Therefore, Dr. Christmas stated that the evidence regarding the improvement of urologic complications through vaginal estrogen therapy remains inconclusive, necessitating further research.

Overall, the findings emphasize that genitourinary symptoms associated with menopause are prevalent and significantly impact quality of life. They often go unrecognized and untreated, which is concerning given that local, low-dose vaginal estrogen therapy is widely acknowledged as a safe and effective treatment option with minimal risks. As GSM continues to be an under-discussed aspect of women's health, the study advocates for greater awareness and proactive management to prevent severe health outcomes.

No external funding or author disclosures were mentioned in the study. Dr. Christmas reported no conflicts of interest. This research serves as a crucial reminder of the importance of addressing GSM in clinical practice and the need for increased education and awareness among healthcare providers regarding its potential complications.