Introducing 'Genitourinary Syndrome of Menopause'

Ricki Lewis, PhD

August 25, 2014

The International Society for the Study of Women's Sexual Health and the North American Menopause Society have endorsed a new term for symptoms associated with menopause: genitourinary syndrome of menopause (GSM). The term has been or will be introduced by David J. Portman, MD, from the Columbus Center for Women's Health Research in Ohio, and colleagues in Climacteric, the Journal of Sexual Medicine, Maturitas , and Menopause.

The Vulvovaginal Atrophy Terminology Consensus Conference Panel met in May 2013 in Chicago, Illinois, to discuss a more accurate and all-encompassing term that would be acceptable for women, researchers, educators, the media, and the public. The primary goal was to improve and ease conversations between menopausal patients and their healthcare providers.

Neither of the terms in current use to describe menopausal symptoms is adequate, the panel and its consultants agreed. Vulvovaginal atrophy refers to the appearance of the vulva and vagina postmenopause, but it does not describe symptoms. Atrophic vaginitis suggests inflammation or infection, which are pathological and not typically present. Neither term covers urinary symptoms.

Older terms may also make patients feel uncomfortable. "Atrophy" suggests wasting away, and many people will not say "vagina." The authors compare use of GSM to the term erectile dysfunction replacing the emotionally charged "impotence" and having to say "penis."

The genitourinary signs and symptoms of menopause arise from decreasing levels of estrogens and other steroid hormones. They include burning and irritation of reproductive organs and structures; dryness, discomfort, or pain with intercourse; and urinary urgency, dysuria, and recurrent infections.

A common embryonic origin for genitourinary structures and their density of estrogen receptors make them all vulnerable to change once hormone levels drop. Specific alterations include reduced collagen and elastin, thinning epithelium, altered function of smooth muscle, loss of elasticity and flexibility, and diminished blood supply.

GSM can include any or all signs and symptoms, which must be attributed to menopause and not another cause, such as infection, allergy, skin conditions, pelvic floor muscle dysfunction, cystitis, or pudendal neuralgia. GSM affects about half of all postmenopausal women, but surveys show that women are hesitant to discuss these symptoms with their healthcare providers, and vice versa.

The conference concluded that GSM is more accurate, inclusive, and less embarrassing than the older terms. In addition to easing conversations, the new term will be used to develop a tool to help standardize physical examinations so that women can take advantage of treatments such as vaginal moisturizers, vaginal estrogen, and estrogen mimics.

Dr. Portman reports receiving research grants from Abbvie, Activas, Amneal, Bayer, Endoceutics, Noven, Palatin, Pfizer, QuatRx, Sun Pharmaceuticals, and Teva, TherapeuticsMD; consultant fees from Activas, Noven, NovoNordisk, Palatin, Pfizer, Shionogi, Sprout, and TherapeuticsMD; and speaking fees from Noven, Pfizer, and Shionogi. The other investigators have disclosed no relevant financial relationships.

Maturitas. Published online August 14, 2014. Abstract

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