Genitourinary Syndrome Of Menopause Symptoms Research Articles

Multifaceted Impact of CO2 Laser Therapy on Genitourinary Syndrome of Menopause, Vulvovaginal Atrophy and Sexual Function.

Genitourinary syndrome of menopause (GSM) encompasses a range of distressing symptoms in the vulvovaginal and/or bladder-urethral regions related to menopause changes, negatively influencing woman's quality of life and sexual activity. Fractional micro-ablative CO2 laser therapy has shown the potential to reinstate the vaginal epithelium to a condition akin to the premenopausal state, thereby ameliorating the subjective symptoms associated with GSM. We conducted a prospective, pilot study in 73 sexually active postmenopausal women treated with CO2 laser for their GSM symptoms, while assessing Vaginal Health Index Score (VHIS) and sexual function through the Female Sexual Function Index (FSFI) Questionnaire. The laser treatment resulted in a decrease in VHIS and patient-reported vulvovaginal atrophy (VVA) symptoms, with a significantly lower prevalence of vaginal itching, dryness, and burning (p < 0.001), as well as dyspareunia (p = 0.002). The occurrence of urinary incontinence, urgency, and vaginal heaviness significantly reduced, with an improvement in the staging of cystocele, either to Stage 1 or complete resolution (p < 0.001). FSFI total and domain scores were significantly higher after the treatment, indicating better sexual function, with a post-treatment score median of 25 (p < 0.001). Therefore, using a three-cycle fractional CO2 laser was an effective choice for reducing urogenital discomfort related to GSM in postmenopausal women.

(070) SUCCESSFUL TREATMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA IN MENOPAUSAL PATIENTS

Abstract Introduction As pain symptoms from neuroproliferative vestibulodynia (NPV) often arise at initial attempt at tampon insertion or penetrative sex, most vestibulodynia patients present in their 20’s or 30’s. Consequently, individuals who reached this age prior to 2004-when Dr. Bornstein and colleagues delineated the excess mast cell and nerve pathology-had limited opportunity for successful NPV diagnosis and treatment. Menopausal patients often experience vulvar pain with genitourinary syndrome of menopause (GSM) due to the paucity of sex steroid hormonal support of their genital tissues. While symptoms of painful penetration are similar in both of these conditions, NPV is diagnosed when severe allodynia/hyperalgesia is still present with a normal or corrected hormonal milieu. A treatment for NPV is complete vestibulectomy surgery, performed in premenopausal eugonadal patients. However, in hormonally depleted patients with GSM, the vaginal tissue is thinner and less robust making it less optimal for reconstructive surgery. Objective To examine the intersection of genitourinary syndrome of menopause and neuroproliferative vestibulodynia symptoms in a subgroup of at-risk patients and to report techniques for optimizing management of this patient population. Methods We reviewed charts of two menopausal patients with NPV and report a clinical strategy for successful management. Results Two patients, ages 58 and 63 reported histories consistent with NPV during their reproductive years-one with lifelong entrance pain with any insertion and one with pain-free penetration prior to experiencing severe burning upon use of topical miconazole for candidiasis. At presentation, both had entry pain symptoms consistent with GSM and NPV. Since NPV is a diagnosis of exclusion, each was treated for GSM with intravaginal DHEA and vestibular topical compounded testosterone/estradiol cream. After 6 months, vestibular pallor and erythema resolved, however, cotton-tip swab testing scores did not improve. A positive improvement with vestibular anesthesia testing was consistent with NPV. Each underwent a complete vestibulectomy with vaginal advancement flap with successful wound healing and no adverse events despite their age and prior GSM diagnosis. Both patients report “very much better” symptoms on post-op Patient Global Impression of Improvement. Immunohistochemical staining of excised vestibular tissue confirmed a high density of CD117 and PGP9.5 staining consistent with an NPV diagnosis. Each patient has continued their menopause treatments post-op. Conclusions We report on two menopausal patients with NPV who had classic symptoms of severe allodynia/hyperalgesia in their reproductive years but who were not managed as NPV patients due to lack of knowledge at that time. Treating the GSM first with hormone replacement may restore health to vaginal tissues, thereby allowing the excised vestibular region to be covered with a vaginal advancement flap. Managing GSM symptoms prior and then undergoing vestibulectomy allowed them to have pain-free penetration. Disclosure No.

