PSF 2024 – Put an end to genitourinary syndrome of menopause (GUMS)

PSF 2024 – Put an end to genitourinary syndrome of menopause (GUMS)
PSF 2024 – Put an end to genitourinary syndrome of menopause (GUMS)

Vaginal atrophy secondary to menopause can result in genitourinary menopausal syndrome (GUMS), which is particularly bothersome for women. Treatments exist, but they still need to be prescribed. And, beforehand, that the syndrome is diagnosed. In order to fight against a certain fatalism among women, secondary to an invisibility of the subject in consultation, it is important to break down the taboo. It is in this sense that, during the Pari(s) Santé Femmes congress (June 12-14, 2024, Paris), Dr. Brigitte Letombe (CHRU Lille) highlighted the burden linked to this syndrome and its principles, however simple support.

In the scientific literature, numerous studies describe the extent of the problem in menopausal women and the lack of treatment: “ SGUM is often underestimated because of the silence of patients and health professionals,” regretted the gynecologist. “During gynecological consultations, it is easy to spot this atrophy. But it is alarming to see that women leave the consultation without the problem being discussed. They think that everything is fine or that there is no solution to their problems. »

The impact of menopause is however significant: studies which have looked into the subject reveal the frequent existence of sexual problems, from the start of menopause. The REVIVE study described among a cohort of women with GUM that, in half of the cases, this syndrome had never been mentioned by the doctor and that only 40% of women broached the subject on their own. Consequently, ” women have lower self-esteem, feel old and less attractive “. This results in repercussions on the marital relationship, with the man avoiding intimacy in 76% of cases.

Local trophic treatment, maintained as long as the syndrome persists

« To avoid SGUM, you need to be sexually active and for sexual activity, you of course need good trophicity », recalled Brigitte Letombe. Its management is based on first-line local treatment with hyaluronic acid or vaginal lubricants and moisturizers. They improve vaginal hydration and elasticity if used regularly. Vaginal estrogens, recognized for their long-term effectiveness, are recommended as a second line. Local estrogens promote the thickening of the vaginal epithelium, which allows Doderlein’s flora to develop and subsequently reduces the risk of infections. Finally, oral probiotics can be used together and would reduce the risk of sexually transmitted infections. “ In cases of marked vulvovaginal atrophy, it is recommended to first use lubricants and moisturizers before introducing local estrogens.insisted the gynecologist, “because this limits the systemic passage of hormones favored by atrophy “Other approaches – physical (radiofrequency, biomodulation) or local (hyaluronic acid injection, lipofilling) – are currently being developed and may perhaps join the available arsenal in the coming months or years.

Local estrogens, THMs and breast cancer

There is no contraindication to using local hormonal treatments in addition to systemic treatment. Also, they can be offered in addition to menopausal hormone therapy (MHT) when the latter, prescribed as part of menopause management, is insufficient to relieve SGUM. There are many dosage forms (creams, ovules, capsules, rings, etc.) that allow women to choose the one that suits them best.

Local estrogens do not have significant systemic effects and are therefore not associated with an increased risk of cancer or cardiovascular events. They could also be used in women who have had breast cancer, including those treated with aromatase inhibitors, when local non-hormonal treatments are not indicated or are insufficiently effective. Current data do not seem to show any risk of recurrence of breast cancer, but caution remains in order.

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