ALGORITHM FOR THE DIAGNOSIS AND TREATMENT OF GENITOURINARY SYNDROME OF MENOPAUSE

Yarmolinskaya M.I., Koloshkina A.V.

1 D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg; 2 Mechnikov North-Western State Medical University, Ministry of Health of Russia, St. Petersburg
For citation: Yarmolinskaya M.I., Koloshkina A.V. Algorithm for the diagnosis and treatment of genitourinary syndrome of menopause. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; 9 (Suppl.): 22-36 (in Russian)
https://dx.doi.org/10.18565/aig.2024.181

References

1. Российское общество акушеров‑гинекологов. Клинические рекомендации. Менопауза и климактерическое состояние у женщины. Проект 2024. Доступно по: https://roag‑portal.ru/projects_gynecology [Russian Society of Obstetricians and Gynecologists. Clinical Guidelines. Menopause and climacteric state in women. Project 2024. Available at: https://roag‑portal.ru/projects_gynecology (in Russian)].

2. Резолюция Совета экспертов «Дискуссионные вопросы применения локального эстриола». Акушерство, гинекология и репродукция. 2023; 17(1): 154‑62. [Experts Council Resolution «Controversial issues of local estriol application». Obstetrics, Gynecology and Reproduction. 2023; 17(1): 154‑62. (in Russian)]. https://dx.doi.org/10.17749/2313‑7347/ob.gyn.rep.2023.379.

3. The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society. Menopause. 2020; 27(9): 976‑92. https://dx.doi.org/10.1097/GME.0000000000001609.

4. Nappi R.E., Martini E., Cucinella L., Martella S., Tiranini L., Inzoli A. et al. Addressing vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) for healthy aging in women. Front. Endocrinol. (Lausanne). 2019; 21(10): 561. https://dx.doi.org/10.3389/fendo.2019.00561.

5. Wu L.Y., Yang T.H., Ou Y.C., Lin H. The role of probiotics in women’s health: An update narrative review. Taiwan J. Obstet. Gynecol. 2024; 63(1): 29‑36. https://dx.doi.org/10.1016/j.tjog.2023.09.018.

6. Donders G.G.G., Donders F.H.W.V. New developments in the management of vulvovaginal atrophy: a comprehensive overview. Expert Opin. Pharmacother. 2023; 24(5): 599‑616. https://dx.doi.org/10.1080/14656566.2023.2194017.

7. Зайнетдинова Л.Ф., Телешева Л.Ф., Медведев Б.И., Хахулина В.В. Вульвовагинальная атрофия: современные методы диагностики и лечения (обзор литературы). Бюллетень сибирской медицины. 2024; 23(1): 134‑43. [Zainetdinova L.F., Telesheva L.F., Medvedev B.I., Khakhulina V.V. Vulvovaginal atrophy: current methods of diagnosis and treatment. Bulletin of Siberian Medicine. 2024; 23(1): 134‑43 (in Russian)]. https://dx.doi.org/10.20538/1682‑0363‑2024‑1‑134‑143.

8. Ulhe S.C., Acharya N., Vats A., Singh A. Study of vulvovaginal atrophy and genitourinary syndrome of menopause and its impact on the quality of life of postmenopausal women in Central India. Cureus. 2024; 16(2): e54802. https://dx.doi.org/10.7759/cureus.54802.

9. Chua Y., Limpaphayom K.K., Cheng B., Ho C.M., Sumapradja K., Altomare C. et al. Genitourinary syndrome of menopause in five Asian countries: results from the Pan‑Asian REVIVE survey. Climacteric. 2017; 20(4): 367‑73. https://dx.doi.org/10.1080/13697137.2017.1315091.

10. Palma F., Volpe A., Villa P., Cagnacci A.; Writing group of AGATA study. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas. 2016; 83: 40‑4. https://dx.doi.org/10.1016/j.maturitas.2015.09.001.

11. Bachmann G. Urogenital ageing: an old problem newly recognized. Maturitas. 1995; 22 Suppl: S1‑S5. https://dx.doi.org/10.1016/ 0378‑5122(95)00956‑6.

