Doctor Domingo Molina: “More than half of the women suffering from genitourinary syndrome of menopause are under 50 years old”

What exactly is genitourinary syndrome (GMS) of menopause?

Genitourinary syndrome (GMS) of menopause is a group of changes that affect the entire female intimate area.: Vagina, vulva, urinary tract and pelvic floor. These changes occur at the anatomical, physiological and functional level, both in the vulvovaginal area and in the urinary tract.

What causes and what are the most common symptoms of GMS?

Genitourinary syndrome is caused by decreased production of female hormones (sex steroids, especially estrogen) during menopause. At the vaginal level, symptoms are dryness, burning sensation, lack of lubrication during sexual activity, odor, light bleeding, and burning sensation., And at the urinary level, dysuria (pain while urinating), urinary urgency (intense and sudden need to urinate) and urinary infections. Indeed, the prevalence of symptoms related to genitourinary atrophy in menopause is not well defined. This is because many women consider these symptoms to be an inevitable consequence of aging, which is why they do not seek medical help. Prevalence studies estimate that symptoms of urogenital atrophy affect 10 to 40% of postmenopausal women. From a gynecological perspective, the first reason for consultation for menopausal women is vaginal dryness; Some women describe it as being linked to orgasm, leading to the condition reducing the frequency of sexual intercourse. Dyspareunia, defined as pain experienced by women during intercourse, favors atrophic vaginitis.

Why does this happen

Mainly for two reasons: Changes in the formation and function of the vaginal mucosa and changes in the vaginal microbiota. (Microorganisms that normally live in the vagina). One of the primary functions of estrogen is vaginal lubrication. Due to its stimulation, the vaginal mucosa produces a transparent lubricating fluid that prevents dehydration and dryness of the mucous membrane. On the other hand, the vagina is covered with an epithelium that regenerates due to the stimulation of estrogen and when its levels decrease during menopause, this proliferation process is reduced, causing thinning of the urovaginal epithelium. Since the nerve endings are located close to the surface, sensitivity increases and can cause pain. Similarly, estrogens affect the pH of the vaginal epithelium, which helps keep the vaginal microbiota in balance and, when estrogen is reduced, the good bacteria are reduced and this leads to infection. More than half of the women suffering from this disorder are under 50 years of age. Symptoms range from minor discomforts to limitations in a woman’s personal, social, and work performance. In short, it affects and reduces the quality of life of women.

How are the symptoms treated?

At HPS we recommend our patients to treat the symptoms of genitourinary syndrome through a combination of healthy lifestyle habits and gynecological treatments. Regarding healthy lifestyle, You should avoid being overweight and obese (increasing menopausal symptoms), reduce tobacco and alcohol, get regular physical exercise, maintain sexual activity, and do Kegel exercises. (Pelvic floor exercises that help strengthen, tone and oxygenate the vaginal structures and tissues).

What type of treatment is recommended?

There are several options depending on the severity and frequency of symptoms. Some of them can be used in a scaled manner and are moisturizing creams, applied to the vagina several times a week. They attach to the vaginal epithelium, retain water in the vagina, maintaining its hydration and elasticity. Additionally, the pH level in the vagina decreases, so the higher the acidity, the better control there is on bacterial growth. Local hormone therapy is used to treat symptoms of vaginal atrophy when they are moderate or severe. Low doses of local estrogen are administered, applied directly to the area in the form of vaginal suppositories or tablets, creams, and silicone vaginal rings. Non-hormonal oral therapy using ospemifene belongs to a group of non-hormonal drugs that are selective estrogen receptor modulators. In colloquial language, they work where we want and do not work where we do not want., MHT, menopausal hormone therapy. It is the most effective of all menopausal symptoms, although it has largely fallen out of use due to fear arising from contradictory information. All national and international societies indicate that, under medical prescription, and following the recommendations of current guidelines, the benefits outweigh the risks, although we have to select patients who can use it. And, finally, regenerative techniques based on jet plasma, laser, radiofrequency, hyaluronic acid, matrix cells (hyaluronic acid with stem cells), PRP (platelet-rich plasma) and exosomes. These techniques activate the production of collagen and elastin and generate neovascularization with increased blood flow to the area. They are painless, without anesthesia and outpatient.