Genitourinary syndrome of menopause

Abstract

<jats:p> Genitourinary syndrome of menopause affects approximately 50% of women post-menopause and is under-reported. This review of the condition including established and newer treatment options aspires to empower clinicians to ask about symptoms and be more proactive in their management. </jats:p>

The Genitourinary Syndrome of Menopause: An Overview of the Recent Data

“…While both receptors can be found in premenopausal women, only estrogen-b receptors can be detected in postmenopausal women [12]. Irritation and trauma occurring during sexual intercourse is the result of the hypoestrogenic environment of urogenital tract tissue, and It reflects changes in the thickness of the vaginal epithelium and lamina propria, atrophy of smooth muscles, reduction of vaginalarea blood flow, and loss of tissue elasticity (decreased concentration of collagen, elastin, and hyaluronic acid) [5,6]. Diminution of glycogen concentration in vaginal cells results in an alteration in the vaginal microbiome (fewer lactobacilli) and an increase of vaginal pH [1].…”

“…The primary goal of GSM's treatment is symptom relief. The available treatment options, besides local and systemic hormonal therapy, include lifestyle changes and non-hormonal treatments ( Table 3) [5,19,20]. Concerning the conservative approach, a positive link between maintenance of vaginal elasticity and lubricative response to sexual arousal with sexual activity has been demonstrated [21].…”

“…It may also be used in conjunction with a conservative approach [2,7]. The hormonal therapy includes estrogen-based products that can be administered through different routes (vaginally, orally, transdermally or subcutaneously), with vaginal tablets or creams showing better outcomes than the others [5]. Estrogens delivered orally, in many cases, do not lead to beneficial effects on the lower genital tract.…”

“…To this day, GSM remains extremely underdiagnosed despite its high prevalence, mostly because of the reluctance among women to seek help due to embarrassment, or as a result of a tendency among many women to consider it as a normal feature of natural aging. However, in many cases, the reluctance of healthcare professionals to address these issues constitutes a major cause of the lack of awareness about this syndrome among affected women [4,5].…”

Carbon Dioxide Laser Vulvovaginal Rejuvenation: A Systematic Review

“…GSM symptomatology results from estrogen decline in the vaginal mucosa that reduced epithelial thickness, lamina propria, and muscular layer, as well as connective tissue changes, i.e., decreased collagen and elastin content and decreased blood flow. These effects make the vulvovaginal tissues vulnerable to trauma during "sexual intercourse" and gynecology examination [3,4].…”