Genitourinary Syndrome of Menopause Assessment Tools

Mensión, Eduard; Alonso, I.; Tortajada, Marta; Matas, Isabel; Gómez, Sílvia; Ribera, Laura Badenes; Ros, Cristina; Anglès‐Acedo, Sònia; Castelo-Branco, Camil

doi:10.4103/jmh.jmh_93_21

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…The VHI subjectively assesses the elasticity of the vagina, the amount of discharge, the integrity of the epithelium, and humidity, along with pH as the only objective criteria. The results range from 5 to 21, and scores of 15 or lower indicate vulvovaginal atrophy …”

Section: Methodsmentioning

confidence: 99%

Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause

et al. 2023

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ImportanceSurvivors of breast cancer present more severe symptoms of genitourinary syndrome of menopause (GSM) than patients without history of breast cancer. Recently, new treatments, such as vaginal laser therapy, have appeared, but evidence of their efficacy remains scarce.ObjectiveTo assess the safety and efficacy of carbon dioxide (CO2) vs sham vaginal laser therapy after 6 months of follow-up in survivors of breast cancer with GSM receiving aromatase inhibitors.Design, Setting, and ParticipantsThis prospective double-blind sham-controlled randomized clinical trial with two parallel study groups was performed during October 2020 to March 2022 in a tertiary referral hospital. Survivors of breast cancer using aromatase inhibitors were assessed for eligibility, and eligible patients were randomized into the 2 treatment groups. Follow-up was conducted at 6 months. Data were analyzed in July 2022.InterventionsAll patients from both groups were instructed to use the first-line treatment (FLT) based on nonhormonal moisturizers and vaginal vibrator stimulation. Patients for each group were allocated to 5 monthly sessions of fractional CO2 laser therapy (CLT) or sham laser therapy (SLT).Main Outcomes and MeasuresThe primary outcome was sexual function, evaluated through Female Sexual Function Index (FSFI) score. Other subjective measures of efficacy included a visual analog scale of dyspareunia, vaginal pH, a Vaginal Health Index, quality of life (assessed via Short-Form 12), and body image (assessed with the Spanish Body Image Scale). Objective measures of efficacy included vaginal maturation index, vaginal epithelial elasticity (measured in Pascals) and vaginal epithelial thickness (measured in millimeters). Measures were assessed before and after the intervention. Tolerance (measured on a Likert scale), adverse effects, and estradiol levels were recorded.ResultsAmong 211 survivors of breast cancer assessed, 84 women were deemed eligible and 72 women (mean [SD] age, 52.6 [8.3] years) were randomized to CLT (35 participants) or SLT (37 participants) and analyzed. There were no statistically significant differences between groups at baseline. At 6 months, both groups showed improvement in FSFI (mean [SD] score at baseline vs 6 months: CLT, 14.8 [8.8] points vs 20.0 [9.5] points; SLT, 15.6 [7.0] points vs 23.5 [6.5] points), but there was no significant difference between CLT and SLT groups in the improvement of sexual function evaluated through the FSFI test overall (mean [SD] difference, 5.2 [1.5] points vs 7.9 [1.2] points; P = .15) or after excluding women who were not sexually active (mean [SD] difference, 2.9 [1.4] points vs 5.5 [1.1] points; P = .15). There were also no differences between improvement of the 2 groups at 6 months of follow-up in the other assessed subjective outcomes, including dyspareunia (mean [SD] difference, −4.3 [3.4] vs −4.5 [2.3]; P = .73), Vaginal Health Index (mean [SD] difference, 3.3 [4.1] vs 5.0 [4.5]; P = .17), body image (mean [SD] difference, −3.7 [4.5] vs −2.7 [4.8]; P = .35), and quality of life (mean [SD] difference, −0.3 [3.6] vs −0.7 [3.2]; P = .39). Similarly, there were no differences in improvements in objective outcomes, including vaginal pH (mean [SD] difference, −0.6 [0.9] vs −0.8 [1.2]; P = .29), vaginal maturation index (mean [SD] difference, 10.2 [17.4] vs 14.4 [17.1]; P = .15), vaginal epithelial thickness (mean [SD] difference, 0.021 [0.014] mm vs 0.013 [0.012] mm; P = .30), vaginal epithelial elasticity (mean [SD] difference, −1373 [3197] Pascals vs −2103 [3771] Pascals; P = .64). There were significant improvements in the overall analysis regardless of group in many outcomes. The 2 interventions were well tolerated, but tolerance was significantly lower in the CLT group than the SLT group (mean [SD] Likert scale score, 3.3 [1.3] vs 4.1 [1.0]; P = .007). No differences were observed in complications or serum estradiol levels.Conclusions and RelevanceIn this randomized clinical trial, vaginal laser treatment was found to be safe after 6 months of follow-up, but no statistically significant differences in efficacy were observed between CLT and SLT.Trial RegistrationClinicalTrials.gov identifier: NCT04619485

