{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T02:27:45Z","timestamp":1773368865875,"version":"3.50.1"},"reference-count":72,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women\u2019s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA\/SUFU\/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review\/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS\/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach.<\/jats:p>","DOI":"10.3390\/clinpract16030060","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:12:24Z","timestamp":1773321144000},"page":"60","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case-Based Perspectives on the Management of Genitourinary Syndrome of Menopause"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6340-4254","authenticated-orcid":false,"given":"Jissy","family":"Cyriac","sequence":"first","affiliation":[{"name":"Menopause and Women\u2019s Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8747-0459","authenticated-orcid":false,"given":"Richa","family":"Sood","sequence":"additional","affiliation":[{"name":"Menopause and Women\u2019s Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","article-title":"Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women\u2019s Sexual Health and the North American Menopause Society","volume":"21","author":"Portman","year":"2014","journal-title":"Menopause"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3109\/13697137.2013.871696","article-title":"Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause","volume":"17","author":"Nappi","year":"2014","journal-title":"Climacteric"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1111\/jsm.12190","article-title":"Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal Women\u2019s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey","volume":"10","author":"Kingsberg","year":"2013","journal-title":"J. Sex. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"The Menopause Society (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause, 27, 976\u2013992.","DOI":"10.1097\/GME.0000000000001609"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/SPV.0000000000000975","article-title":"Utilization of a Mirror During Pelvic Examinations: Does it Improve the Patient\u2019s Experience?","volume":"27","author":"Tam","year":"2021","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/GME.0000000000001194","article-title":"WISDOM survey: Attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history","volume":"26","author":"Kingsberg","year":"2019","journal-title":"Menopause"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/0092623X.2021.1998270","article-title":"Sexual Counseling with the PLISSIT Model: A Systematic Review","volume":"48","author":"Tuncer","year":"2022","journal-title":"J. Sex Marital Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/009262300278597","article-title":"The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function","volume":"26","author":"Rosen","year":"2000","journal-title":"J. Sex Marital Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/JU.0000000000004589","article-title":"The AUA\/SUFU\/AUGS Guideline on Genitourinary Syndrome of Menopause","volume":"214","author":"Kaufman","year":"2025","journal-title":"J. Urol."},{"key":"ref_10","unstructured":"National Institute for Health and Care Excellence (2024). National Institute for Health and Care Excellence: Clinical Guidelines. Menopause: Identification and Management, National Institute for Health and Care Excellence (NICE)."},{"key":"ref_11","unstructured":"World Health Organization (2012). Use and Procurement of Additional Lubricants for Male and Female Condoms, FHI360."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/13697137.2020.1820478","article-title":"Vaginal lubricants and moisturizers: A review into use, efficacy, and safety","volume":"24","author":"Potter","year":"2021","journal-title":"Climacteric"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1097\/AOG.0b013e31818aa7c3","article-title":"Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet","volume":"112","author":"Simon","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3109\/13697137.2015.1136926","article-title":"Pharmacokinetic studies of solubilized estradiol given vaginally in a novel softgel capsule","volume":"19","author":"Pickar","year":"2016","journal-title":"Climacteric"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.maturitas.2017.02.008","article-title":"A vaginal estradiol softgel capsule, TX-0Me04HR, has negligible to very low systemic absorption of estradiol: Efficacy and pharmacokinetic data review","volume":"99","author":"Simon","year":"2017","journal-title":"Maturitas"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/GME.0000000000001463","article-title":"Systemic estradiol levels with low-dose vaginal estrogens","volume":"27","author":"Santen","year":"2020","journal-title":"Menopause"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/SPV.0b013e3181ab4804","article-title":"Local Effects of Vaginally Administered Estrogen Therapy: A Review","volume":"15","author":"Krause","year":"2009","journal-title":"J. Pelvic Med. Surg."},{"key":"ref_18","unstructured":"Wen, L.S. (2025, November 30). The FDA Should Stop Scaring Women About This Menopause Treatment. Available online: https:\/\/www.washingtonpost.com\/opinions\/2025\/07\/29\/fda-menopause-hormone-therapy-black-box-warning\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/GME.0000000000000956","article-title":"Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women\u2019s Health Initiative Observational Study","volume":"25","author":"Crandall","year":"2018","journal-title":"Menopause"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1097\/GME.0000000000001284","article-title":"Vaginal estrogen use and chronic disease risk in the Nurses\u2019 Health Study","volume":"26","author":"Bhupathiraju","year":"2018","journal-title":"Menopause"},{"key":"ref_21","unstructured":"Release, F.N. (2025, November 30). HHS Avances Women\u2019s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy, Available online: https:\/\/www.fda.gov\/news-events\/press-announcements\/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/GME.0000000000000808","article-title":"Science of intracrinology in postmenopausal women","volume":"24","author":"Labrie","year":"2017","journal-title":"Menopause"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1097\/gme.0b013e31819e8e2d","article-title":"Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy","volume":"16","author":"Labrie","year":"2009","journal-title":"Menopause"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/GME.0000000000000571","article-title":"Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause","volume":"23","author":"Labrie","year":"2016","journal-title":"Menopause"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jsbmb.2016.03.016","article-title":"Serum steroid concentrations remain within normal postmenopausal values in women receiving daily 6.5 mg intravaginal prasterone for 12 weeks","volume":"159","author":"Martel","year":"2016","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_26","unstructured":"FDA (2026, February 09). Osphena. Highlights of Prescribing Information 2013, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/203505s015lbl.