12. Erekson E.A., Yip S.O., Wedderburn T.S., Martin D.K., Li F.Y., Choi J.N. et al. The Vulvovaginal Symptoms Questionnaire: a questionnaire for measuring vulvovaginal symptoms in postmenopausal women. Menopause. 2013; 20(9): 973‑9. https://dx.doi.org/10.1097/ GME.0b013e318282600b.

13. Huang A.J., Gregorich S.E., Kuppermann M., Nakagawa S., Van Den Eeden S.K., Brown J.S. et al. Day‑to‑Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well‑being in postmenopausal women. Menopause. 2015; 22(2): 144‑54. https://dx.doi.org/10.1097/GME.0000000000000281.

14. Wiegel M., Meston C., Rosen R. The female sexual function index (FSFI): cross‑validation and development of clinical cutoff scores. J. Sex. Marital. Ther. 2005; 31(1): 1‑20. https://dx.doi.org/10.1080/00926230590475206.

15. Российское общество акушеров‑гинекологов. Клинические рекомендации. Вульварные интраэпителиальные неоплазии. Проект 2024. Доступно по: https://roag‑portal.ru/projects_gynecology [Russian Society of Obstetricians and Gynecologists. Clinical Guidelines. Vulvar intraepithelial neoplasia. Project 2024. Available at: https://roag‑portal.ru/projects_gynecology (in Russian)].

16. Santoro N., Epperson C.N., Mathews S.B. Menopausal symptoms and their management. Endocrinol. Metab. Clin. North Am. 2015; 44(3): 497‑515. https://dx.doi.org/10.1016/j.ecl.2015.05.001.

17. van der Laak J.A., Schijf C.P., Kerstens H.M., Heijnen-Wijnen T.H., de Wilde P.C., Hanselaar G.J. Development and validation of a computerized cytomorphometric method to assess the maturation of vaginal epithelial cells. Cytometry. 1999; 35(3): 196‑202.

18. Tucker K.M., Godha K., Mirkin S., Archer D.F. Vaginal pH: a simple assessment highly correlated with vaginal morphology and symptoms in postmenopausal women. Menopause. 2018; 25(7): 762‑6. https://dx.doi.org/10.1097/GME.0000000000001081.

19. Palacios S. Sequential treatment in vulvovaginal atrophy. Climacteric. 2023; 26(4): 292‑5. https://dx.doi.org/10.1080/13697137.2023.2197588.

20. Stabile G., Topouzova G.A., De Seta F. The role of microbiota in the management of genitourinary syndrome of menopause. Climacteric. 2023; 26(4): 353‑60. https://dx.doi.org/10.1080/13697137.2023.2223923.

21. Pitsouni E., Grigoriadis T., Douskos A., Kyriakidou M., Falagas M.E., Athanasiou S. Efficacy of vaginal therapies alternative to vaginal estrogens on sexual function and orgasm of menopausal women: A systematic review and meta‑analysis of randomized controlled trials. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 229: 45‑56. https://dx.doi.org/10.1016/j.ejogrb.2018.08.008.

22. Hickey M., Marino J.L., Braat S., Wong S. A randomized, double‑blind, crossover trial comparing a silicone‑ versus water‑based lubricant for sexual discomfort after breast cancer. Breast Cancer Res. Treat. 2016; 158(1): 79‑90. https://dx.doi.org/10.1007/s10549‑016‑3865‑1.

23. Nappi R.E., Martella S., Albani F., Cassani C., Martini E., Landoni F. Hyaluronic acid: a valid therapeutic option for early management of genitourinary syndrome of menopause in cancer survivors? Healthcare (Basel). 2022; 10(8): 1528. https://dx.doi.org/10.3390/ healthcare10081528.

24. Crean-Tate K.K., Faubion S.S., Pederson H.J., Vencill J.A., Batur P. Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy. Am. J. Obstet. Gynecol. 2020; 222(2): 103‑13. https://dx.doi.org/10.1016/j.ajog.2019.08.043.

25. Santen R.J., Mirkin S., Bernick B., Constantine G.D. Systemic estradiol levels with low‑dose vaginal estrogens. Menopause. 2020; 27(3): 361‑70. https://dx.doi.org/10.1097/GME.0000000000001463.

