Urologists must start the conversation about genitourinary syndrome of menopause
Fewer than 6% of women with GSM signs and symptoms are being treated.
Genitourinary syndrome of menopause (GSM), a spectrum of symptoms and signs caused by hypoestrogenic changes in urogenital tissues typically occurring during menopause, affects up to 87% of postmenopausal women. The discomfort, pain and irritation in symptomatic women can greatly impact their quality of life, including their sexual function and interpersonal relationships. Yet fewer than 6% of women with GSM signs and symptoms are being treated.
“An unfortunate barrier to treatment is that women believe symptoms of GSM are a normal consequence of aging they must accept,” said Melissa R. Kaufman, MD, PhD, FACS, chair of urological surgery at Vanderbilt University Medical Center. “As a result, women rarely discuss symptoms with their health care provider, and providers do not consistently ask about symptoms.”
It’s time for urologists to start the conversation.
“Urologists need to stand up and get really loud about GSM and educate patients and other providers about it,” said Rachel S. Rubin, MD, during Friday’s Instructional Course, “Navigating Genitourinary Syndrome of Menopause: Path to Patient Satisfaction.” The course synthesized the totality of evidence available on the benefits and harms of screening, diagnosing and treating GSM to inform decision-making for health care professionals and clinicians. “We have a unique opportunity to make this about the bladder,” said Dr. Rubin, who is a board-certified urologist with fellowship training in sexual medicine.
The deficit of estrogen in menopause creates a cascade of effects, including a change in the microbiota and in the anatomy of the vagina, that can increase the risk of infection in the urinary tract, said Una J. Lee, MD, head of urology and renal transplantation and urology physician lead at Virginia Mason Franciscan Health.
Symptoms of GSM may include vulvovaginal dryness, pain during intercourse, vaginal irritation/discomfort, itching, pain during exercise, tenderness and bleeding related to intercourse. Urinary symptoms include urgency, dysuria, recurrent urinary tract infections, urge incontinence and stress incontinence. Signs can include decreased moisture and elasticity, labia minora resorption, loss of vaginal rugae and urethral eversion or prolapse.
Localized vaginal estrogen creams, inserts and rings are Food and Drug Administration-approved treatment options that are safe and effective.
“Vaginal hormones are the foundation of treatment,” Dr. Rubin said. “Patient education is essential for adherence.” GSM is progressive. To maintain healthy vaginal tissue, patients will need to refill their vaginal estrogen prescription indefinitely.
The AUA is in the process of developing a clinical practice guideline based on an independent systematic review of the evidence.
“GSM guidelines will change the landscape,” Dr. Kaufman said. “We have to own it.”