menopausal genitourinary syndrome; genitourinary syndrome of menopause

Introduction

A term referenced by the North American Menopause Society.

Also see atrophic vaginitis

Epidemiology

• affects ~50-70% of postmenopausal women
• most common cause of post-menopausal vaginal bleeding (60%)
• only ~1/2 of symptomatic women report ever discussing their symptoms with a clinician

Clinical manifestations

• includes atrophic vaginitis*
• vaginal bleeding
• vulvovaginal dryness
  • severe patchy erythema may be noted
• dyspareunia
• sparse pubic hair
• no discharge or foul smell
• discomfort on pelvic exam

* not clear what else it might include

Management

• vaginal lubricants 1st line
  • except if urinary symptoms, then vaginal estrogen
• vaginal estrogen
  • 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
• fractionated CO2 laser therapy for selected patients
  • 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
• vaginal dehydroepiandrosterone (DHEA)
• literature of complementary & alternative medicine for genitourinary syndrome of menopause is heterogenous
  • trials have been small, with few done in North America
  • recommendations are premature

* treatment may improve some symptoms in the short term

* few long-term data exist on efficacy, comparative effectiveness, tolerability, & safety of treatments

More general terms

• menopausal disorder
• syndrome

Patient information

genitourinary syndrome of menopause patient information