26. Nappi R.E., Cucinella L., Martini E., Cassani C. The role of hormone therapy in urogenital health after menopause. Best Pract. Res. Clin. Endocrinol. Metab. 2021; 35(6): 101595. https://dx.doi.org/10.1016/j.beem.2021.101595.

27. Nappi R.E., Tiranini L., Martini E., Bosoni D., Cassani C., Cucinella L. Different local estrogen therapies for a tailored approach to GSM. Climacteric. 2023; 26(4): 361‑6. https://dx.doi.org/10.1080/13697137.2023.2218998.

28. Delgado J.L., Estevez J., Radicioni M., Loprete L., Moscoso Del Prado J. et al. Pharmacokinetics and preliminary efficacy of two vaginal gel formulations of ultra‑low‑dose estriol in postmenopausal women. Climacteric. 2016; 19(2): 172‑80. https://dx.doi.org/10.3109/ 13697137.2015.1098609.

29. Rueda C., Osorio A.M., Avellaneda A.C., Pinzón C.E., Restrepo O.I. The efficacy and safety of estriol to treat vulvovaginal atrophy in postmenopausal women: a systematic literature review. Climacteric. 2017; 20(4): 321‑30. https://dx.doi.org/10.1080/13697137.2017.1329291.

30. Lethaby A., Ayeleke R.O., Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst. Rev. 2016; 2016(8): CD001500. https://dx.doi.org/10.1002/14651858.pub3.

31. Weidlinger S., Schmutz C., Janka H., Gruetter C., Stute P. Sustainability of vaginal estrogens for genitourinary syndrome of menopause ‑ a systematic review. Climacteric. 2021; 24(6): 551‑9. https://dx.doi.org/10.1080/13697137.2021.1891218.

32. Шляхто Е.В., Сухих Г.Т., Серов В.Н., Дедов И.И., Арутюнов Г.П., Сучков И.А. Российские критерии приемлемости назначения менопаузальной гормональной терапии пациенткам с сердечно‑сосудистыми и метаболическими заболеваниями. Согласительный документ Российского кардиологического общества, Российского общества акушеров‑гинекологов, Российской ассоциации эндокринологов, Евразийской ассоциации терапевтов, Ассоциации флебологов России. Акушерство и гинекология. 2023; 11: 211‑32. [Shlyakhto E.V., Sukhikh G.T., Serov V.N., Dedov I.I., Arutyunov G.P., Suchkov I.A. Russian eligibility criteria for menopausal hormone therapy in patients with cardiovascular and metabolic diseases. Consensus document of the Russian Society of Cardiology, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Russian Phlebological Association. Obstetrics and Gynecology. 2023; (11): 211‑32 (in Russian)]. https://dx.doi.org/10.18565/ aig.2021.267.

33. Hirschberg A.L., Bitzer J., Cano A., Ceausu I., Chedraui P., Durmusoglu F. et al. Topical estrogens and non‑hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide. Maturitas. 2021; 148: 55‑61. https://dx.doi.org/10.1016/ j.maturitas.2021.04.005.

34. Инструкция по применению лекарственного препарата для медицинского применения ГИНОФЛОР Э. Регистрационный номер: ЛСР‑008765/09. [Instructions for use of the medicinal product for human use GYNOFLOR E. Registration number: LSR‑008765/09. (in Russian)].

35. Donders G.G.G., Ruban K., Bellen G., Grinceviciene S. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin. Pharmacother. 2019; 20(7): 821‑35. https://dx.doi.org/10.1080/14656566.2019.1574752.

36. Савичева А.М., Шалепо К.В., Назарова В.В., Менухова Ю.Н. Сравнительное контролируемое рандомизированное исследование оценки эффективности двухэтапного лечения бактериального вагиноза. Гинекология. 2013; 15(5): 12‑5. [Savicheva A.M., Shalepo K.V., Nazarova V.V., Menuhova Yu.N. A comparative controlled randomized study assessing the effectiveness of two‑stage treatment of bacterial. Gynecology. 2013; 15(5): 12‑5. (in Russian)].

