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.