Abstract
The genitourinary syndrome of menopause (GSM) is a relatively new term for the condition previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. The term was first introduced in 2014. GSM is a chronic, progressive, vulvovaginal, sexual, and lower urinary tract condition characterized by a broad spectrum of signs and symptoms. Most of these symptoms can be attributed to the lack of estrogen that characterizes menopause. Even though the condition mainly affects postmenopausal women, it is seen in many premenopausal women as well. The hypoestrogenic state results in hormonal and anatomical changes in the genitourinary tract, with vaginal dryness, dyspareunia, and reduced lubrication being the most prevalent and bothersome symptoms. These can have a great impact on the quality of life (QOL) of the affected women, especially those who are sexually active. The primary goal of the treatment of GSM is to achieve the relief of symptoms. First-line treatment consists of non-hormonal therapies such as lubricants and moisturizers, while hormonal therapy with local estrogen products is generally considered the “gold standard’’. Newer therapeutic approaches with selective estrogen receptor modulators (SERMs) or laser technologies can be employed as alternative options, but further research is required to investigate the viability and scope of their implementation in day-to-day clinical practice.
Highlights
BackgroundThe genitourinary syndrome of menopause (GSM) is a relatively new term, first introduced in 2014 by a consensus of the International Society for the Study of Women's Sexual Health and the North American Menopause Society
GSM, previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy, is a term that describes the spectrum of changes caused by the lack of estrogens during menopause [1]
Breast cancer is a hormone-sensitive carcinoma in many cases; systemic hormonal therapy is not usually recommended for women with breast cancer [29,30]
Summary
The genitourinary syndrome of menopause (GSM) is a relatively new term, first introduced in 2014 by a consensus of the International Society for the Study of Women's Sexual Health and the North American Menopause Society. The use of liquid lidocaine compresses to the vulvar vestibule before sexual penetration has been described in breast cancer survivors with menopausal dyspareunia who should not receive estrogen-based therapy This has shown promising results since 90% of patients reported comfortable intercourse [24]. In survivors of epithelial ovarian cancer, hormonal treatment could be considered in selected cases, since evidence suggests a neutral effect in survival; but it should be avoided in certain histologic types, such as advanced serous and endometrioid and other estrogen-sensitive tumor types [29,30,31] Another medication used to treat GSM symptoms is the intravaginal dehydroepiandrosterone (DHEA). Intravaginal testosterone has shown positive effects in relieving vaginal atrophy symptoms and decreased libido, but its efficacy in GSM generally remains uncertain [33] Another available option is an oral selective estrogen receptor (SERM) known as ospemifene. A recent study has reported that laser intervention with the intravaginal use of either CO2 or Er:YAG laser-technologies is a safe and potentially effective nonpharmacologic intervention for GSM [37]
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