Exosomas como tratamiento alternativo del síndrome genitourinario de la menopausia / Exosomes as an alternative treatment for genitourinary syndrome of menopause

Objetivo: Evaluar el efecto de los exosomas como tratamiento alternativo en la restauración del síndrome genitourinario de la menopausia en pacientes que acuden a una consulta ginecológica, en Valencia, Estado Carabobo, en el período junio - agosto de 2023. Métodos: Estudio prospectivo, descriptivo, exploratorio, incluyó tres casos de mujeres con diagnóstico de síndrome genitourinario de la menopausia. Se evaluó la respuesta en cuanto a los síntomas, examen clínico según el índice de salud vaginal, la satisfacción con el tratamiento y la tolerabilidad. Se aplicó el tratamiento con exosomas: 2 cc con técnica de punto a punto en todas las paredes vaginales y 1 cc en el vestíbulo, en 3 sesiones, con intervalo de 15 días. Resultados: La edad de las pacientes estuvo entre 53 y 56 años, con un promedio de tiempo de menopausia de 6,6 años. Previo al tratamiento, había un nivel alto de irritación vaginal (100 %), dolor en el introito (100 %), sequedad vaginal, dispareunia, hipersensibilidad y las no relaciones sexuales (66,67 %). Postratamiento predominó la ausencia de los síntomas: sequedad vaginal, dispareunia, hipersensibilidad y dolor en introito (100 %); irritación vaginal y no relaciones sexuales (66,67 %) (p = 0,0001). La mediana del índice de salud vaginal previa fue 13 (10 ­ 13) y posterior fue 18 (17 ­ 20) (p = 0,0476). La satisfacción y tolerabilidad fue de 66,67 %. Una paciente refirió dolor leve. Conclusión: La terapia con exosomas es eficaz para reducir los síntomas y signos del síndrome genitourinario de la menopausia, y bien tolerado(AU)

Objective: To evaluate the effect of exosomes as an alternative treatment in the restoration of genitourinary syndrome of menopause in patients attending a gynecological consultation in Valencia, Carabobo State, in the period June - August 2023. Methods: A prospective, descriptive, exploratory study included three cases of women diagnosed with genitourinary syndrome of menopause. Response was assessed in terms of symptoms, clinical examination according to vaginal health index, satisfaction with treatment and tolerability. Treatment with exosomes was applied: 2 cc with point-to-point technique on all vaginal walls and 1 cc in the vestibule, in 3 sessions, with an interval of 15 days. Results: The age of the patients was between 53 and 56 years, with a mean menopause time of 6.6 years. Prior to treatment, there was a high level of vaginal irritation (100%), pain in the introitus (100%), vaginal dryness, dyspareunia, hypersensitivity and non-sexual intercourse (66.67%). Post-treatment, the absence of symptoms predominated: vaginal dryness, dyspareunia, hypersensitivity and pain in the introitus (100%); vaginal irritation and no sexual intercourse (66.67%) (p = 0.0001). The median index of previous vaginal health was 13 (10 ­ 13) and subsequent was 18 (17 ­ 20) (p = 0.0476). Satisfaction and tolerability was 66.67%. One patient reported mild pain. Conclusion: Exosome therapy is effective in reducing the symptoms and signs of genitourinary syndrome of menopause, and well tolerated(AU)

Changes of the vaginal environment in genitourinary syndrome of menopause and progress on the use of mesenchymal stem cells as an intervention / 中华老年医学杂志

Due to decreased estrogen levels in patients with genitourinary syndrome of menopause(GSM), changes occur in the vaginal environment, including changes in vaginal tissue structure, the vaginal microbiota and vaginal mucosal immunity, resulting in a series of symptoms and signs.To develop effective treatment methods for GSM, it is necessary to fully understand potential molecular mechanisms underlying these changes.Mesenchymal stem cells(MSCs)can promote the regeneration of aging tissues, secrete growth factors, and have excellent immune regulation and anti-inflammatory capabilities.They are a powerful treatment option for reproductive aging.Therefore, it is essential to understand changes of the vaginal environment in GSM patients and progress on the use of MSCs as an intervention, in order to gain insight into research on the treatment of GSM.

