Retrospective Cohort Study of Symptoms and Quality of Life in Women With Genitourinary Syndrome of Menopause.

Genitourinary Syndrome of Menopause (GSM) encompasses a constellation of vulvovaginal and urinary signs and symptoms associated with estrogen deficiency and the resulting thinning of the urogenital mucosa. These symptoms include vaginal dryness, dyspareunia, itching/burning, irritation, dysuria, urinary frequency and urgency, among others. GSM symptoms are typically chronic and, unlike vasomotor symptoms of menopause, tend to worsen over time.

GSM affects between 27% and 84% of postmenopausal women and remains a frequently underdiagnosed and consequently undertreated condition. This underdiagnosis is primarily related to insufficient physician-patient communication regarding the condition. Patients may not report symptoms because they consider them a normal consequence of aging or feel embarrassed, while healthcare professionals do not always actively inquire about them.

Furthermore, GSM symptoms have a variable impact on the quality of life of menopausal women and may significantly affect multiple aspects of patients' lives, including daily activities, self-esteem, intimate relationships, and psychological well-being. In routine clinical practice, there is often limited information regarding which symptoms patients perceive as most bothersome and which dimensions of quality of life are most affected. For this reason, and in line with the principles of Value-Based Healthcare, questionnaires assessing the impact of GSM on women's quality of life have increasingly been incorporated into clinical practice in recent years, with the aim of focusing healthcare activities on those that generate the most meaningful patient outcomes. One example is the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire, extensively used in the Women´s Health Unit of the Hospital Universitario La Luz Quirónsalud.

The usual management of women with GSM includes the use of topical agents aimed at improving symptoms, with or without local estrogen therapy. When estrogen use is contraindicated, or when patients prefer non-hormonal alternatives, hormone-free creams and gels are commonly recommended. XCM INTIM (a non-hormonal topical gel containing olive oil, betaine, and xylitol; Mucosa Innovations S.L.) is among these products.

This study aims to retrospectively describe the pattern of GSM symptoms and their impact on quality of life among postmenopausal women who used XCM INTIM gel. Additionally, when available data from medical records, healthcare professional notes, and/or patient-completed questionnaires collected as part of routine clinical practice permit, the study will explore symptom evolution and functional impact in women with sufficient follow-up (defined as documentation of at least 8 weeks of product use).

Real-world data (RWD) studies provide valuable complementary evidence to clinical trials by capturing the effectiveness and safety of treatments in routine clinical practice settings.

In this context, the present protocol describes a retrospective observational study in a cohort of menopausal women with GSM who attended the Women's Health Unit of Hospital Universitario La Luz Quirónsalud between January 2022 and April 2026. The study aims to characterize the most prevalent genitourinary symptoms, their severity, and their impact on quality of life, as well as evaluate their evolution following the use of XCM INTIM topical gel.

Inclusion criteria

Patients included in this retrospective data evaluation must have met all of the following criteria:

• Postmenopausal women (defined as at least 12 consecutive months of amenorrhea)
• Present at least one symptom of GSM documented in the medical record
• Evidence in the medical record that the patient had perceived the GSM symptom(s) as having an impact on her quality of life.
• Documentation in the medical record that the patient had initiated treatment with XCM INTIM, together with follow-up clinical data including an assessment performed at least 8 weeks after treatment initiation.
• Patients that had attended at the Department of Obstetrics and Gynecology of Hospital Universitario La Luz between January 2022 and April 2026, regardless of whether they had participated in another study during this period.

Exclusion criteria

Patients will be excluded from the study if any of the following conditions were present:

• Use of topical vulvovaginal hormonal products within 4 weeks prior to initiation of XCM INTIM treatment.
• Use of systemic estrogen therapy within 8 weeks prior to initiation of XCM INTIM treatment.
• Presence of relevant gynecological and/or urinary conditions that could have interfered with the assessment of symptoms attributed to GSM, including but not limited to active vulvovaginal and/or urinary tract infections, significant vulvar lesions, active gynecological malignancies, severe stress urinary incontinence (Sandvik score ≥ 8), pelvic organ prolapse stage III or higher (POP-Q), or any other condition considered by the investigator to be a significant confounding factor.
• Previous radiotherapy involving the pelvic and/or genital region.
• Previous laser and/or radiofrequency treatment in the pelvic region.
• Medical records containing insufficient information for analysis of the primary study variables.