The impact of perceived vaginal and urinary symptoms and treatment burden in predicting sexual functioning among perimenopausal and postmenopausal women.

This study aimed to explore the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire, arousal, and satisfaction. A cross-sectional study was conducted with a sample of 326 patients from three tertiary care hospitals in the United Arab Emirates. The frequency and severity of urogenital symptoms, emotional and physical functioning, and treatment burden were assessed using the validated genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVATQ). To examine the mediating roles of emotional and physical functioning, as well as the perceived treatment burden on sexual functioning, a partial least squares-structural equation model was developed using the SmartPLS 4 Software. The measurement model was successfully established. All constructs had a reliability of > 0.70 and discriminant validity of < 0.90. Emotional, physical and sexual functioning showed an adjusted R2 values of 0.377, 0.282 and 0.169, respectively.The multistep multiple mediator model revealed a full mediation effect of both emotional and physical functioning between symptom, treatment burden and sexual functioning. The model showed high predictive performance with all manifest variables showing lower mean absolute errors compared to the naiive benchmark model. This study enhances our understanding of the relationships between urogenital symptoms, perceived treatment burden, emotional functioning, and sexual well-being. The findings emphasize the importance of addressing emotional well-being in managing urogenital symptoms and in addressing emotional factors associated with the use of vaginal treatments.

Fractional and Microablative CO2 LASER and Radiofrequency in the Treatment of Genitourinary Syndrome of Menopause: A Descriptive Study.

Objectives: This study aimed to evaluate the vagina clinically, cytologically, and histologically before and after treating genitourinary syndrome of menopause (GSM) with fractional microablative carbon dioxide LASER (CO2L), radiofrequency (RF), and estrogen vaginal cream (CT). Methods: Women with moderate-to-severe symptoms of GSM, denoted by a GSM Visual analog scale (VAS) score of >4, were eligible for this study. The patients were randomized into treatment groups. In the energy groups, three vulvovaginal applications were administered monthly. The CT group used 0.5 mg vaginal estriol cream for 14 consecutive days, followed by twice a week for 4 months. The follow-up visits occurred 120 days after the beginning of the treatments. The same parameters obtained at the first visit were re-evaluated: GSM VAS score, Incontinence Quality of Life Questionnaire (I-QOL), gynecological examination determining Vaginal Health Index (VHI), vaginal smear for Vaginal Maturation Value (VMV), and vaginal biopsy. Results: Seventy-one women were included, 48 completed the study and provided adequate samples for analysis (CO2L [21 patients], RF [15 patients], and CT [12 patients]). GSM symptoms, I-QOL, and VHI significantly improved after all proposed treatments, with no significant differences between them. VMV did not change after any treatment; however, only 22.9% of the patients presented with cytological atrophy before treatment. Histological vaginal atrophy was identified in 6 (12.5%) pretreated vaginal samples. After the intervention, all histological parameters were normalized, no tissue damage was observed, and no major clinical complications were observed. Conclusion: CO2L and RF seem to be good alternatives to CT for GSM treatment, with no tissue damage.

Effect and acceptability of jasmine compound essential oil for premenopausal breast cancer survivors suffering from genitourinary syndrome of menopause: A prospective interventional study.

