Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management

American Journal of Obstetrics and Gynecology

Volumn 215, Issue 6, 2016, Pages 704-711

  Gandhi, Jason ^a   Chen, Andrew ^a   Dagur, Gautam ^a   Suh, Yiji ^a   Smith, Noel ^b   Cali, Brianna ^a   Khan, Sardar Ali ^a  

^a STONY BROOK UNIVERSITY   (United States)

^b Foley Plaza Medical ^*  (United States)

Author keywords

atrophic vaginitis; dyspareunia; estrogen progestin therapy; genitourinary syndrome of menopause; hypoestrogenism; menopausal hormone therapy; nonhormonal vaginal therapy; quality of life; urinary incontinence; urogenital atrophy; vaginal maturation index; vulvovaginal atrophy

Indexed keywords

ESTROGEN; HOMEOPATHIC AGENT; LUBRICATING AGENT; OXYTOCIN; PRASTERONE; SELECTIVE ESTROGEN RECEPTOR MODULATOR; STEROID; OXYTOCIC AGENT;

ATROPHIC VAGINITIS; CLINICAL FEATURE; EARLY DIAGNOSIS; ESTROGEN THERAPY; GENITOURINARY SYNDROME; HOMEOPATHY; HORMONE SUBSTITUTION; HUMAN; LIFESTYLE MODIFICATION; LOW LEVEL LASER THERAPY; MENOPAUSE; PATHOPHYSIOLOGY; PATIENT CARE; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; SYSTEMIC THERAPY; VAGINA ATROPHY; DYSPAREUNIA; FEMALE; LIFESTYLE; METABOLISM; PROCEDURES; SYNDROME; URINARY INCONTINENCE; VULVAR DISEASES;

ATROPHIC VAGINITIS; DEHYDROEPIANDROSTERONE; DYSPAREUNIA; ESTROGEN REPLACEMENT THERAPY; FEMALE; HUMANS; LIFE STYLE; LOW-LEVEL LIGHT THERAPY; LUBRICANTS; MENOPAUSE; OXYTOCICS; OXYTOCIN; QUALITY OF LIFE; SELECTIVE ESTROGEN RECEPTOR MODULATORS; SYNDROME; URINARY INCONTINENCE; VULVAR DISEASES;

EID: 84994387303     PISSN: 00029378     EISSN: 10976868     Source Type: Journal    
DOI: 10.1016/j.ajog.2016.07.045     Document Type: Review

References (49)

