Urogenital atrophy: The 'unknown factors' challenging current practice

Area of Science:

• Gynecology
• Menopause Research
• Urogynecology

Background:

• Urogenital atrophy is a frequent consequence of estrogen deficiency post-menopause, affecting up to 80% of women.
• Symptoms impact the vulva, vagina, urethra, and bladder, significantly affecting quality of life.
• Current diagnostic approaches rely on subjective clinical assessment and unvalidated research tools.

Purpose of the Study:

• To highlight the knowledge gaps in understanding urogenital atrophy.
• To emphasize the need for a validated, objective diagnostic method.
• To discuss the current limitations in assessing urogenital atrophy.

Main Methods:

• Review of existing diagnostic methods for urogenital atrophy.
• Discussion of subjective clinical assessments (history, examination).
• Exploration of objective measures used in research (vaginal smears, pH, various indices, biopsy, microbiome analysis).

Main Results:

• No universally validated objective diagnostic test for urogenital atrophy currently exists.
• Existing assessment tools, including the Vaginal Health Index and Genitourinary Syndrome of the Menopause assessment tool, lack validation.
• Subjective clinical opinion remains a primary diagnostic factor.

Conclusions:

• There is a critical need for the development and validation of an objective, reproducible diagnostic test for urogenital atrophy.
• Education for both patients and clinicians is essential for improved diagnosis and management.
• Further research is required to clarify prevalence, terminology, etiology, pathogenesis, and optimal assessment strategies.