1063 Background: Genitourinary syndrome of menopause (GSM) includes dyspareunia, vaginal dryness, vaginal burning, urinary urgency, and recurrent urinary tract infections. Breast cancer survivors (BCSs) exhibit more severe symptoms of GSM than healthy aging women, especially premenopausal BCSs in sexually active lifetime. GSM detrimentally impacts their quality of life and contributes to the premature cessation of endocrine therapy for breast disease. This study aims to explore the efficacy and safety of Jasmine compound essential oil in the treatment of GSM in premenopausal breast cancer women. Methods: Premenopausal sextually-active women with hormone receptor (HR) positive stage I to III BC taking ovarian function suppression (OFS) treatment and endocrine therapy with self-reported vaginal dryness, dyspareunia, or decreased libido were enrolled to the 12 weeks topically applied Jasmine compound essential oil trial. E2 and FSH was measured at baseline and weeks 12. A series of validated sexual quality-of-life questionnaires were completed at baseline, and subsequently at weeks 4, 8, and 12. The primary endpoint is the improvement in sexual pain evaluated based on the Female Sexual Function Index scale (FSFI). Acceptability was measured by patient preference and reported intention to continue using the products. Gynecologic examinations and metagenomic profiling of the vaginal microbiota were conducted at baseline and post-treatment for patients in an exploratory cohort. Results: Overall, 96 BCSs signed consent (mean [range] age, 45 [32-55] years) and 89 completed 12 weeks of treatment. E2 and FSH were maintained within the postmenopausal range without significant fluctuations during the treatment. Topically applied Jasmine compound essential oil resulted in significant improvements in dyspareunia, vaginal dryness, irritation and quality of life over time (all P&lt; 0.001). Both BCSs and their sexual partners reported being satisfied with the essential oil treatment and the adherence rate reached 95% (SD 10). In the 20-patient exploratory cohort, there were improvements in vaginal pH (baseline mean 6.07 compared with 12-week mean 4.68[ P&lt;.001]), and vaginal maturation index (45.3 compared with 52.1[ P&lt;.001]). We also observed a positive influence on the vaginal microbiota after intervention. In patients with elevated baseline abundance of Lactobacillus in the vaginal microbiome, there was a more pronounced improvement in scale scores following essential oil access. Conversely, a high baseline abundance of Escherichia coli may be considered a detrimental factor associated with less benefit from essential oil. Conclusions: Jasmine compound essential oil could relieve vaginal symptoms and improve vaginal health in breast cancer survivors who have experienced menopause after cancer treatment.

Thai postmenopausal woman's view in genitourinary syndrome of menopause.

To determine the prevalence of genitourinary syndrome of menopause (GSM) and their awareness, attitudes, and perception of this issue. Using a specifically designed questionnaire, interviews were performed on 500 Thai postmenopausal women who attended at Vajira Hospital, Bangkok, Thailand, from August 2021 to April 2022. The mean age of the 500 participants was 60.39 ± 8.12years. The prevalence of GSM was 47.2%. The common symptoms affected by GSM were vaginal dryness (38.5%), urinary urgency (24.6%), dyspareunia (13.6%), vaginal irritation (10.2%), vaginal burning (7.2%), and dysuria (5.9%). One-half of the women were uncomfortable talking about GSM. Three-quarters who did not reveal GSM symptoms believed that the problem was a part of aging. Only 20.3% of women who suffer from symptoms consulted a health care provider (HCP). Of the women who had been prescribed treatment, 84.6% of these women reported better quality of life. GSM is a meaningful decrement in quality of life. Most Thai postmenopausal women who had symptoms believed that the problem was the aging process. Awareness of GSM and available treatment would be a further benefit.

Clinical Study of Carbon Dioxide Laser and Pelvic Floor Function Exercise for Urinary Incontinence Complicated by Genitourinary Syndrome of Menopause.

Urinary incontinence is common in patients with genitourinary syndrome of menopause (GSM). A retrospective cohort study was conducted to analyse the clinical efficacy of carbon dioxide laser combined with pelvic floor functional exercise for GSM with urinary incontinence, aiming to provide evidence for its clinical treatment. Patients diagnosed with GSM and urinary incontinence and admitted to our hospital from January 2021 to December 2022 were included and allocated to a control group (pelvic floor function exercise) and combined group (carbon dioxide laser combined with pelvic floor function exercise). Confounding factors among the groups were balanced by the propensity score matching method. The clinical efficacy, GSM scale scores, urinary indicators, urinary incontinence quality of life scale (I-QOL) scores and the degree of urinary incontinence of the groups were compared. A total of 192 patients were included in this study, and 36 cases were included in each group after the propensity scores were matched. No statistical difference in baseline data was found between the groups (p > 0.05). The combined group had higher total effective rate and I-QOL scores but lower GSM symptom scale scores than the control group. Urination during daytime and nighttime was less frequent in the combined group than in the control group, which showed a lower degree of urinary incontinence (p < 0.05). Combining carbon dioxide laser treatment with pelvic floor exercises is potentially effective for patients with GSM and urinary incontinence. This combined approach not only alleviated GSM and urinary incontinence symptoms but also reduced the severity of urinary incontinence, promoted bladder function recovery and enhanced overall quality of life.