Applicability of vaginal energy-based devices in urogynecology: evidence and controversy

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Effects of oxytocin versus promestriene on genitourinary syndrome: a pilot, prospective, randomized, double-blind study

Abstract Objectives: In this pilot, prospective, randomized, double-blind study, the authors compared the efficacy of oxytocin with promestriene in improving vaginal atrophy of Genitourinary Syndrome of Menopause (GSM). Methods: A total of 51 postmenopausal women with symptoms of GSM were evaluated. They were randomized into two groups: oxytocin (25 patients) and promestriene (26 patients) and were evaluated before and after 90 days of treatment; the evaluation was based on the domains of the Female Sexual Function Index (FSFI) (lubrication, satisfaction, and pain during sexual intercourse), clinical visual examination, and vaginal wall thickness. Results: After the use of the medications, both groups showed significant improvement in the three evaluated FSFI domains (p < 0.05) and there was no significant difference between the groups (p > 0.05). On clinical examination, the medications improved all the evaluated parameters but without statistical significance (p > 0.05). The evaluation of the thickness of the vaginal epithelium showed that both treatments led to increase in the vaginal epithelium (p < 0.05); however, the efficacy of promestriene was higher than that of oxytocin (p < 0.05). Conclusions: Both medications were effective, however, studies with larger samples and longer follow-ups are needed to confirm the clinical applicability.

Hindi translated version of menopausal rating score questionnaire: a method to evaluate post menopausal symptoms in India

Background: There are large number of post menopausal patients in India deserving more care and attention than is given at present.MRS questionnaire in Hindi (MRS-H), a translated and validated version of original MRS Scale (MRS-E), self assessed by patients in their own native language. This tool can be used to assess and document current quality of life as well as improvement with treatment of severe post menopausal symptoms, in Indian population.Methods: 30 bilingual English and Hindi speaking postmenopausal patients were recruited for this study.MRS Questionnaire has 11 questions covering somatic, pschycological and genitourinary symptoms of menopause. The scoring system is simple. Hindi translation of MRS Questionare was done from English (MRS-E) to Hindi (MRS-H) by 4 independent translations using standard protocol. The MRS-H was tested for internal validity and also compared with MRS - E.Results: Quality of life is a subjective perception modified by the cultural habitat in which one lives. MRS-H showed high validity and good co-relation with MRS-E. The MRS-H possessed good convergent and discriminant validity. MRS-H showed anICC (Intraclass coefficient) was more than 0.5 and cronbach alpha more than0.5. There was found to be strong correlation between MRS-E and MRS-H questionnaire with all correlation value above 0.7.Conclusions: The authors recommend the use of the self assessed MRS-H in Hindi should be used to assess menopausal complaints and relief with treatment in India.

To strengthen the treatment of genitourinary syndrome of menopause in breast cancer patients / 中华内分泌外科杂志

Genitourinary syndrome of menopause (GSM),is a common disease in postmenopausal women.It is reported that the incidence of GSM in breast cancer patients (79％-95％) was higher than that in normal counterparts (more than 50％).GSM significantly reduced the quality of life in breast cancer patients,but was not given enough attention,and most of breast cancer patients with GSM were not diagnosed and treated.In addition,chemotherapy and endocrine therapy for breast cancer may increase the incidence and severity of GSM.Hence,prevention and treatment of GSM should be strengthened in breast cancer patients.

