A Dermatologist’s Approach to Genitourinary Syndrome of Menopause

Hum, Matthew; Dytoc, Marlene

doi:10.1177/1203475417708165

Cited by 5 publications

(3 citation statements)

References 61 publications

(115 reference statements)

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“…This coexistence makes treatment challenging. Therefore, recognizing and treating SGM symptoms can improve the management of other vulvovaginal conditions and patient's situation [8].…”

Section: Discussionmentioning

confidence: 99%

Vulvar Craurosis due to Severe Genitourinary Syndrome of Menopause Complicated by Lichen Sclerosus: Two Case Reports and Literature Review

Febles¹,

Escudero²,

Manso³

et al. 2021

JOGRS

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Background: Vulvovaginal atrophy aﬀects approximately 45% of middle-aged women, as a result of decreased estrogen circulating levels and is often associated with vulvovaginal discomfort in menopausal patients. The spectrum of adverse consequences makes long-term treatment essential, not only for symptom relief, but also to avoid further complications. These symptoms can even be worsened if other vulvar conditions coexist, such as inflammatory dermatoses. Clinical presentation: We present two cases of patients with severe vulvar atrophy and craurosis, who required vulvo-vaginal opening associated with medical treatment. In both patients, we diagnosed severe genitourinary syndrome of menopause (GSM) complicated by vulvar lichen sclerosus, a very rare clinical situation. In case 1, the symptoms had progressed despite local estrogen treatment for vulvovaginal atrophy, and lichen wasn’t considered in previous check-ups. In contrast, patient nº 2 presented in the ER with impossibility to urinate and was then diagnosed and treated for underlying causes. Conclusions: GSM treatment should be a priority. The absence of improvement or progression of genital atrophy should alert the specialist to the coexistence of other vulvar pathologies.

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“…This coexistence makes treatment challenging. Therefore, recognizing and treating SGM symptoms can improve the management of other vulvovaginal conditions and patient's situation [8].…”

Section: Discussionmentioning

confidence: 99%

Vulvar Craurosis due to Severe Genitourinary Syndrome of Menopause Complicated by Lichen Sclerosus: Two Case Reports and Literature Review

Febles¹,

Escudero²,

Manso³

et al. 2021

JOGRS

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“…8 The exact number of affected women is thus unknown, with speculative estimates ranging from 10–84% of menopausal women. 3,4,24–55 Improving diagnostic accuracy has the potential to improve precision in relation to prevalence rates and to support a more accurate estimate of the burden of the disease.…”

Section: Methodsmentioning

confidence: 99%

Urogenital atrophy: The ‘unknown factors’ challenging current practice

Briggs

Hapangama

2021

Post Reprod Health

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Urogenital atrophy occurs as a result of the effect of estrogen deficiency on the tissue quality in the vulva, vagina, urethra and bladder. It is a common consequence of the menopause, with possibly up to 80% of women experiencing symptoms. Despite a number of different diagnostic methods, there is no validated objective method by which to confirm the diagnosis in clinical practice and research settings. Education, for women and clinicians, is called for to support diagnosis and treatment. However, before this can be of global benefit, development of an accessible and reproducible diagnostic test is required. Current assessment methods include routine history and clinical examination, with the clinician’s opinion based on their subjective observations. A vaginal smear to assess the ratio of superficial to parabasal cells and measurement of the pH of the vaginal secretions is more commonly used in research settings. A number of formulae have been postulated to facilitate the diagnosis including the Vaginal Health Index, the Vulval Health Index, the Genitourinary Syndrome of the Menopause assessment tool, the Genital Health Clinical Evaluation and vaginal biopsy and assessment of the vaginal microbiome. However, none of these potential methods of assessment has been validated. This article focuses on what we do not know about urogenital atrophy including the prevalence, the most appropriate terminology, aetiology, pathogenesis and the most objective and reproducible method of assessment.

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“…The patient’s subjective symptoms during history-taking and their objective signs in the clinical examination are effective in the initial diagnosis of atrophic vaginitis. 5 These common symptoms include feeling of dryness; itching; burning; irritation (even urinary burning following irritation and itching); pain during intercourse; 6 the observation of thin, fragile and pale vaginal epithelium and also petechiae or red spots during physical examination. 7…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of intravaginal oxytocin on vaginal atrophy: A systematic review

Ghorbani

Mirghafourvand

2020

Post Reprod Health

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Genitourinary syndrome of menopause is a major issue in menopausal health. Because unlike vasomotor symptoms, it has a progressive trend. In this regard we conducted a systematic review to evaluate the efficacy of intravaginal oxytocin on postmenopausal vaginal atrophy. A search was performed for published studies in Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar and Persian databases without time and language limitations. Only randomized controlled trials that compared intravaginal oxytocin with placebos were included. The outcome measures were objective and subjective assessed symptoms of vaginal atrophy. Statistical heterogeneity was evaluated using the I2. The standardized mean differences were pooled the fixed effects model. Of the five included studies, four studies meta-analysed. The meta-analysis in terms of the cytological analysis (standardized mean difference: 35.13, 95% confidence interval: 32.59–37.67, n = 218, I2 = 96%) was statistically significant. In terms of histological assessments (standardized mean difference: −0.38, 95% confidence interval: −0.94 to 0.17, n = 38, I2 = 0%) and endometrial thickness (standardized mean difference: 0.05, 95% confidence interval: −0.20 to −0.31, n = 95, I2 = 0%), there were no statistically significant differences between the groups. Three studies reported a statistically significant improvement in the subjective symptoms; however, we were unable to perform a meta-analysis. Four of the included studies assessed side effects, but only two studies reported them. Oxytocin as a nonestrogenic compound can be a suitable alternative for the treatment of vaginal atrophy, especially in women with contraindications for using estrogenic compounds. Further good quality clinical trials with long-term follow-ups are recommended to demonstrate the effects of intravaginal gel in the treatment of vaginal atrophy.

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A Dermatologist’s Approach to Genitourinary Syndrome of Menopause

Abstract: GSM is a debilitating and common condition that suffers from barriers to diagnosis and treatment. Current treatments are well tolerated, rewarding, and effective with rapid onset.

Cited by 5 publications

References 61 publications

Vulvar Craurosis due to Severe Genitourinary Syndrome of Menopause Complicated by Lichen Sclerosus: Two Case Reports and Literature Review

Vulvar Craurosis due to Severe Genitourinary Syndrome of Menopause Complicated by Lichen Sclerosus: Two Case Reports and Literature Review

Urogenital atrophy: The ‘unknown factors’ challenging current practice

The efficacy and safety of intravaginal oxytocin on vaginal atrophy: A systematic review

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