Enhancing the diagnosis & management of genitourinary syndrome of menopause in primary care: a quality improvement project

Abstract

Problem: Genitourinary syndrome of menopause (GSM) is a chronic condition caused by estrogen deficiency affecting vaginal and lower urinary tract tissues that can significantly impact quality of life for midlife and older women. Although research suggests that approximately 50- 70% of postmenopausal women experience symptoms, the condition remains substantially underrecognized and undertreated in primary care. At a primary care clinic serving urban and rural populations, a baseline chart review identified a diagnostic rate of only 0.76%, with three documented diagnoses among a panel of 396 female patients aged 40 years and older. No standardized screening workflow existed to support consistent identification of symptoms. Methods: This quality improvement project aimed to improve identification and management of GSM in a primary care setting. The project included provider and staff education, development of a feasible screening approach, and establishment of consensus-based diagnostic and treatment practices aligned with current clinical guidelines. Clinicians collaboratively reviewed existing screening tools and adapted a single-question screening prompt for use during routine visits. Clinic staff were trained to administer the screening question during eligible visits for women aged 40 years and older, and positive screening results prompted provider evaluation to confirm diagnosis and initiate treatment when appropriate. Results: Over a six-week implementation period, 116 eligible visits were reviewed and 67 screenings were completed, representing a screening rate of 57.8%. Screening identified 12 new diagnoses of genitourinary syndrome of menopause, corresponding to a diagnosis rate of 17.9% among screened patients. Treatment was initiated for eight of the twelve patients diagnosed during the project period. Staff surveys indicated improvements in knowledge and confidence related to screening, documentation, and workflow procedures following the educational intervention. Conclusions: Implementation of a brief screening workflow improved identification of GSM in a primary care clinic and revealed a substantial gap between documented diagnoses and expected prevalence. These findings suggest that simple, structured screening approaches integrated into routine primary care workflows may improve recognition and management of this common yet frequently overlooked condition.