Introduction Vasomotor symptoms (VMS) and genitourinary symptoms are common over the menopause transition and may profoundly impact quality of life. To promote consistency and ensure research outcomes reflect what matters most to women with lived experience, the Core Outcomes in Menopause (COMMA) initiative developed core outcome sets (COS) for these symptoms (published 2021). Methods We explored uptake of these COS in three ways. First, we reviewed outcome reporting in historical randomised trials identified through existing systematic reviews. Second, we examine recently registered trials to see whether awareness of the COS is beginning to translate into practice. Finally, we consider how frontline treatments—menopause hormone therapy (MHT) for VMS and vaginal estrogen for genitourinary symptoms—have been evaluated against the two COS. Results Overall, alignment of outcome reporting against the COS was moderate and appears to have increased after publication of the COS. While reporting of the distress, bother or interference caused by these symptoms has historically been rare (2% of trials), 62% of registered clinical trials are now capturing this outcome. Common treatments for VMS and genitourinary symptoms, MHT and vaginal estrogen, have not been evaluated for all core outcomes, with treatment satisfaction and dysuria reported in only 9% of studies. Conclusion Despite strong endorsement and improvement in capture of symptom experience and impact, uptake of the full COMMA COS is limited. We call on the menopause research community to prioritise reporting of these outcomes that reflect people’s lived experience, so that future evidence is more meaningful, comparable, and patient-centred.

Background: Urogenital changes associated with menopause are now classified as genitourinary syndrome of menopause (GSM) which includes symptoms of urgency, frequency, dysuria, and recurrent urinary tract infections (UTIs) for which the recommended, treatment is estrogen. However, the association between menopause and urinary symptoms and the efficacy of hormone therapy (HT) for these symptoms is uncertain. Objectives: Our objectives were (1) to define the relationship between menopause and urinary symptoms including dysuria, urgency, frequency, recurrent UTIs, and urge and stress incontinence, and 2) to systematically review the effects of HT for urinary symptoms in peri and post-menopausal women. Search strategy: PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched until April 2022 Selection criteria: RCTs of peri or postmenopausal women with urinary symptoms including dysuria, frequent UTI, urgency, frequency, and incontinence, in English were included. Data collection and analysis: Two authors reviewed each paper with discrepancies resolved through whole group consensus. Data extracted included: publication date, country, setting, subject number, follow-up, duration, age, race/ethnicity, study design, inclusion criteria, and main findings. Main results: There is insufficient evidence to confirm that menopause is associated with urinary symptoms. The effect of HT on urinary symptoms depends on type. Systemic HT may cause urinary incontinence or worsen existing urinary symptoms. Vaginal estrogen improves dysuria, frequency, urge and stress incontinence, and recurrent UTI in postmenopausal women. Conclusions: Menopause has not been shown to cause urinary symptoms. Vaginal estrogen improves urinary symptoms and decreases the risk of recurrent UTI in postmenopausal women.