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menopausal genitourinary syndrome; genitourinary syndrome of menopause

A term referenced by the North American Menopause Society. Also see atrophic vaginitis Epidemiology: - affects ~50-70% of postmenopausal women [7] - most common cause of post-menopausal vaginal bleeding (60%) - only ~1/2 of symptomatic women report ever discussing their symptoms with a clinician [7] Clinical manifestations: - formerly atrophic vaginitis - vaginal bleeding - vulvovaginal dryness, burning, or irritation - severe patchy erythema may be noted - smooth, shiny, and dry vaginal epithelium - visible blood vessels beneath a pale vaginal mucosa with increased friability - dyspareunia - sparse pubic hair - dry labia - no discharge or foul smell - discomfort on pelvic exam - urinary urgency - urinary frequency - dysuria - recurrent urinary tract infections Differential diagnosis: - contact dermatitis - should not result in sparse pubic hair or dry labia -identifiable trigger - lichen planus - purplish skin lesions - yellowish or gray discharge - associated with hepatitis C infection - Candida albicans - cottage cheese-like discharge - most commonly found vagina exposed to estrogen, with vaginal lining producing glycogen - risk factors include diabetes & obesity Management: - vaginal lubricants 1st line [2] - except if urinary symptoms, then vaginal estrogen [5] - vaginal estrogen [1] - vaginal estrogen (conjugated estrogen cream, 0.5 g intravaginally daily for 14 days followed by 0.5 g twice weekly - women with urinary symptoms may benefit more from topical estrogen therapy [5] - fractionated CO2 laser therapy for selected patients [3] - 3 intravaginal treatments at least 6 weeks apart - ospemifene a selective estrogen receptor modulator is FDA approved for treatment of dyspareunia & moderate to severe genitourinary syndrome of menopause - adverse effects of hot flashes & risk for venous thromboembolism - reserved for women who cannot or will not use topical estrogens [2] - vaginal dehydroepiandrosterone (DHEA) [8] - capacitive-resistive monopolar radiofrequency in six weekly sessions significantly improves sexual function & vaginal health [12] - literature of complementary & alternative medicine for genitourinary syndrome of menopause is heterogenous - trials have been small, with few done in North America [7] - recommendations are premature * treatment may improve some symptoms in the short term [8] * few long-term data exist on efficacy, comparative effectiveness, tolerability, & safety of treatments [8]

General

menopausal disorder syndrome

References

  1. North American Menopause Society The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017 Jul;24(7):728-753 PMID: 28650869 http://www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19 American College of Physicians, Philadelphia 2015, 2018, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  3. Paraiso MFR, Ferrando CA, Sokol ER et al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause 2020 Jan; 27:50-56. PMID: 31574047 https://journals.lww.com/menopausejournal/Abstract/2020/01000/A_randomized_clinical_trial_comparing_vaginal.9.aspx
  4. Rahn DD, Carberry C, Sanses TV et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol. 2014;124(6):1147-1156 PMID: 25415166 PMCID: PMC4855283 Free PMC article https://journals.lww.com/greenjournal/Abstract/2014/12000/Vaginal_Estrogen_for_Genitourinary_Syndrome_of.12.aspx
  5. The North American Menopause Society (NAMS). The 2020 Genitourinary Syndrome of Menopause Position Statement of the North American Menopause Society. Menopause. 2020;27(9): 976-992 PMID: 32852449 https://journals.lww.com/menopausejournal/Abstract/2020/09000/The_2020_genitourinary_syndrome_of_menopause.5.aspx
  6. Danan ER, Diem S, Sowerby C et al Genitourinary Syndrome of Menopause. Comparative Effectiveness Review No. 272. Agency for Healthcare Research & Quality (AHRQ). July 31, 2024 https://effectivehealthcare.ahrq.gov/products/genitourinary-syndrome/research
  7. Ullman KE, Diem S, Forte ML et al Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause: An Evidence Map Ann Intern Med. 2024 Sep 10. PMID: 39250808 Review. https://www.acpjournals.org/doi/10.7326/ANNALS-24-00603
  8. Danan ER, Sowerby C, Ullman KE et al Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review. Ann Intern Med. 2024 Sep 10. PMID: 39250810 Review. https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610
  9. Christmas M, Huguenin A, Iyer S. Clinical practice guidelines for managing genitourinary symptoms associated with menopause. Clin Obstet Gynecol. 2024;67:101-114. PMID: 38126460
  10. Sarmento ACA, Costa APF, Vieira-Baptista P et al Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. Front Reprod Health. 2021 Nov 15;3:779398. PMID: 36304000 PMCID: PMC9580828 Free PMC article. Review https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2021.779398/full
  11. Cox S, Nasseri R, Rubin RS, et al. Genitourinary syndrome of menopause. Med Clin North Am. 2023;107:357-369. PMID: 36759102
  12. Quezada-Bascunan C, Ferri-Morales A, Martinez-Vizcaino V Efficacy of nonablative radiofrequency on sexual function in postmenopausal women: a randomized clinical trial. Menopause. 2026 Feb 10. PMID: 41665605 https://journals.lww.com/menopausejournal/fulltext/9900/efficacy_of_nonablative_radiofrequency_on_sexual.610.aspx