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1097\/GME.0000000000000900","article-title":"Ospemifene\u2019s effects on lipids and coagulation factors: A post hoc analysis of phase 2 and 3 clinical trial data","volume":"24","author":"Archer","year":"2017","journal-title":"Menopause"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/gme.0b013e318279ba64","article-title":"Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy","volume":"20","author":"Portman","year":"2013","journal-title":"Menopause"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1097\/GME.0000000000002211","article-title":"Efficacy, tolerability, and endometrial safety of ospemifene compared with current therapies for the treatment of vulvovaginal atrophy: A systematic literature review and network meta-analysis","volume":"30","author":"Simon","year":"2023","journal-title":"Menopause"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1097\/GME.0000000000001121","article-title":"Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: Consensus recommendations from The North American Menopause Society and The International Society for the Study of Women\u2019s Sexual Health","volume":"25","author":"Faubion","year":"2018","journal-title":"Menopause"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/14681994.2017.1419557","article-title":"Genital vibration for sexual function and enhancement: A review of evidence","volume":"33","author":"Rullo","year":"2018","journal-title":"Sex. Relatsh. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.jmig.2020.08.001","article-title":"The Efficacy of Vaginal Laser and Other Energy-based Treatments on Genital Symptoms in Postmenopausal Women: A Systematic Review and Meta-analysis","volume":"28","author":"Li","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1086\/516221","article-title":"Vaginal microflora in postmenopausal women who have not received estrogen replacement therapy","volume":"25","author":"Hillier","year":"1997","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"24380","DOI":"10.1038\/srep24380","article-title":"Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis","volume":"6","author":"Shen","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5306\/wjco.v13.i2.71","article-title":"Management of genitourinary syndrome of menopause in breast cancer survivors: An update","volume":"13","year":"2022","journal-title":"World J. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/OLQ.0000000000001272","article-title":"Clinical and Personal Lubricants Impact the Growth of Vaginal Lactobacillus Species and Colonization of Vaginal Epithelial Cells: An in Vitro Study","volume":"48","author":"Owen","year":"2021","journal-title":"Sex. Transm. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/AOG.0b013e31828786f8","article-title":"Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States","volume":"121","author":"Brown","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1001\/jamainternmed.2018.0116","article-title":"Efficacy of vaginal estradiol or vaginal moisturizer vs placebo for treating postmenopausal vulvovaginal symptoms","volume":"178","author":"Mitchell","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1006\/taap.1998.8544","article-title":"Some alkyl hydroxy benzoate preservatives (parabens) are estrogenic","volume":"153","author":"Routledge","year":"1998","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/jat.958","article-title":"Concentrations of parabens in human breast tumours","volume":"24","author":"Darbre","year":"2004","journal-title":"J. Appl. Toxicol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10549-012-2198-y","article-title":"Local estrogen therapy and risk of breast cancer recurrence among hormone-treated patients: A nested case-control study","volume":"135","author":"Bonnetain","year":"2012","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1093\/jnci\/djac112","article-title":"Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study","volume":"114","author":"Cold","year":"2022","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.ajog.2024.10.054","article-title":"Vaginal estrogen use in breast cancer survivors: A systematic review and meta-analysis of recurrence and mortality risks","volume":"232","author":"Beste","year":"2025","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e-rbgo46","DOI":"10.61622\/rbgo\/2025rbgo46","article-title":"Vaginal estrogen therapy for treatment of menopausal genitourinary syndrome among breast cancer survivors: A systematic review and meta-analysis","volume":"47","author":"Santos","year":"2025","journal-title":"Rev. Bras. Ginecol. Obs."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1001\/jamaoncol.2023.4508","article-title":"Vaginal Estrogen Therapy Use and Survival in Females with Breast Cancer","volume":"10","author":"McVicker","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_46","first-page":"643","article-title":"Evaluating the efficacy of vaginal dehydroepiandosterone for vaginal symptoms in postmenopausal cancer survivors: NCCTG N10C1 (Alliance)","volume":"26","author":"Barton","year":"2018","journal-title":"Support. Care Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jsbmb.2008.06.003","article-title":"Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women","volume":"111","author":"Labrie","year":"2008","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_48","unstructured":"(2025, November 30). Dailymed, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=9accbcc9-78ee-4f84-9b7e-704f2ab1c413."