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Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM) includes genital, sexual, and urinary symptoms of menopause associated with physical changes of the lower urinary tract, along with the vulva and vagina. Genital symptoms include dryness, burning, and irritation, and sexual symptoms include lack of lubrication, pain, and impaired function. These symptoms are related to the lower levels of estrogen circulating in a woman’s body after menopause. Urgency, dysuria, and recurrent urinary tract infections are urinary symptoms of GSM. Around 20%-50% of postmenopausal women experience urgency and stress-related UI.

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Ep 117 Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic with Dr. Rachel Rubin

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Genitourinary Syndrome of Menopause Diagnosis

A full patient history should be performed before diagnosing genitourinary syndrome of menopause. The genitourinary region can be irritated by lubricants, soaps, and powders, and antiestrogen medications can also cause symptoms of genitourinary syndrome of menopause in premenopausal women. Along with the patient’s history, a pelvic examination should be performed to check for lesions, labial fusion, friable epithelium, and introital stenosis. Laboratory tests are helpful in making a diagnosis. Cytology, ultrasound, vaginal culture, Pap test, are useful in assessing the symptoms of genitourinary syndrome of menopause. Differential diagnoses include bacterial vaginosis, trichomoniasis, and candidiasis.

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Genitourinary Syndrome of Menopause Treatment

First line therapies, such as long-acting vaginal moisturizers and low-dose vaginal estrogen, are used to treat postmennopausal women with vulvovaginal symptoms that are unrelated to sexual activity. If symptoms are related to sexual activity, a more complex treatment regimen is used. Systemic therapies include hormone therapy, selective ER modulators, bazedoxifene, and conjugated estrogens while local treatments can be hormonal or non-hormonal. Vaginal creams, intravaginal tablets, and intravaginal rings are all forms of low dose vaginal estrogen therapies. Non-hormonal therapies can be effective in women at risk for estrogen responsive neoplasia.

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References

[1] Kim, H.-K., Kang, S.-Y., Chung, Y.-J., Kim, J.-H., & Kim, M.-R. (2015, August 28). The recent review of the Genitourinary Syndrome of Menopause. Journal of menopausal medicine. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561742/
[2] Gandhi, J., Chen, A., Dagur, G., Suh, Y., Smith, N., Cali, B., & Khan, S. A. (2016, December). Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. AJOG. Retrieved November 5, 2021, from https://www.ajog.org/article/S0002-9378(16)30518-X/pdf

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