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Section: Methodsmentioning

confidence: 99%

Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause

et al. 2023

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“…The vaginal Maturation Index assesses the proportion of parabasal, intermediate and superficial vaginal epithelial cells. More significant proportions of parabasal cells associated with less than 5% of superficial cells and a pH >5 suggest the diagnosis of GSM 39 …”

Section: Clinical Diagnosismentioning

confidence: 99%

“…More significant proportions of parabasal cells associated with less than 5% of superficial cells and a pH >5 suggest the diagnosis of GSM. 39 History, physical evaluation, laboratory tests, and scores should be used to discard differential diagnoses. These conditions include bacterial vaginosis and other vaginal infections, foreign bodies, genital prolapses, sexual trauma, neoplasia o precancerous lesions of the internal or external genitalia, endocrine disorders, lichen sclerosus, and lichen planus.…”

Section: Clinical Diagnosismentioning

confidence: 99%

Urologic perspective of genitourinary syndrome of menopause

González‐Arboleda,

Arias‐Castillo,

García‐Perdomo

2024

Int J of Uro Nursing

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BackgroundExperts define the Genitourinary Syndrome of Menopause (GSM) as a collection of signs and symptoms associated with decreased oestrogen levels. Its prevalence ranges between 13% and 87% in postmenopausal women.ObjectiveWe aimed to describe the main pathophysiology mechanisms of GSM affecting the lower urinary tract and the manifestations and treatment options for lower urinary tract dysfunction in GSM.ResultsSeveral treatments and recommendations have been proposed to enhance patients' ability to manage their symptoms, such as regular sexual activity or masturbation, to increase this physiological response and reduce the severity of GSM.ConclusionGSM is a multifactorial and complex syndrome that affects postmenopausal women. Impairment of urogenital structures implies diverse manifestations of genital atrophy and lower urinary tract symptoms.

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“…The frequently utilized research indices to evaluate the effectiveness of GSM treatment include the Visual Analogue Scale (VAS), Vaginal Health Index Score (VHIS), Vaginal Maturation Index (VMI), Female Sexual Function Index (FSFI), and FSFI for breast cancer patients (FSFI-BC) [ 10 ]. The VAS subjectively measures the symptom intensity.…”

Section: Reviewmentioning

confidence: 99%

“…Vaginal atrophy is believed to occur under conditions of low estrogen levels, resulting in increased parabasal cells. Nevertheless, the VMI is seldom utilized in clinical trials associated with GSM [ 10 , 13 ]. To comprehensively assess GSM, clinical and research settings can benefit from employing a combination of subjective and objective evaluation tools [ 14 ].…”

Section: Reviewmentioning

confidence: 99%

Vaginal Laser Treatment for the Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Narrative Review

Okui

2023

Cureus

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Vulvovaginal atrophy (VVA) is a chronic condition resulting from reduced estrogen levels during menopause. The North American Menopause Society and the International Society for the Study of Women's Sexual Health suggested the term "genitourinary syndrome of menopause" (GSM) to indicate the broader aspects of VVA. Breast cancer treatments, such as chemotherapy and endocrine therapy, can induce early and abrupt menopausal symptoms, including GSM, which negatively affects sexual function and the quality of life of the survivors. Vaginal laser therapy has emerged as a safe and effective option for the management of GSM in breast cancer survivors (BCSs). Two main types of lasers, the non-ablative erbium:YAG laser and fractional microablative CO 2 vaginal laser, have been evaluated for GSM treatment. While there are few randomized controlled trials (RCTs) on the subject of BCSs, a wealth of prospective and retrospective studies have highlighted the beneficial effects of vaginal laser therapy on the symptoms of VVA, vaginal health, sexual function, and overall quality of life. More comprehensive research is essential to confirm its enduring effectiveness and safety, with a focus on conducting standardized and meticulously controlled investigations. This study is a narrative review that summarizes clinical trials ranging from the earliest to the most recent ones on laser treatment for GSM in BCSs.

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Genitourinary Syndrome of Menopause Assessment Tools

Cited by 12 publications

References 11 publications

Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause

Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause

Urologic perspective of genitourinary syndrome of menopause

Vaginal Laser Treatment for the Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Narrative Review

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