Genitourinary Syndrome Of Menopause

Introduction

• Description: A collection of symptoms and changes that occur in the female reproductive tract due to a lack of estrogen. Previously known as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis.

• Prevalence: Occurs to some extent in 100% of postmenopausal women who do not undergo estrogen therapy; roughly 10%–40% will experience one or more symptoms of vaginal atrophy (eg, vaginal dryness affects up to 85% of patients older than 40 years of age). Up to 70% of symptomatic patients do not seek treatment.

• Predominant Age: Generally beginning within 5 years of menopause (natural or surgical).

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Changes in the support and function of the tissues of the reproductive tract due to loss of estrogen stimulation, resulting in changes to the labia majora and minora, clitoris, vestibule, vaginal introitus, vagina, urethra, and bladder.

• Risk Factors: Loss of ovarian function because of age, chemotherapy, radiation, or surgery, antiestrogenic drugs, or gonadotropin-releasing hormone agonist therapy. A transient hypoestrogenic state can occur during the postpartum period or while lactating, but generally resolves before significant genital changes can occur.

Signs and Symptoms

• Sensation of vaginal dryness

• Vaginal itching, burning, or irritation

• Loss of vaginal acidity (pH ≥5, may reach 6.8 or higher)

• Insertional dyspareunia, decreased arousal, orgasm, or sexual desire

• Thinning of labia majora and loss of the labia minora

• Dry, inflamed vaginal tissues seen on pelvic examination

• Loss of normal vaginal rugae

• Bleeding, petechiae, and ulceration of the vaginal tissues

• Urethral prolapse/caruncle

• Recurrent urinary tract infections

• Urinary urgency (urge incontinence), frequency, dysuria

Diagnostic Approach