Genitourinary Syndrome of Menopause is Overlooked and Undertreated

Genitourinary Syndrome of Menopause (GSM), a condition caused by declining hormones, especially the decline of estrogen, results in progressive but treatable vulvovaginal and urinary symptoms. However, it is often overlooked by providers.

GSM represents a collection of symptoms that can cause a decrease in the quality of lives and relationships of menopausal women. However, symptoms are treatable and with better provider awareness, patient education, evaluation, and treatment, women can have a sense of restored wellbeing, according to a review published in the journal Menopause.

Nancy Phillips, MD

Nancy Phillips, MD, associate professor at the department of obstetrics, gynecology, and reproductive sciences and director of the Center for Vulvovaginal Health at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, along with colleagues collected data through searches of vulvovaginal atrophy and GSM from PubMed, Google Scholar, and OVID. They also looked at US Society Guidelines to write a narrative review of GSM.

GSM’s symptoms include, but are not limited to, urinary symptoms of urgency, dysuria, recurrent urinary tract infection, and vulvovaginal symptoms of dryness, burning, irritation, and dyspareunia. Symptoms can be very disruptive in women’s lives and affect their sense of physical and emotional wellbeing. Phillips and colleagues reported that the symptoms are usually progressive and do not resolve spontaneously on their own.

They added that symptoms require a clinical diagnosis from a provider.

The authors said that telemedicine may play an important role in diagnosis, treatment initiation, and follow-up, and that a variety of treatments are available. These include local therapy with hormones (estrogen or dehydroepiandrosterone), oral selective estrogen receptor agonists, moisturizers, and lubricants.

Clinical follow-up treatment is necessary, and evaluation is needed if symptoms change, worsen, or do not improve.Good clinical judgement is needed because telemedicine treatment guidelines of GSM are not yet developed. The review said that laser or radiofrequency procedures that are currently being used are still being studied for safety and efficacy, as is the influence and effect of the vaginal microbiome and its manipulation for GSM treatment possibilities.

In this video, Phillips presents a sample roleplaying interaction between doctor and patient on how to start the discussion about GSM with women who may be suffering from symptoms. Communication with patients is essential to address the problem and offer treatment options for women, especially since Phillips explains in the video that women will tend to not bring up symptoms during visits with their provider.

In an interview with Contemporary OB/GYN®, Phillips said that despite GSM’s negative effects on a patient’s life and relationship quality, the symptoms are often not discussed, evaluated, or treated as part of routine care. She said multiple effective treatments with and without hormones are available. “Relief of symptoms is possible for most women with guided clinical management,” Phillips explained. “From a clinical perspective, increasing awareness and encouraging dialogue between women and healthcare providers is key. Screening and early intervention, even in peri- or early-menopausal woman with minimal symptoms should be undertaken. However, treatment can be initiated at any age that symptoms become apparent.”

Phillips told Contemporary OB/GYN® that better long-term safety data of hormone therapies in breast cancer survivors and at-risk women is needed. In addition, “laser and radiofrequency procedures for the treatments of GSM also need better safety and outcome data before their role can be clarified,” she said, and added that “investigation of the vaginal microbiome and how it relates to vulvovaginal health and disease are just beginning, and clinical applications from this research are yet to be seen.”

Source

Phillips NA, Bachmann GA. The genitourinary syndrome of menopause [published online ahead of print, 2021 Feb 1]. Menopause. 2021; doi:10.1097/GME.0000000000001728.