Deconstructing the genitourinary syndrome of menopause

Area of Science:

• Gynecology
• Urology
• Menopause Research

Background:

• The genitourinary syndrome of menopause (GSM) is a recently introduced concept with increasing clinical use.
• The GSM definition encompasses numerous unspecific symptoms and signs without establishing a minimum diagnostic threshold.
• Concerns exist regarding the potential for underdiagnosis of vulvar and urinary pathology under the GSM umbrella.

Purpose of the Study:

• To critically evaluate the concept and definition of genitourinary syndrome of menopause (GSM).
• To identify potential drawbacks and limitations associated with the broad GSM diagnosis.
• To advocate for more precise urogenital diagnoses for improved patient care.

Main Methods:

• Critical review and analysis of the existing literature and clinical definitions of GSM.
• Examination of the implications of GSM on the diagnosis and treatment of specific genitourinary conditions.
• Discussion of the potential for iatrogenization of menopause and its impact on patient management.

Main Results:

• The GSM definition may obscure serious conditions like high-grade squamous intraepithelial lesions or vulvar intraepithelial neoplasia.
• Specific conditions such as lichen sclerosus or overactive bladder might not receive targeted treatment.
• The broad GSM concept can lead to a 'panacea of treatments' approach, potentially harming patients needing focused therapy.

Conclusions:

• The current GSM definition may lead to underdiagnosis and inappropriate treatment of distinct vulvar and urinary conditions.
• The transformation of symptoms into a syndrome risks iatrogenization and over-treatment.
• Precise urogenital diagnoses are essential to meet women's healthcare needs effectively.