MANAGEMENT PROTOCOLS FOR GENITOURINARY MENOPAUSAL SYNDROME (GMS): FROM CLINICAL EVALUATION TO INDIVIDUALIZED TREATMENT

Abstract

Genitourinary Syndrome of Menopause (GSM), a chronic and progressive condition resulting from estrogen deficiency, affects more than half of postmenopausal women, manifesting as symptoms such as vaginal dryness, dyspareunia, and urinary urgency, and significantly impacting quality of life. This study is a narrative literature review aimed at consolidating clinical and therapeutic management protocols for GSM, with an emphasis on the most affected population, including breast cancer survivors. The bibliographic survey was conducted in the PubMed database, using MeSH descriptors such as "Genitourinary Atrophy" and "Menopause," encompassing articles from the last five years. The clinical evaluation of GSM requires the reporting of symptoms and the use of diagnostic tools such as the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI), with a vaginal pH of 4.6 being an objective indicator. Treatment should be individualized: non-hormonal moisturizers and lubricants are the first line for mild cases, while low-dose local estrogen therapy is the gold standard for moderate to severe cases. Approaches such as prasterone, ospemifene, and energy-based therapies (fractional CO2 laser and Erbium:YAG laser) emerge as alternatives. In breast cancer survivors, non-hormonal approaches and lifestyle changes (smoking cessation, weight loss, and probiotic use) are prioritized, reserving hormonal therapy and laser for refractory cases after multidisciplinary evaluation. Individualization and a multidisciplinary approach are essential pillars for successful management, aiming for early diagnosis, clinical improvement, restoration of vaginal health, and promotion of quality of life.