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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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Obstetrics and Gynegology2026№7

Genitourinary syndrome of menopause: the role of androgens in current understanding of pathogenesis, proteomic data and new therapeutic opportunities

DOI
https://dx.doi.org/10.18565/aig.2026.195

Oganesyan T.M., Ermakova E.I., Smetnik A.A., Starodubtseva N.L.

1) Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) Moscow Institute of Physics and Technology (National Research University), Dolgoprudny, Russia

Genitourinary syndrome of menopause (GSM) is a spectrum of symptoms associated with declining levels of estrogens and other sex steroids during peri- and postmenopausal periods, comprising changes that occur in the external genitalia, perineum, vagina, urethra and bladder. Despite the high prevalence of the disease, a lack of awareness of the syndrome means that many women do not receive effective treatment. However, treatment started at the right time can slow the progression of the disease, prevent complications and significantly improve quality of life. The gold standard for the treatment of GSM is the use of local estrogens. According to the new concept of the pathogenesis of GSM, not only estrogen deficiency but also androgen deficiency plays a role in the development of this condition. This is supported by proteomics findings, which demonstrate that proteins in the cervicovaginal fluid are involved in molecular processes regulated by estrogens and androgens, or are produced as a result of their activation. Thus, the introduction of prasterone (dehydroepiandrosterone), a drug that is metabolized via intracrine mechanisms to produce both estrogens and androgens, represents a novel approach to the treatment of GSM. Prasterone has been studied in numerous randomized placebo-controlled trials which confirm its efficacy in treating the symptoms of urogenital atrophy.
Conclusion. The current understanding of GSM pathogenesis supported by proteomic data on estrogen- and androgen-dependent molecular processes points to the key role of deficiency of both classes of sex steroids. Prasterone, a precursor to both estrogens and androgens that are produced intracellularly, is an effective alternative to standard local estrogen therapy.

Authors’ contributions. Oganesyan T.M. – collecting and processing the material, writing the text; Ermakova E.I., Smetnik A.A., Starodubtseva N.L. – editing the article.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. In writing this article, artificial intelligence was used to search for sources and translate primary sources, following which the authors reviewed and edited the translated content.
For citation: Oganesyan T.M., Ermakova E.I., Smetnik A.A., Starodubtseva N.L. Genitourinary syndrome of menopause: the role of androgens in current understanding of pathogenesis, proteomic data and new therapeutic opportunities.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (7): 38-46 (in Russian)
https://dx.doi.org/10.18565/aig.2026.195

Keywords

genitourinary syndrome of menopause
dyspareunia
local estrogens
local prasterone
proteome
cervicovaginal fluid
intracrinology
Full text (in Russian)

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Received 23.06.2026

Accepted 09.07.2026

About the Authors

Tatiana M. Oganesyan, PhD student at the Department of Gynecological Endocrinology named after Professor V.P. Smetnik, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia, +7(915)284-57-07, tanya.movsisyan.1998@mail.ru,
https://orcid.org/0009-0008-3557-4297
Elena I. Ermakova, PhD, Leading Researcher at the Department of Gynecological Endocrinology named after Professor V.P. Smetnik, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia; Vice President of the Russian Society of Gynecological Endocrinology and Menopause Specialists, +7(916)848-37-46, ermakova.health@mail.ru, https://orcid.org/0000-0002-6629-051X
Antonina A. Smetnik, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Institute of Postgraduate Education, Head of the Department of Gynecological Endocrinology named after Professor V.P. Smetnik, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia; President of the Russian Society of Gynecological Endocrinology and Menopause; Member of the Board of the European Society for Menopause and Andropause (EMAS), +7(495)531-44-44, a_smetnik@oparina4.ru, https://orcid.org/0000-0002-0627-3902
Natalia L. Starodubtseva, PhD (Bio), Associate Professor, Head of the Laboratory of Clinical Proteomics, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia; Associate Professor at the Department of Chemical Physics, Moscow Institute of Physics and Technology, Moscow Region, Dolgoprudny, +7(495)438-18-00, n_starodubtseva@oparina4.ru, https://orcid.org/0000-0001-6650-5915

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