Comparison of promestriene with vaginal fractional CO2 laser and radiofrequency treatments of genitourinary syndrome of menopause

ObjectiveTo compare the effects of fractional CO2 laser and microablative fractional radiofrequency treatment with promestriene topical estrogen on sexual function and genitourinary syndrome of menopause symptoms. MethodsThis was a prospective randomized open-label clinical trial conducted with 62 postmenopausal women assigned to three intervention groups: a) topical promestriene for 90 days (n = 17); b) fractional CO2 laser treatment (n = 24); and c) microablative fractional radiofrequency treatment (n = 21). Each of the latter two groups underwent three treatment sessions at 4-week intervals. At baseline and at the end of the study, all participants had a gynecological examination that included vaginal pH measurement, and the completion of the Vaginal Symptom Score, the Vaginal Health Index, and the Female Sexual Function Index. For the energy treatment groups, adverse effects were evaluated after each session. Group homogeneity was assessed at baseline, and results were evaluated over time (from baseline to the end of treatment) and between groups over time. ResultsAll baseline parameters were similar among studied groups. At the end of the study, all 3 treatments had produced similar effects: a reduction of vaginal pH, and an improvement of vulvovaginal symptoms (Vaginal Symptom Score and Vaginal Health Index scores) as well as sexual function (higher total Female Sexual Function Index scores, and in the desire, arousal, lubrication and pain domain scores), with no differences observed between groups. Side-effects were slight for both energy treatment groups, mainly represented by vaginal discharge. ConclusionThe present study suggests that the two energy treatments were efficient along with promestriene at improving postmenopausal genitourinary and sexuality symptoms.Clinical trial identification numberNCT04717245.

(002) An Update to The Safety of VE Therapy for Genitourinary Syndrome of Menopause in Women with a History of Breast Cancer – A Claims Database Analysis

Abstract Introduction Systemic therapies for breast cancer (BC) may result in genitourinary syndrome of menopause (GSM) in up to 70% of postmenopausal breast cancer survivors. Though systemic estrogen therapy is usually avoided in these patients, vaginal estrogen (VE) therapy may be prescribed to treat GSM symptoms. However, we recently demonstrated, few eligible patients with GSM and a history of breast cancer are prescribed VE. Objective To assess the recurrence rates of breast cancer in women diagnosed with GSM with a history of breast cancer by VE therapy status using a large US claims database. Methods A US health research network was queried. Our cohort consisted of females diagnosed with BC within five years prior to the initial GSM diagnosis. Patients with active disease within three months prior to diagnosis of GSM were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within three months to five years after initiating VE therapy for GSM. The study cohort included those with ≥3 VE prescriptions. The control cohort included women with BC without any VE prescriptions after GSM diagnosis. Propensity matching was performed. A sub-analysis evaluating the effect of concurrent aromatase inhibitor (AI) use with VE was also conducted with concurrent AI use defined as ≥3 AI prescriptions. Results We identified 42,113 females with a diagnosis of GSM following BC diagnosis with any ER status; 5.0% received VE. Of the initial cohort, 10,584 patients had ER+ BC; 3.9% of this group received VE. Risk of BC recurrence was comparable between those who received VE and those who did not in both the any-ER (RR 1.03, 95% CI [0.91-1.18]) and ER+ status (RR 0.94, 95% CI [0.77-1.15]) analyses. BC recurrence-free survival was comparable between those who received VE and those who did not in both the any-ER (HR 0.98, 95% CI [0.85 – 1.14]) and ER+ status (HR 0.88, 95% CI [0.69 – 1.12]) analysis. A sub-analysis comparing concurrent VE and AI prescriptions to those with VE-only was performed. Risk of BC recurrence was significantly higher among those who received AI+VE versus VE-only in both the any-ER (RR 5, 95% CI [3.05 – 8.19]) and ER+ status (RR 2.64, 95% CI [1.55 – 4.47]) analysis (Table 1). Significant differences in BC recurrence-free survival were observed between the AI+VE and VE-only groups in both the any-ER (HR 9.88, 95% CI [5.50 – 17.73]) and ER+ status (HR 4.82, 95% CI [2.36 – 9.84]) analysis. (Figure 1). No mortality event was observed at five- or ten-year follow-up in either analysis. Conclusions We found similar BC recurrence risk between BC survivors with and without prescriptions of VE. An increased risk of BC recurrence was seen with concurrent AI and VE use. These results suggest that VE therapy in select patients with GSM is safe. Disclosure No.

