Many females who are postmenopausal experience genitourinary syndrome of menopause (GSM), a condition affecting the vulva, vagina, and urinary tract that can cause vaginal dryness, painful sexual intercourse, reduced libido, and recurrent urinary tract infections. Treatments for GSM include vaginal estrogen and testosterone, vaginal and systemic dehydroepiandrosterone (DHEA), and nonhormonal moisturizers.

After reviewing 46 randomized clinical trials of postmenopausal people with at least 1 symptom of GSM, the researchers assessed how well each treatment worked and how safe they were. They found 4 treatments that may improve some GSM symptoms in the short term: vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers. However, the effects were modest compared with placebos, the researchers noted.

Moreover, vaginal estrogen didn't show significant benefits over placebo in alleviating pain from intercourse in more than half of the high-quality studies the researchers analyzed. Instead, vaginal DHEA and oral ospemifene might offer more consistent relief from painful sex, as well as vulvovaginal dryness. No treatment relieved vulvovaginal irritation or urinary discomfort. There were few serious adverse effects of any treatment.

Most of the studies lasted 12 weeks or less and had small sample sizes. Therefore, "long-term follow-up for efficacy, tolerability, and endometrial safety represents a critical gap to guide treatment longer than 1 year," the researchers noted in Annals of Internal Medicine.