1. 1 Portman, D.J., Gass, M.L., Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause 21 (2014), 1063–1068.
2. 2 Palacios, S., Managing urogenital atrophy. Maturitas 63 (2009), 315–318.
3. 3 DiBonaventura, M., Luo, X., Moffatt, M., Bushmakin, A.G., Kumar, M., Bobula, J., The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe. J Womens Health (Larchmt) 24 (2015), 713–722.
4. 4 Keil, K., Urogenital atrophy: diagnosis, sequelae, and management. Curr Womens Health Rep 2 (2002), 305–311.
5. 5 Mac Bride, M.B., Rhodes, D.J., Shuster, L.T., Vulvovaginal atrophy. Mayo Clin Proc 85 (2010), 87–94.
6. 6 Nappi, R.E., Kokot-Kierepa, M., Vaginal health: insights, views and attitudes (VIVA)–results from an international survey. Climacteric 15 (2012), 36–44.
7. 7 Nappi RE, Panay N, Rabe T, Krychman M, Particco M. Results of the European REVIVE (REal Women's VIew of Treatment Options for Menopausal Vulvar/Vaginal ChangEs) survey. 10th Congress of the European Menopause and Andropause Society; May 20-22, 2015; Madrid, Spain.
8. 8 Castelo-Branco, C., Biglia, N., Nappi, R.E., Schwenkhagen, A., Palacios, S., Characteristics of post-menopausal women with genitourinary syndrome of menopause: implications for vulvovaginal atrophy diagnosis and treatment selection. Maturitas 81 (2015), 462–469.
9. 9 Davila, G.W., Singh, A., Karapanagiotou, I., et al. Are women with urogenital atrophy symptomatic?. Am J Obstet Gynecol 188 (2003), 382–388.
10. 10 Wines, N., Willsteed, E., Menopause and the skin. Australas J Dermatol 42 (2001), 149–158 quiz 159.
11. 11 North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause 14 (2007), 355–369 quiz 370-1.
12. 12 Goldstein, I., Recognizing and treating urogenital atrophy in postmenopausal women. J Womens Health (Larchmt) 19 (2010), 425–432.
13. 13 Chen, G.D., Oliver, R.H., Leung, B.S., Lin, L.Y., Yeh, J., Estrogen receptor alpha and beta expression in the vaginal walls and uterosacral ligaments of premenopausal and postmenopausal women. Fertil Steril 71 (1999), 1099–1102.
14. 14 Nappi, R.E., Palacios, S., Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric 17 (2014), 3–9.
15. 15 Luthje, P., Hirschberg, A.L., Brauner, A., Estrogenic action on innate defense mechanisms in the urinary tract. Maturitas 77 (2014), 32–36.
16. 16 Willhite, L.A., O'Connell, M.B., Urogenital atrophy: prevention and treatment. Pharmacotherapy 21 (2001), 464–480.
17. 17 Robinson, D., Cardozo, L.D., The role of estrogens in female lower urinary tract dysfunction. Urology 62:Suppl (2003), 45–51.
18. 18 Hyun, H.S., Park, B.R., Kim, Y.S., Mun, S.T., Bae, D.H., Urodynamic characterization of postmenopausal women with stress urinary incontinence: retrospective study in incontinent pre- and post-menopausal women. J Korean Soc Menopause 16 (2010), 148–152.
19. 19 Utian, W.H., Biosynthesis and physiologic effects of estrogen and pathophysiologic effects of estrogen deficiency: a review. Am J Obstet Gynecol 161 (1989), 1828–1831.
20. 20 Kao, A., Binik, Y.M., Kapuscinski, A., Khalife, S., Dyspareunia in postmenopausal women: a critical review. Pain Res Manag 13 (2008), 243–254.
21. 21 Butcher, J., ABC of sexual health: female sexual problems II: sexual pain and sexual fears. BMJ 318 (1999), 110–112.
22. 22 North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of the North American Menopause Society. Menopause 20 (2013), 888–902 quiz 903-4.
23. 23 Rahn, D.D., Carberry, C., Sanses, T.V., et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol 124 (2014), 1147–1156.
24. 24 Palacios, S., Castelo-Branco, C., Currie, H., et al. Update on management of genitourinary syndrome of menopause: a practical guide. Maturitas 82 (2015), 308–313.
25. 25 Cardozo, L., Bachmann, G., McClish, D., Fonda, D., Birgerson, L., Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 92 (1998), 722–727.
26. 26 Brockie, J., Managing menopausal symptoms: hot flushes and night sweats. Nurs Stand 28 (2013), 48–53.
27. 27 Suckling, J., Lethaby, A., Kennedy, R., Local estrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev, 2006, CD001500.
28. 28 Castelo-Branco, C., Cancelo, M.J., Villero, J., Nohales, F., Julia, M.D., Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 52:Suppl (2005), S46–S52.
29. 29 Paton, D.M., Ospemifene for the treatment of dyspareunia in postmenopausal women. Drugs Today (Barc) 50 (2014), 357–364.
30. 30 Constantine, G.D., Goldstein, S.R., Archer, D.F., Endometrial safety of ospemifene: results of the phase 2/3 clinical development program. Menopause 22 (2015), 36–43.
31. 31 Moffett, A., Ettinger, M., Bolognese, M., et al. Lasofoxifene, a next generation SERM, is effective in preventing loss of BMD and reducing LDL-C in postmenopausal women. J Bone Miner Res, 19, 2004, S96.
32. 32 McClung, M.R., Siris, E., Cummings, S., et al. Prevention of bone loss in postmenopausal women treated with lasofoxifene compared with raloxifene. Menopause 13 (2006), 377–386.
33. 33 Cummings, S., Eastell, R., Ensrud, K., The effects of lasofoxifene on fractures and breast cancer: 3 year results from the PEARL trial. J Bone Miner Res, 23, 2008, S81.
34. 34 Gennari, L., Lasofoxifene, a new selective estrogen receptor modulator for the treatment of osteoporosis and vaginal atrophy. Expert Opin Pharmacother 10 (2009), 2209–2220.
35. 35 Komm, B.S., Mirkin, S., Jenkins, S.N., Development of conjugated estrogens/bazedoxifene, the first tissue selective estrogen complex (TSEC) for management of menopausal hot flashes and postmenopausal bone loss. Steroids 90 (2014), 71–81.
36. 36 Kagan, R., The tissue selective estrogen complex: a novel approach to the treatment of menopausal symptoms. J Womens Health (Larchmt) 21 (2012), 975–981.
37. 37 Abrahamse, H., Regenerative medicine, stem cells, and low-level laser therapy: future directives. Photomed Laser Surg 30 (2012), 681–682.
38. 38 Stefano, S., Stavros, A., Massimo, C., The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol 27 (2015), 504–508.
39. 39 Hutchinson-Colas, J., Segal, S., Genitourinary syndrome of menopause and the use of laser therapy. Maturitas 82 (2015), 342–345.
40. 40 Salvatore, S., Nappi, R.E., Zerbinati, N., et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric 17 (2014), 363–369.
41. 41 Salvatore, S., Nappi, R.E., Parma, M., et al. Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric 18 (2015), 219–225.
42. 42 Gambacciani, M., Levancini, M., Cervigni, M., Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause. Climacteric 18 (2015), 757–763.
43. 43 Nicoletti, G., Cornaglia, A.I., Faga, A., Scevola, S., The biological effects of quadripolar radiofrequency sequential application: a human experimental study. Photomed Laser Surg 32 (2014), 561–573.
44. 44 Vicariotto, F., Raichi, M., Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol 68 (2016), 225–236.
45. 45 Mendoza, N., Abad, P., Baro, F., et al. Spanish Menopause Society position statement: use of tibolone in postmenopausal women. Menopause 20 (2013), 754–760.
46. 46 Al-saqi, S.H., Uvnäs-moberg, K., Jonasson, A.F., Intravaginally applied oxytocin improves post-menopausal vaginal atrophy. Post Reprod Health 21 (2015), 88–97.
47. 47 Labrie, F., Archer, D.F., Koltun, W., et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause 23 (2016), 243–256.
48. 48 Edwards, D., Panay, N., Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric 19 (2016), 151–161.
49. 49 Panay, N., Genitourinary syndrome of the menopause–dawn of a new era?. Climacteric 18:Suppl (2015), 13–17.