menopausal genitourinary syndrome; genitourinary syndrome of menopause
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Introduction
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
- lichen planus
- purplish skin lesions
- yellowish or gray discharge
- associated with hepatitis C infection
- Candida albicans
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]
- 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]
More general terms
References
- ↑ 1.0 1.1 North American Menopause Society The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017 Jul;24(7):728-753 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/28650869 <Internet> http://www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf
- ↑ 2.0 2.1 2.2 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 - ↑ 3.0 3.1 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: https://pubmed.ncbi.nlm.nih.gov/31574047 https://journals.lww.com/menopausejournal/Abstract/2020/01000/A_randomized_clinical_trial_comparing_vaginal.9.aspx
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/25415166 PMCID: PMC4855283 Free PMC article https://journals.lww.com/greenjournal/Abstract/2014/12000/Vaginal_Estrogen_for_Genitourinary_Syndrome_of.12.aspx
- ↑ 5.0 5.1 5.2 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: https://pubmed.ncbi.nlm.nih.gov/32852449 https://journals.lww.com/menopausejournal/Abstract/2020/09000/The_2020_genitourinary_syndrome_of_menopause.5.aspx
- ↑ 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
- ↑ 7.0 7.1 7.2 7.3 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: https://pubmed.ncbi.nlm.nih.gov/39250808 Review. https://www.acpjournals.org/doi/10.7326/ANNALS-24-00603
- ↑ 8.0 8.1 8.2 8.3 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: https://pubmed.ncbi.nlm.nih.gov/39250810 Review. https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610
- ↑ Christmas M, Huguenin A, Iyer S. Clinical practice guidelines for managing genitourinary symptoms associated with menopause. Clin Obstet Gynecol. 2024;67:101-114. PMID: https://pubmed.ncbi.nlm.nih.gov/38126460
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/36304000 PMCID: PMC9580828 Free PMC article. Review https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2021.779398/full
- ↑ Cox S, Nasseri R, Rubin RS, et al. Genitourinary syndrome of menopause. Med Clin North Am. 2023;107:357-369. PMID: https://pubmed.ncbi.nlm.nih.gov/36759102