GENITOURINARY SYNDROME OF MENOPAUSE

 Genitourinary Syndrome of Menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. The main signs and symptoms of GSM include burning, irritation, vulvovaginal dryness, dyspareunia, and urinary symptoms such as urgency, dysuria, or recurrent urinary tract infection. Labial atrophy, vaginal introitus narrowing, and clitoral atrophy may also be observed.

The Topic of sexual intercourse should not be something that we shy away from when consulting women in the 60s or even 80s. most women in this age category are very sexually active and suffer from vaginal dryness, dyspareunia. It should not be that way. They deserve to enjoy that aspect of life like younger women. 

Each symptom alone may indicate a specific diagnosis; however, in women undergoing menopause or perimenopause, it is important to consider the overall pattern of symptoms and rule out other potential causes of these symptoms. Isolated urinary symptoms should prompt a targeted evaluation of the urinary tract, including urinalysis with dipstick, urine culture, and ultrasound, to identify causes such as polyps or bladder cancer. Sexual symptoms, including reduced libido or dyspareunia, require assessment of the patient’s emotional and relational well-being, along with screening for depression or intimate partner violence. Similarly, genital symptoms appearing alone may reflect various gynecologic conditions, including infections, pelvic organ prolapse, and vulvar lichen sclerosus.

Using non-hormonal treatment for GSM, such as lubricants, may not be sufficient. Local hormonal treatment can then be considered the treatment of choice. Options include vaginal estrogen in the form of suppositories, rings, or creams, which restore vaginal pH, epithelial integrity, and microbiota balance. Dehydroepiandrosterone suppositories are also effective for vulvovaginitis and dyspareunia.

Systemic hormonal treatment may be required in selected cases. Tibolone has beneficial effects on the vagina and bladder. Ospemifene is particularly indicated for the treatment of severe dyspareunia and vaginal dryness.

CO₂ laser treatment is a nonhormonal alternative that has shown effectiveness, particularly for vaginal dryness and urinary symptoms. Treatment restores vaginal epithelium, microbiota, and pelvic vascularization.

In conclusion, GSM affects most postmenopausal women but remains undertreated despite the availability of effective treatments. General practitioners play a key role in the detection of this condition, and early management can improve symptoms and quality of life.