Evidence on Genitourinary Syndrome of Menopause in Africa: A Systematic Review and Narrative Synthesis of Symptom-Based Studies and Care Gaps

<ns5:p>Background Genitourinary syndrome of menopause (GSM) encompasses a spectrum of vulvovaginal, sexual, and urinary symptoms associated with estrogen deficiency and is increasingly recognized as a major contributor to morbidity among midlife and older women. While global evidence suggests that GSM is highly prevalent, data from African populations remain fragmented, often reported as isolated symptoms rather than a unified clinical syndrome. This limits understanding of burden, context, and healthcare needs across the continent. Methods Based on PRISMA 2020 and SWiM recommendations, a systematic review with narrative synthesis was performed to investigate evidence on GSM and other urogenital symptoms in Africa. PubMed/MEDLINE, Scopus, Web of Science and African Journals Online were searched, and manual searches were used to supplement them. Only primary studies performed in African populations that reported either formally defined GSM or menopause-related urogenital symptoms were eligible. Results Eleven articles were included and most of them were cross-sectional studies in Ghana, Nigeria, Ethiopia, and Zimbabwe. GSM was only explicitly defined in one study, which reported a prevalence of 46.8%. Most studies relied on proxy symptom measures, with vaginal dryness ranging from 7.2% to 71.4%, sexual symptoms reported in approximately 40–90% of participants, and urinary symptoms varying widely depending on measurement approach. High heterogeneity was noted, which was motivated by the difference in the population of the studies, instruments, and sociocultural contexts. Conclusions Evidence on GSM in Africa is limited, heterogeneous, and geographically concentrated, with most studies relying on symptom-based proxies rather than standardized definitions. Nevertheless, irrespective of these shortcomings, the impact of menopause-associated urogenital symptoms seems to be massive and generally in line with world trends. Addressing this gap requires standardized measurement approaches, expanded research across underrepresented regions, and integration of menopause care into health systems, with attention to sociocultural factors influencing symptom reporting and care-seeking.</ns5:p>