Современные лазерные технологии в гинекологической практике: возможности инновационного неодимового лазера

Aim. To summarize a review of modern literature and present a clinical observation of the use of the Magic Gyno Nd:YAG laser for the treatment of vulvovaginal atrophy in postmenopausal patients. Key points. One of the most significant problems of the menopausal period is genitourinary syndrome of menopause (GSM), the symptoms of which have a significant impact on the quality of life and sexual health of most women during menopause and occur in more than 50% of patients. The search and study of new effective and safe methods for treating the symptoms of GSM is an extremely urgent task, the importance of which, taking into account existing demographic and social trends, will only increase in the coming years. In addition to the objective risks associated with hormonal therapy, which is the "gold standard" in the treatment of GSM, it should be noted that for some patients it is contraindicated for medical reasons, and sometimes women themselves do not want to use hormone-containing drugs. Thus, there is a need to select other methods of therapy that will provide long-term symptomatic effect. Based on the available data, treatment of GSM using laser devices may be comparable in effectiveness to local hormonal therapy, and superior in safety. One of the most promising instruments of this class is the Nd:YAG laser, successfully used in cosmetology, ophthalmology, dentistry, surgery, urology, as well as in gynecology. After therapy with a neodymium laser, an improvement in lubrication and elasticity of the tissues of the vulva and vagina, normalization of the pH of the vaginal discharge was shown, as well as a significant reduction in the manifestations of sexual dysfunction and an increase in the quality of sexual life noted by patients. Conclusion. The neodymium laser method in gynecological practice is a new promising method of treatment. Although further randomized controlled trials are required, it has now been successfully used in the treatment of GSM and for patients who are contraindicated for hormonal therapy, or those who do not want to use even topical estrogens due to obsessive stereotypes and unreasonable fears. may become an alternative to local estrogen therapy. Key words: vulvovaginal atrophy, neodymium laser, Nd:YAG laser, genitourinary syndrome of menopause, hormone replacement therapy, estriol, vaginal wall prolapse.

EPIDEMIOLOGIC GEROSCIENCE INNOVATIONS AT THE NEXUS OF REPRODUCTIVE AGING AND WOMEN’S HEALTH

Abstract Signs of reproductive aging in women usually begin in women’s 30s and co-occur with declining circulating estrogen concentrations and irregular menstrual cycle onset. Menopause, defined by cessation in menstruation for ≥1 year, occurs on average at age 51 years, but about 1% experience menopause before age 40. Menopause and reproductive aging contribute to multiple health conditions such as certain cancers; however, a less studied condition is the genitourinary syndrome of menopause (GSM). GSM signs and symptoms include vulvovaginal atrophy, vaginal dryness, urinary tract infections, and more. Additionally, menopause leads to increased risk of osteoporosis, dementia, and other aging-related conditions. Given the multifactorial implications of reproductive aging in women’s health, an interdisciplinary geroscience-guided framework for epidemiology of aging is needed to identify biological contributors and consequences of reproductive aging to develop healthspan-enhancing interventions. In this symposium, we present five new developments across multiple stages of reproductive aging, consistent with meeting theme “Building Bridges. Catalyzing Research. Empowering All Ages”. Among women aged 35-60 years, we assess the role of cervical “inflamm-aging” in GSM; diabetes and vaginal dysbiosis associations with GSM; and vaginal microbial and metabolic signatures of urinary conditions/dysfunction. Among women aged ≥65 years, we examine associations of post-hip fracture sex hormones with physical recovery and links between age and type of menopause with Alzheimer’s disease. Building on the 2021 Journals of Gerontology Series A special issue on intersections of reproductive and aging biology, we discuss opportunities to advance reproductive aging and women’s health research by combining molecular assessment with rigorous epidemiology. This is a collaborative symposium between the Epidemiology of Aging, Geroscience, and Women’s Issues Interest Groups.

Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta-analysis.

