Menopause and its management: A review

Menopausal transition (premenopause) is the phase in the ageing process of women representing the transition from the reproductive stage of life to the non-reproductive stage. With improvements in average life expectancy, women live an increased proportion of their lives in the postmenopause. The consequences of oestrogen loss are the early symptoms (psychological and vasomotor), the genitourinary syndrome (intermediate), as well as postmenopausal osteoporosis with increased risk of fractures and cardiovascular diseases (late). The diagnosis of climacteric syndrome is based on typical clinical symptoms. Perimenopausal women should understand physiological changes occurring in menopausal transition. They should be encouraged to live a healthy lifestyle. Menopausal hormone therapy is indicated for relief of the acute symptoms of menopause and for treatment of urogenital atrophy. It should be administered in the lowest effective dose for the shortest period of time. The treatment should be initiated before the age of 60 years or within 10 years after menopause in order to decrease its risks. The benefit/risk profile needs to be individually re-assessed every year.

Augmented Core Breathing Pelvic Floor Muscle Training for Patients with Genitourinary Syndrome in Different Phases of Menopause

Pelvic floor muscle has a role in core breathing for twenty-four hours and offers an influence to modulate the lumbar spine and pelvic floor. Several studies reported on pelvic floor muscle strength. Women with genitourinary syndrome do not seek care for their condition and are dismayed to speak with the health care provider about the condition. In the present work, we evaluated the efficiency of augmented core breathing in the genitourinary syndrome of menopause for pelvic floor muscle strength. We tested the role of augmented core breathing efficacy using pelvic floor muscle training in patients with the genitourinary syndrome. Our data revealed significant beneficial effects of core breathing with pelvic floor muscle training and Kegel’s exercise in patients with genitourinary syndrome in different phase of menopause. KEY WORDS: genitourinary syndrome; menopause; pelvic exerciser; pelvic floor muscle training; Utian quality of life scale.

Involutive changes in the vulvovaginal area

Involutional changes in the vulvovaginal area involve a series of transformations leading to vulvovaginal atrophy (VVA) during menopause. Signs and symptoms most often observed in this syndrome: vaginal dryness (54.4100%), dyspareunia (17.677.6%), burning (2.056.9%), itching (7.856.6%) and dysuria (5.936.1%). Other complaints include deformity of the vulva, irritation, and recurrent bacterial infections of the urinary tract or vagina, and yeast infection. Vaginal dryness, dyspareunia and irritation are the symptoms that most affect a woman's quality of life. The article analyzes modern ideas about the genitourinary syndrome of menopause. The questions of the mechanisms of occurrence are considered, a description of the clinical picture is given. The issues of treatment of atrophy of the vulvovaginal region are discussed in detail, in particular, special attention is paid to physiotherapeutic methods of treatment.

Microablative Fractional Radiofrequency as a Therapeutical Option for Genitourinary Syndrome of Menopause: Perspectives

The genitourinary syndrome in menopause can occur at different stages of life, with different causes or triggering factors, such as prolonged use of antiestrogens, chemotherapy, radiotherapy, and extensive vaginal surgeries, which can alter vascularization, hydration, collagen quality, and tissue elasticity. Despite hormonal therapy being considered the best evidenced treatment for genitourinary syndrome of menopause (GSM), there are limitations concerning the latter. Thus, alternative, complementary, or even substitutive treatments have emerged, such as energy use, promoting thermal tissue stimulation to improve tropism. Due to its practicality and feasibility, the micro ablative fractional radiofrequency (MAFRF) has gained space among these energies. It uses high-frequency electromagnetic waves and promotes thermal micro points in the superficial and deep dermis. The safety of these energies limits thermal action laterality and depth. Laterally, it is essential for an adequate regenerative effect without scarring marks or sequelae; the appropriate depth is important for stimulating the obligatory tissue repair response with the production and reorganization of collagen, elastic fibers, increased vascularization and hydration, and the consequent improvement in tropism. In gynecology, the MAFRF is used with therapeutic indication and functional improvement; it is applied to the entire length of the vaginal walls, the vulvar vestibule, urethral meatus, labia minora, clitoris prepuce, labia majora, perineum, and perianal region. The MAFRF has been proved to be an effective and safe treatment for GSM, with long-lasting effects, significantly reducing symptoms and improving vaginal tropism. This review aims to analyze the MAFRF as a non-hormonal therapeutic option for GSM.

Women's knowledge about the genitourinary syndrome of menopause: adherence to its treatments in the COVID-19 era in a sample of them: COMEM-GSM study

Objective To study knowledge regarding genitourinary syndrome of menopause (GSM) and the treatments for it and to analyze treatment adherence during the COVID-19 confinement. Methods Multi-center observational study including women between 35 and 75 years. An extension study of treatment adherence was conducted during the coronavirus pandemic between March and April 2020. Results A sample of 2355 women were included. Vaginal dryness was the most frequently identified symptom (74.3%). Lubricants were the best-known treatments (69.6%), followed by local estrogens (25.7%); 66% of the women did not speak to their gynecologist about sexuality. Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care received and level of education. During the coronavirus confinement period, adherence to treatments for vulvovaginal atrophy was poor in 72.5% asked (n = 204). Reduced sexual activity (p > 0.001) and coronavirus diagnosis (p = 0.003) were significantly associated with poorer treatment compliance. Conclusions There is great lack of knowledge of the treatments used for GSM. Most women do not talk to their gynecologist about sexuality. Adherence to treatments during the coronavirus confinement has been worryingly low.