Table 3. Treatment options for GSM.

GSM: genitourinary syndrome of menopause; SERM: selective estrogen receptor modulator; DHEA: dehydroepiandrosterone

Therapeutic modalities of GSM
Non-hormonal therapy	Lifestyle changes (maintenance of sexual activity, smoking cessation)
	Vaginal lubricants
	Vaginal moisturizers
	Liquid lidocaine compresses to the vulvar vestibule
	Microablative fractional CO2 laser
	Non-ablative photothermal erbium: YAG laser
	Oral ospemifene (SERM)
	Nutraceuticals (phytoestrogens)
	Alternative and complementary therapies	Oral vitamin D
		Vaginal vitamin E
		Probiotics
Hormonal therapy	Estrogen systemic	Orally
		Transdermally (patch or gel)
		Subcutaneously (implant)
		Vaginally
	DHEA
	Testosterone