Energy-based devices (laser and radiofrequency) have been used to treat genitourinary syndrome of menopause (GSM). To evaluate the efficacy and safety of physical energy use in managing GSM symptoms. Five databases were searched from inception to December 2022. Language restrictions were not imposed. We included all Cochrane and non-Cochrane systematic reviews with or without meta-analyses that described postmenopausal women with symptoms of GSM treated with physical energy. We performed a network meta-analysis using frequentist methods to calculate standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs). Methodological and reporting quality were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2). Nine reviews were included in the overview, six of which were meta-analyses. Four randomized controlled trials, representing 218 participants and nine different study arms, met the criteria for inclusion in our component network meta-analysis. Confidence in review findings was low in six reviews and critically low in three. Our network meta-analysis results showed that premarin (SMD 2.60, 95% CI 7.76-3.43), conjugated estrogens (SMD 2.13, 95% CI 1.34-2.91), carbon dioxide laser (SMD 1.71, 95% CI 1.10-2.31), promestriene (SMD 1.41, 95% CI 0.59-2.24), and vaginal lubricant (SMD 1.37, 95% CI 0.54-2.20) were more effective than sham for reducing sexual dysfunction, with a consequent increase in Female Sexual Function Index (FSFI). Two studies showed a high risk of bias, owing to a lack of blinding. Several gaps in the use of physical energy for managing GSM still need to be addressed. The small number of blind clinical trials made the results fragile.

CO2 Laser versus Sham Control for the Management of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

In the context of the menopausal transition, genitourinary syndrome of menopause (GSM) refers to a range of genitourinary symptoms, from vaginal dryness to dysuria and urinary urgency. While hormonal treatments are standard, their associated side effects have driven the exploration of alternatives like vaginal CO2 laser. We aimed to evaluate the randomized controlled trials (RCTs) comparing vaginal CO2 laser treatment for GSM to sham controls. This systematic review sourced four electronic databases until June 2023. The analysis incorporated seven RCTs with 407 women. The CO2 laser and sham control were comparable for most parameters, including the female sexual function index (FSFI) and visual analogue scale (VAS) for dyspareunia, vaginal health index, pH, and patient satisfaction. However, the CO2 laser group showed significant improvement in the vaginal assessment scale for GSM symptoms. Sensitivity analyses revealed that parameters like FSFI showed significant differences in favor of CO2 laser group upon the exclusion of specific studies. In conclusion, vaginal CO2 laser therapy emerges as a promising alternative for GSM management, especially for most bothersome GSM symptoms; however, the need for further well-designed RCTs remains to validate its broad safety and efficacy.

Genitourinary Syndrome of Menopause: A Narrative Review Focusing on Its Effects on the Sexual Health and Quality of Life of Women.

Genitourinary syndrome of menopause (GSM) is a progressive condition due to a hypoestrogenic state affecting perimenopausal and menopausal women. GSM was previously known as urogenital syndrome, vulvovaginal atrophy, or atrophic vaginitis. The term vulvovaginal atrophy did not encompass the symptoms of the urinary tract like incontinence, urgency, and discomfort, or allude that it is due to a hypoestrogenic state. Although a significant segment of the population is affected by GSM, it is very sparsely studied, detected, and treated. GSM affects the quality of life and sexual health of most menopausal women suffering from it. Only a few healthcare providers ask about the symptoms of GSM and a tiny percentage of women seek consultation for it. This may be because they are either embarrassed or believe it to be a part of the natural process of aging. As the life expectancy of women has increased in general, the prevalence of GSM has also risen, while it still remains underdiagnosed and untreated. Properly educating women so that they can seek consultation regarding symptoms of GSM, and training healthcare professionals about communicating with the patient, as well as correctly identifying, diagnosing, and managing the patient are all important to overcome this communication barrier.Once we cross the barrier of diagnosing patients with GSM, we still have to manage the patients with tailor-made prescriptions according to the severity of the symptoms and their preferences. While there are various treatment options, the most effective one is low-dose topical estrogen therapy. In this review, we intend to explore the existing knowledge about GSM and its effect on the quality of life and sexual health of women along with the treatment options for managing and reversing the effects of GSM.

Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation.

