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The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
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InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
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Obstetrics and Gynegology2024№11
Current trends in the treatment...

Current trends in the treatment of genitourinary syndrome of menopause: the role of androgens

DOI
https://dx.doi.org/10.18565/aig.2024.284

Ermakova E.I., Smetnik A.A., Tabeeva G.I.

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Genitourinary syndrome of menopause (GSM) is commonly observed in peri- and postmenopausal women and is characterized by a wide variety of symptoms resulting from vulvovaginal atrophy (VVA) and lower urinary tract. Population studies have shown an extremely negative impact of genitourinary symptoms on women’s quality of life, their emotional state, sexual activity and self-esteem. Several studies have demonstrated a close relationship between sexual dysfunction and GSM-related symptoms. GSM/VVA is a chronic disease characterized by symptoms that progress over time, leading to functional and anatomical changes in the pelvic organs. Timely treatment can reduce the severity of clinical manifestations, prevent disease progression and complications, and improve women’s quality of life. For many years, local estrogen therapy has been considered the gold standard for the treatment of GSM/VVA symptoms. However, given the modern concept of the GSM pathogenesis that not only estrogen deficiency but also a decrease in androgen production contributes to the development of genitourinary symptoms with age, the use of local DHEA (prasterone) is a new trend in the correction of GSM and sexual dysfunction in postmenopausal women. Numerous randomized clinical trials have shown the high efficacy of local prasterone for the symptoms and signs of VVA, as well as an increase in libido and sexual function compared to placebo. These effects are achieved through the specific intracellular metabolism of DHEA into active estrogens and androgens according to the mechanisms of modern intracrinology. The obtained data on the high level of safety of local prasterone indicate that Intrarosa can be used for a long time in postmenopausal patients, including those over the age of 60.
Conclusion: This literature review provides current information on the epidemiology, pathogenesis and treatment of GSM. The study presents scientific evidence on the efficacy and safety of intravaginal DHEA (prasterone) and describes the impact of this hormone on GSM signs and symptoms according to the mechanisms of intracrinology.

Authors’ contributions: Ermakova E.I., Smetnik A.A., Tabeeva G.I. – developing the concept and design of the study, collecting and processing the material, writing the text, editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Ermakova E.I., Smetnik A.A., Tabeeva G.I. Current trends in 
the treatment of genitourinary syndrome of menopause: the role of androgens.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 207-214 (in Russian)
https://dx.doi.org/10.18565/aig.2024.284

Keywords

genitourinary syndrome of menopause
vulvovaginal atrophy
dyspareunia
dehydroepiandrosterone
local prasterone
intracrinology
Full text (in Russian)

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Received 07.11.2024

Accepted 13.11.2024

About the Authors

Elena I. Ermakova, PhD, Senior Researcher at the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Vice President of the Russian Society of Specialists in Gynecological Endocrinology and Menopause, +7(916)848-37-46, e_ermakova@oparina4.ru, https://orcid.org/0000-0002-6629-051X
Antonina A. Smetnik, PhD, Head of the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; President of the Russian Society of Specialists in Gynecological Endocrinology and Menopause, +7(495)531-44-44, a_smetnik@oparina4.ru, https://orcid.org/0000-0002-0627-3902
Gyuzyal I. Tabeeva, PhD, Senior Researcher at the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Scientific Secretary of the Russian Society of Specialists in Gynecological Endocrinology and Menopause, +7(495)531-44-44, g_tabeeva@oparina4.ru, https://orcid.org/0000-0003-1498-6520

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