Genitourinary syndrome of menopause: the unmet need

Abstract

Genitourinary syndrome of menopause (GSM) is a highly prevalent and progressive condition of postmenopausal women that has significant negative effects on vulvovaginal health, sexual health, and overall quality of life. Despite many available safe and effective therapies, GSM often goes undiagnosed and untreated. This Practice Pearl addresses the pathophysiology of GSM and reviews available treatment options.

Urologic perspective of genitourinary syndrome of menopause

“…Hypoestrogenism induces a reduction in collagen, hyaluronic acid, and elastin, epithelial shrinkage, cytoskeleton changes, connective tissue arrangement, and loss of nerves and vascularity. These changes predispose vaginal irritation, sexual trauma, and the characteristic findings in physical examination 13–15 …”

“…These changes predispose vaginal irritation, sexual trauma, and the characteristic findings in physical examination. [13][14][15] Loss of oestrogen is also responsible for reducing mucosal glycogen and Lactobacillus, the predominant part of the healthy vaginal microbiome. These microorganisms normally metabolize glucose into lactic acid to maintain an acid pH that protects the urogenital tract from common infections.…”