To describe vaginal microbiota classified by community state types (CST) in a diverse cohort of postmenopausal women and evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms (vaginal dryness, vulvovaginal irritation, sexual pain, dysuria, urinary urgency), CSTs, estrogen, vaginal maturation index (VMI), and vaginal pH. In the Study of Women's Health Across the Nation, 1,320 women aged 60.4 to 72.5 years self-collected (2015-2017) vaginal samples analyzed for microbiota composition and structure (CSTs) using 16S rRNA gene amplicon sequencing, VMI, and pH. GSM symptoms were collected with self-administered questionnaires; interviewers elicited estrogen use and measured body mass index. Serum E2 and E1 were measured using high-performance liquid chromatography. We analyzed data using Pearson χ2 tests, analysis of variance, Kruskal-Wallis tests, and binomial logistic regression. The most frequently occurring CST was low Lactobacillus species IV-C (49.8%); 36.4% of women had CSTs dominated by Lactobacillus species. More than half of the women with vaginal atrophy biomarkers (VMI <50 and pH >5) had CST IV-C0, whereas women using estrogen or with higher E1 and E2 levels had a higher prevalence of Lactobacillus crispatus-dominated CST I (P values < 0.001). Sexual pain was associated with atrophy biomarkers and independently associated with Streptococcus species-dominated CST IV-C1 (odds ratio, 2.26; 95% confidence intervals, 1.20-4.23). For all other GSM symptoms, we found no consistent associations with E1 or E2 levels, atrophy biomarkers, or any CST. Although close relationships exist among estrogen, CSTs, VMI, and pH, sexual pain was the only GSM symptom associated with the structure of vaginal microbiota and atrophy biomarkers.

Development and validation of the genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVTAQ): An electronic patient-reported outcomes measure.

To develop and validate an electronic, patient-reported outcomes measure (PROM) specific for genitourinary syndrome of menopause (GSM) patients. The PROM aimed to accurately assess the burden of GSM symptoms, their impact on health-related and sexual quality of life, and the acceptability of vaginal treatments. The study encompassed a comprehensive three-stage approach to the development and validation of the PROM. Initially, during the preliminary design stage, the necessity for a new PROM was recognized, an expert panel was formed, and semi-structured qualitative interviews were carried out with GSM patients. In the second stage, the study used the five-step pre-validation methodology established by Prior et al. to generate and refine the PROM items. The third and final stage encompassed the determination of scale and item content validity indexes to ensure validity. Additionally, the reliability of each construct was evaluated using Cronbach's α. The resulting PROM was named GSM-SVTAQ (GSM-symptoms and vaginal treatments acceptability questionnaire). It demonstrated excellent validity in assessing symptoms burden, health-related and sexual quality of life, and vaginal treatment acceptability, with high content validity indices and strong internal consistency. The scale content validity indices and Cronbach's α coefficients for the three domains were (0.926, 0.939), (0.875, 0.947), and (0.824, 0.855), respectively. The GSM-SVTAQ stands as the first GSM-specific, valid, and reliable PROM capable of comprehensively measuring the three components of GSM and the acceptability of vaginal treatments. Its implementation has the potential to significantly enhance patient care and outcomes in GSM management.

Clinical and laboratory results in vaginal wall restoration using a fractional-pixel-CO2 laser: histological findings and changes in the Ki67 protein and telomere length.

Thermal deposition of laser energy in the vaginal epithelium in genitourinary syndrome of menopause (GSM) results in clinical and biological effects, but many cellular and molecular changes indicating cell proliferation or senescence inhibition are unknown. The aim of this study is to evaluate the clinical efficacy of the fractional-pixel-CO2 laser in the possible improvement of GMS signs and symptoms that can be correlated with histological changes or with cellular or molecular indicators of restoration. A detailed prospective study was designed to assess 17 women diagnosed with GSM who were treated intravaginally with two laser sessions. Seven non-treated women diagnosed with GSM were used as controls. Three validated outcome questionnaires for assessment of quality of sexual life and urinary incontinence were performed. Vaginal biopsies were collected before the first laser treatment and 4months following the second session. Histological status, elastin, collagen, and hyaluronic acid content of the biopsies were also evaluated. Cell proliferation was assessed by Ki67 staining. Telomere length (TL) was measured by qPCR. The results show an improvement of the clinical symptoms of GSM (p < 0.05), vaginal epithelium recovery and enhancement of collagen (p < 0.05), elastic fibers (p < 0.005), and hyaluronic acid (p < 0.0005) content in the lamina propria after fractional-pixel-CO2 laser treatment. The laser treatment induced a significant rise on the TL of vaginal epithelial cells (VECs), and a positive correlation was found between the improvements of the collagen and hyaluronic acid content and TL changes (r = 0.82, p < 0.05; r = 0.38, p < 0.05). The percentage of proliferative Ki67-positive VECs was increased in patients whose vaginal TL lengthened after laser treatment (p < 0.05). In conclusion, the results indicate that laser treatment may induce restoration of the vaginal epithelium which is associated to increased TL and proliferation in the VECs. Performing a TL assay could be a suitable tool to evaluate the efficacy of vaginal laser treatment.