37. Mitchell C.M., Srinivasan S., Zhan X., Wu M.C., Reed S.D., Guthrie K.A. et al. Vaginal microbiota and genitourinary menopausal symptoms: a cross‑ sectional analysis. Menopause. 2017; 24(10): 1160‑6. https://dx.doi.org/10.1097/GME.0000000000000904.

38. Shardell M., Gravitt P.E., Burke A.E., Ravel J., Brotman R.M. Association of vaginal microbiota with signs and symptoms of the genitourinary syndrome of menopause across reproductive stages. J. Gerontol. A Biol. Sci. Med. Sci. 2021; 76(9): 1542‑50. https://dx.doi.org/10.1093/gerona/ glab120.

39. Castro J., Martins A.P., Rodrigues M.E., Cerca N. Lactobacillus crispatus represses vaginolysin expression by BV associated Gardnerella vaginalis and reduces cell cytotoxicity. Anaerobe. 2018; 50: 60‑63. https://dx.doi.org/10.1016/j.anaerobe.2018.01.014.

40. Muzny C.A., Taylor C.M., Swords W.E., Tamhane A., Chattopadhyay D., Cerca N. et al. An updated conceptual model on the pathogenesis of bacterial vaginosis. J. Infect. Dis. 2019; 220(9): 1399‑405. https://dx.doi.org/10.1093/infdis/jiz342.

41. Unlü C., Donders G. Use of lactobacilli and estriol combination in the treatment of disturbed vaginal ecosystem: a review. J. Turk. Ger. Gynecol. Assoc. 2011; 12(4): 239‑46. https://dx.doi.org/10.5152/jtgga.2011.57.

42. Donders G., Bellen G., Neven P., Grob P., Prasauskas V., Buchholz S. et al. Effect of ultra‑low‑dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors. Eur. J. Clin. Microbiol. Infect. Dis. 2015; 34(10): 2023‑8. https://dx.doi.org/10.1007/ s10096‑015‑2447‑1.

43. Robinson C., Holm J., Brown S., Ravel J., Ghanem K., Brotman R. P592 Microbiota concordance between mid‑vaginal swabs and both clean‑ and random‑catch urine samples. Sexually Transmitted Infections. 2019; 95: A264. https://dx.doi.org/10.1136/ sextrans‑2019‑sti.663.

44. Thomas-White K., Taege S., Limeira R., Brincat C., Joyce C. Vaginal estrogen therapy is associated with increased Lactobacillus in the urine of postmenopausal women with overactive bladder symptoms. Am. J. Obstet. Gynecol. 2020; 223(5): 727.e1‑727.e11. https://dx.doi.org/10.1016/ j.ajog.2020.08.006.

45. Capobianco G., Wenger J.M., Meloni G.B., Dessole M., Cherchi P.L., Dessole S. Triple therapy with Lactobacilli acidophili, estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women. Arch. Gynecol. Obstet. 2014; 289(3): 601‑8. https://dx.doi.org/10.1007/ s00404‑013‑3030‑6.

46. Bilardi J.E., Walker S., Temple-Smith M., McNair R., Mooney-Somers J., Bellhouse C. et al. The burden of bacterial vaginosis: women’s experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One. 2013; 8(9): e74378. https://dx.doi.org/10.1371/journal.pone.0074378.

47. Mitchell C.M., Srinivasan S., Plantinga A., Wu M.C., Reed S.D., Guthrie K.A. et al. Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem. Menopause. 2018; 25(5): 500‑7. https://dx.doi.org/10.1097/GME.0000000000001037.

About the Authors

Maria I. Yarmolinskaya, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Head of the Department of Gynecology and Endocrinology, Head of the Center of Diagnostics and Treatment of Endometriosis, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3; Professor, Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, 191015, Russia, Saint-Petersburg, Kirochnaya str., 41, m.yarmolinskaya@gmail.com, SPIN-code: 3686-3605, Researcher ID: P-2183-2014, Scopus Author ID: 7801562649, https://orcid.org/0000-0002-6551-4147
Anastasiya V. Koloshkina, Resident, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3, nastyasalukhova@gmail.com, https://orcid.org/0000-0002-5200-7672
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.