Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.
TL;DR: The term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy and was formally endorsed by the respective Boards of NAMS and ISSWSH in 2014.
Abstract: BackgroundIn 2012, the Board of Directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms rel
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TL;DR: Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture.
Abstract: The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees. Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT. For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended. This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociacion Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d’etudes de la menopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Societa Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.
801 citations
TL;DR: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric and benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause.
Abstract: Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Men...
574 citations
TL;DR: The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.
Abstract: The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace Hormonal changes that begin during the menopausal transition affect many biological systems Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health
284 citations
TL;DR: The most up-to-date literature pertaining to clinical manifestations, pathophysiology, etiology, evaluation, and management of genitourinary syndrome of menopause is comprehensively reviewed.
243 citations
TL;DR: All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophy-related complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs.
226 citations
References
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TL;DR: The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Abstract: ContextWhile recent pharmacological advances have generated
increased public interest and demand for clinical services regarding
erectile dysfunction, epidemiologic data on sexual dysfunction are
relatively scant for both women and men.ObjectiveTo assess the prevalence and risk of experiencing sexual
dysfunction across various social groups and examine the determinants
and health consequences of these disorders.DesignAnalysis of data from the National Health and Social Life
Survey, a probability sample study of sexual behavior in a
demographically representative, 1992 cohort of US adults.ParticipantsA national probability sample of 1749 women and 1410
men aged 18 to 59 years at the time of the survey.Main Outcome MeasuresRisk of experiencing sexual dysfunction as
well as negative concomitant outcomes.ResultsSexual dysfunction is more prevalent for women (43%) than
men (31%) and is associated with various demographic characteristics,
including age and educational attainment. Women of different racial
groups demonstrate different patterns of sexual dysfunction.
Differences among men are not as marked but generally consistent with
women. Experience of sexual dysfunction is more likely among women and
men with poor physical and emotional health. Moreover, sexual
dysfunction is highly associated with negative experiences in sexual
relationships and overall well-being.ConclusionsThe results indicate that sexual dysfunction is an
important public health concern, and emotional problems likely
contribute to the experience of these problems.
4,937 citations
"Genitourinary syndrome of menopause..." refers background in this paper
...Women with lower urinary tract symptoms have a 7-fold greater risk of sexual pain disorders and a 4-fold greater risk of sexual arousal disorders than women without such symptoms.(35) The association between vaginal atrophy and other urogenital conditions has been confirmed in a claims database study of more than 9000 postmenopausal US women....
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TL;DR: Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to reportSexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.
Abstract: BACKGROUND Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people. METHODS We report the prevalence of sexual activity, behaviors, and problems in a national probability sample of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age, and we describe the association of these variables with age and health status. RESULTS The unweighted survey response rate for this probability sample was 74.8%, and the weighted response rate was 75.5%. The prevalence of sexual activity declined with age (73% among respondents who were 57 to 64 years of age, 53% among respondents who were 65 to 74 years of age, and 26% among respondents who were 75 to 85 years of age); women were significantly less likely than men at all ages to report sexual activity. Among respondents who were sexually active, about half of both men and women reported at least one bothersome sexual problem. The most prevalent sexual problems among women were low desire (43%), difficulty with vaginal lubrication (39%), and inability to climax (34%). Among men, the most prevalent sexual problems were erectile difficulties (37%). Fourteen percent of all men reported using medication or supplements to improve sexual function. Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to report sexual problems. A total of 38% of men and 22% of women reported having discussed sex with a physician since the age of 50 years. CONCLUSIONS Many older adults are sexually active. Women are less likely than men to have a spousal or other intimate relationship and to be sexually active. Sexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.
1,866 citations
"Genitourinary syndrome of menopause..." refers background in this paper
...Evidence suggests that negative societal attitudes about women_s sexuality at older ages may limit discussion about sex by both the patient and the provider, particularly if the provider is younger or male.(25,42) Furthermore, sexual problems attributed to aging may be perceived as normal and irreversible, and women may be unaware that symptoms are linked to menopause or that treatments are available....
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...In the National Social Life, Health, and Aging Project, which interviewed 3000 men and women 57 to 85 years of age, most reported that they were in intimate relationships and regarded sexuality as an important part of life.(25)...
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TL;DR: This report restates the ICS principle that symptoms, signs and conditions are separate categories and adds a category of urodynamic observations and conditions associated with lower urinary tract dysfunction and UDS, for use in all patient groups from children to the elderly.
1,637 citations
TL;DR: Although middle-aged women are highly symptomatic, the symptoms that appear to be specifically related to hormonal changes of menopausal transition are vasomotor symptoms, vaginal dryness, and breast tenderness.
831 citations
01 Jan 2013
TL;DR: Clinicians can improve the sexual health and QOL of postmenopausal women by educating women about, diagnosing, and appropriately managing symptomatic VVA.
Abstract: Objective: To update and expand the previous position statement of The North American Menopause Society (NAMS) on the management of symptomatic vulvovaginal atrophy (VVA) in postmenopausal women. Methods: NAMS searched PubMed for medical literature on VVA published since their 2007 position statement on the role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women. A panel of acknowledged experts in the field of genitourinary health reviewed the literature to evaluate new evidence on local estrogen as well as on other management options available or in development for symptomatic VVA. The panel_s conclusions and recommendations were reviewed and approved by the NAMS Board of Trustees. Results: Symptomatic VVA can significantly impair the quality of life (QOL) of postmenopausal women and may be underdiagnosed. In most cases, it can be managed successfully. A number of over-the-counter and government-approved prescription therapies available in the United States and Canada demonstrate effectiveness, depending on the severity of VVA symptoms. These include vaginal lubricants and moisturizers, vaginal estrogen, hormone therapy, and the selective estrogen-receptor modulator ospemifene (indicated for dyspareunia). Longterm studies on the endometrial safety of local estrogen and ospemifene are lacking. Changes in the vaginal microbiome have various effects on symptoms. Conclusions: Clinicians can improve the sexual health and QOL of postmenopausal women by educating women about, diagnosing, and appropriately managing symptomatic VVA. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of therapy for the individual patient, and patient preference. Estrogen therapy is the most effective treatment for moderate to severe symptoms, although a direct comparison of estrogen and ospemifene is not available. Nonhormonal therapies available without a prescription provide sufficient relief for most women with mild symptoms. When low-dose estrogen is administered locally, a progestogen is not indicated for women without a uterus and generally is not indicated for women with an intact uterus. However, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data to confirm the safety of local estrogen in women with breast cancer; management of VVA should take the woman’s needs and the recommendation of her oncologist into consideration. Research on the vaginal microbiome may lead to other therapies in the future.
433 citations