A practical guide to managing genitourinary syndrome of menopause in primary care.

Females spend a third to half of their life in menopause, and the number of US females in menopause is growing. A high percentage of postmenopausal females experience bothersome, sometimes debilitating genitourinary symptoms, which can affect quality of life. The genitourinary syndrome of menopause (GSM) describes the condition previously referred to as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. Of concern, many patients with symptoms of GSM have never been asked about nor have they initiated conversations about these concerns with a healthcare provider. This article addresses the need to improve screening, identification, and patient-centered management in primary care of females with GSM.

Long-term clinical and histological safety and efficacy of the CO2 laser for treatment of genitourinary syndrome of menopause: an original study

Objective This study aimed to evaluate histological modifications of the vaginal mucosa after repeated microablative fractional CO2 laser treatments. As secondary objectives we evaluated the clinical effects associated with repeated microablative fractional CO2 laser treatments using validated questionnaires. Methods A prospective intervention study was performed in the Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute with 15 postmenopausal women complaining of genitourinary syndrome of menopause symptoms. The cohort of patients was submitted to at least two previous laser treatment cycles in the past years. The Vaginal Health Index (VHI), visual analog scale (VAS), Female Sexual Function Index (FSFI), Urinary Distress Inventory-6 (UDI-6), International Consultation on Incontinence Questionnaire – Urinary Incontinence (ICIQ-UI) and 5-point Likert scale were used. Moreover, histological examinations were carried out on all samples. Results At 4 weeks after the last treatment, the VHI score and all FSFI items were significantly increased compared with baseline. We observed a statistically significant decrease in both frequency and severity for all urinary symptoms after the follow-up. We observed a statistically significant increase in the number of epithelial cell layers with a consequent increase in epithelial thickness, in the number of glycogen-filled cells and in the number of papillae after the laser treatment. No signs of fibrosis were observed as neovascularization was observed in each woman. Conclusions This is the first study demonstrating the histological persistency of efficacy in repeated annually laser treatment cycles, with tissue changes always leading to regenerative results without any sign of fibrosis. Clinical Trial Registration ClinicalTrials.gov ID: NCT04868812 (release date: 27 April 2021).

Prospective study of safety and objective improvement in sysmptoms of GSM (Genitourinary syndrome of menopause) withEr:YAG vaginal /urethral laser treatment

: Genitourinary Syndrome of Menopause (GSM) is the condition which combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction which are associated with oestrogen deficiency. GSM is treated using vaginal laser therapy by using non-ablative Er: YAG laser therapy to evaluate the effectiveness and safety of this therapy. The present study was planned to evaluate the safety and objective improvement in symptoms of GSM with Er:yag vaginal / urethral laser treatment in sextual and urinary symptoms of post / peri menopausal women on long term basis. A prospective study was conducted at V care laser centre from 2020 on words to till date. Total sample population enrolled was 74 among them 53 completed 1 follow up and 29 had completed 2 follow up. Data were collected before and subsequent 2 follow ups over next 12 months on parameters like dryness, dyspareunia, itching/ burning and lower urinary tract symptoms, data were collected using VLQ (vaginal laxity questionnaire), VHIS (vaginal health index score), FSDS-R (The female sexual distress scale – revised)and Satisfaction questionnaire (0-3) assessed on FSFI. : The study showed symptomatic improvement among patients with GSM like no pain or mild pain among 79.31% and 20.39% respectively, no itching (72.41%) at the end of 2 follow up. There was an improvement in vaginal condition (normal – 93.10%) at the end of 2 follow up. Majority of patients reported no sexual distress (82.7%). : The non-ablative Er: YAG laser therapy is efficacious and safe modality for treatment of symptoms in cases of genitourinary syndrome of menopause. It also offers a promising, minimally invasive safe treatment for SUI.