Modern management of the genitourinary syndrome of menopause (GSM)

Abstract

Genitourinary syndrome of menopause (GSM) affects up to more than 80 % of postmenopausal women. The diagnosis is purely clinical. Differential diagnosis may require additional laboratory diagnostics. Many therapeutic options are now available internationally (hormone-free vaginal preparations, hormone-containing vaginal preparations, vaginal laser). The choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for the individual patient, and the patient's preferences. Long-term studies of the endometrial safety of vaginal estrogen and vaginal dehydroepiandrosterone (DHEA) are not available. Therapy should be continued as long as necessary, i.e., possibly for life. Although the data on hormonal vaginal preparations in breast cancer are insufficient, the international scientific societies are now more open to the use of vaginal estrogen and DHEA.