Genitourinary Syndrome of Menopause: A Systematic Review

Abstract

Genitourinary syndrome is the most common health problem experienced by postmenopausal women. Its pathogenesis is correlated with decreased estrogen levels, which results in thinner vaginal epithelium with a reduced proportion of superficial cells. In the vaginal wall, there is a decrease in the number of collagen fibers, a reduction in smooth muscle mass, and a decrease in vascularization. The consequences of these changes are that the vaginal wall experiences a decrease in size, elasticity, lubrication, and integrity of the mucosal layer. The most common symptom experienced is vaginal pain, which ultimately causes fear of engaging in sexual activity. Handling of genitourinary syndrome symptoms is important because the population of postmenopausal women is large and will continue to increase. The purpose of writing a literature review is to review the pathogenesis of genitourinary syndrome and various treatment options. Literature was obtained through a search on Google Scholar and PubMed database during 2022 and selected publications from the last 5 years, both in Indonesian and English. The keywords used are menopause, genitourinary syndrome, pathogenesis of genitourinary syndrome, genitourinary syndrome therapy, phytoestrogens, selective estrogen receptor modulators (SERM), and hormone replacement therapy. The results found that most cases are undiagnosed and only a few receive appropriate therapy. Most menopausal women self-treat the symptoms of genitourinary syndrome experienced with over-the-counter drugs and many cases are not treated. The main therapy for genitourinary syndrome is hormones given systemically or topically. One systemic therapy is SERM. Many topical therapy options include phytoestrogens, hyaluronic acid, moisturizers, lubricants, colostrum, vitamins, herbs, laser therapy, and radio frequency. Various types of therapy methods have different mechanisms of action, most of which have been proven effective in improving the structure and physiology of the vagina and can reduce symptoms of the genitourinary syndrome and also improve sexual function.