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.maturitas.2020.06.021","article-title":"No increase in incidence or risk of recurrence of breast cancer in ospemifene-treated patients with vulvovaginal atrophy (VVA)","volume":"142","author":"Cai","year":"2020","journal-title":"Maturitas"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.clbc.2025.08.001","article-title":"Quality of life and Satisfaction with Ospemifene for Treating Vulvovaginal Atrophy in Breast Cancer Survivors: Six-Month Results From the PatiEnt SatisfactiON StudY (PEONY)","volume":"25","author":"Villa","year":"2025","journal-title":"Clin. Breast Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3394","DOI":"10.1200\/JCO.2014.60.7366","article-title":"A Practical Solution for Dyspareunia in Breast Cancer Survivors: A Randomized Controlled Trial","volume":"33","author":"Goetsch","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"292","DOI":"10.2478\/raon-2023-0038","article-title":"Modern approach to the management of genitourinary syndrome in women with gynecological malignancies","volume":"57","author":"Kovacevic","year":"2023","journal-title":"Radiol. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1001\/jamaoncol.2016.3904","article-title":"Vaginal Testosterone Cream vs Estradiol Vaginal Ring for Vaginal Dryness or Decreased Libido in Women Receiving Aromatase Inhibitors for Early-Stage Breast Cancer: A Randomized Clinical Trial","volume":"3","author":"Melisko","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s10549-024-07564-8","article-title":"Effects of vaginal estrogen on serum estradiol during aromatase inhibitor therapy in breast cancer patients with vulvovaginal atrophy: A prospective trial","volume":"210","author":"Vehmanen","year":"2025","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_55","first-page":"187","article-title":"Changes in serum estradiol levels with Estring in postmenopausal women with breast cancer treated with aromatase inhibitors","volume":"29","author":"Streff","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e731","DOI":"10.1016\/j.clbc.2019.07.007","article-title":"The Safety of Local Hormonal Treatment for Vulvovaginal Atrophy in Women with Estrogen Receptor-positive Breast Cancer Who Are on Adjuvant Aromatase Inhibitor Therapy: Meta-analysis","volume":"19","author":"Mamillapalli","year":"2019","journal-title":"Clin. Breast Cancer"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/AOG.0000000000006060","article-title":"Updates in Clinical Management of Recurrent Urinary Tract Infections","volume":"146","author":"Siddiqui","year":"2025","journal-title":"Obstet. Gynecol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3109\/13697137.2015.1124259","article-title":"Treating vulvovaginal atrophy\/genitourinary syndrome of menopause: How important is vaginal lubricant and moisturizer composition?","volume":"19","author":"Edwards","year":"2016","journal-title":"Climacteric"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/GCO.0000000000000914","article-title":"Evaluation and management of urethral and periurethral masses in women","volume":"35","author":"Zuo","year":"2023","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e2444495","DOI":"10.1001\/jamanetworkopen.2024.44495","article-title":"Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement","volume":"7","author":"Nelson","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.urology.2020.05.058","article-title":"Effective Prevention of Recurrent UTIs with Vaginal Estrogen: Pearls for a Urological Approach to Genitourinary Syndrome of Menopause","volume":"151","author":"Buck","year":"2021","journal-title":"Urology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0090-4295(03)00676-9","article-title":"The role of estrogens in female lower urinary tract dysfunction","volume":"62","author":"Robinson","year":"2003","journal-title":"Urology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"143.e1","DOI":"10.1016\/j.ajog.2023.05.002","article-title":"Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women","volume":"229","author":"Shah","year":"2023","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00192-020-04397-z","article-title":"Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: A meta-analysis of randomized controlled trials","volume":"32","author":"Chen","year":"2021","journal-title":"Int. Urogynecol. J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"S232","DOI":"10.1016\/j.jsxm.2020.04.264","article-title":"028 Impact of Vaginal Prasterone on the Frequency of Urinary Tract Infections","volume":"17","author":"Rubin","year":"2020","journal-title":"J. Sex. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/phar.2895","article-title":"Methenamine for urinary tract infection prophylaxis: A systematic review","volume":"44","author":"Li","year":"2024","journal-title":"Pharmacotherapy"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/JU.0000000000002860","article-title":"Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA\/CUA\/SUFU Guideline","volume":"208","author":"Anger","year":"2022","journal-title":"J. Urol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"ofac327","DOI":"10.1093\/ofid\/ofac327","article-title":"Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis","volume":"9","author":"Jent","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_69","first-page":"Cd013608","article-title":"D-mannose for preventing and treating urinary tract infections","volume":"8","author":"Cooper","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_70","first-page":"17571774251394869","article-title":"D-Mannose for prevention of recurrent urinary tract infection in adult women: An updated systematic review and meta-analysis of randomized controlled trials","volume":"3","author":"Joseph","year":"2025","journal-title":"J. Infect. Prev."},{"key":"ref_71","first-page":"CD001321","article-title":"Cranberries for preventing urinary tract infections","volume":"11","author":"Williams","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/13697137.2020.1829584","article-title":"CO2 laser and the genitourinary syndrome of menopause: A randomized sham-controlled trial","volume":"24","author":"Salvatore","year":"2021","journal-title":"Climacteric"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/3\/60\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:52:00Z","timestamp":1773327120000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/3\/60"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":72,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["clinpract16030060"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16030060","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}