Tratamento da atrofia vaginal da mulher na pós­menopausa / Treatment of vaginal atrophy of women in postmenopausal

Sintomas relacionados com a atrofia vulvovaginal apresentam um impacto negativo sobre a qualidade de vida de até 50% das mulheres na pós­menopausa. No entanto, algumas recusam o uso de estrogênios, que é a terapia eficaz padrão, devido à publicidade negativa nos últimos anos e à disponibilidade de outras terapias opcionais. Esta revisão avaliou a eficácia de tratamentos hormonais, fitoterápicos de uso oral ou tópico para aliviar os sintomas da atrofia vaginal em mulheres na pós­menopausa. Foram avaliados estudos do Medline, Scopus e Cochrane Central Register de Ensaios Controlados com as palavras­chaves vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications. Estudos de revisão e ensaios clínicos randomizados foram incluídos neste estudo. Os dados mostraram que os estrogênios de uso sistêmico ou local são os mais indicados, as isoflavonas só mostraram efeitos positivos quando de uso local. Alguns tratamentos não hormonais, como hidratantes, lubrificantes e o uso de laser vaginal, também são indicados. Outra possibilidade de tratamento é o ospemifeno, um modulador de receptor hormonal seletivo (SERM) na dispareunia e na atrofia vulvovaginal. Assim, o uso de opções é benéfico para mulheres com risco de neoplasia relacionada aos estrogênios.(AU)

Symptoms related to atrophy vulvovaginal have a negative impact on quality of life up to 50% of women after menopause. However, some refuse the use of estrogens that is the standard effective therapy due to negative publicity in recent years and other available alternatives therapies. This review assessed the effectiveness of hormonal treatments, herbal oral or topical use to relieve the symptoms of vaginal atrophy in women after menopause. We evaluated studies of Medline, Scopus, Cochrane Central Register of Controlled Trials using vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications, as keywords. Review studies and randomized controlled trials were included in this study. The data showed that the systemic or local use of estrogens are the most appropriate, and the isoflavones only showed positive effects when used locally. Some non­hormonal treatments such as moisturizing, lubricating and the use of vaginal laser are also suitable. Another possible treatment is ospemifene, a selective estrogen receptor modulator (SERM) on dyspareunia and vulvovaginal atrophy. Thus, the use of alternatives is beneficial for women with cancer risk related to estrogens.(AU)

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente / Treatment of genitourinary syndrome of menopause by CO2 fractional laser: an emerging therapeutic option

Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.

Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

Láser erbium vaginal como tratamiento del síndrome genitourinario de la menopausia: resultados preliminares / Erbium vaginal laser as a treatment for genitourinary syndrome of menopause: preliminary results

ANTECEDENTES: El síndrome genitourinario de la menopausia (SGM) afecta hasta el 50% de las mujeres posmenopáusicas. Sus síntomas presentan un curso crónico y progresivo, pudiendo alterar significativamente la sexualidad y la calidad de vida. OBJETIVO: Evaluar efectividad a corto plazo y aceptabilidad del láser vaginal de Erbium en cristal de itrio-aluminio-granate (Er:YAG) como una terapia fototérmica no invasiva, no ablativa para el manejo del SGM. MÉTODO: Estudio longitudinal prospectivo, realizado en 28 mujeres posmenopáusicas con SGM. Se aplica láser vaginal Er:YAG en 3 sesiones cada 30 días. En todos los controles, se evalúa sequedad vaginal, dispareunia mediante escala visual analógica, y se registra el "vaginal health index score" (VHIS). Al final del tratamiento se evalúa la aceptabilidad del método. RESULTADOS: Se observa mejoría significativa de los síntomas (sequedad vaginal y dispareunia; p<0,01) durante todo el periodo de estudio y del VHIS (8,2 ± 1,3 previo al tratamiento vs. 19,2 ± 0,4 posterior al tratamiento; p<0,01). El 93,4% de las pacientes calificó el procedimiento como excelente o bueno. CONCLUSIÓN: Nuestro estudio piloto muestra que el tratamiento con láser Er:YAG en mujeres posmenopáusicas con síntomas de SGM es eficaz, factible y seguro en el corto plazo. Se requieren datos a más largo plazo y de mayor tamaño muestral para confirmar nuestros resultados.

BACKGROUND: The genitourinary syndrome of menopause (GSM) affects up to 50% of postmenopausal women. Symptoms are chronic and likely worsen over time. This complains may interfere with sexual function and quality of life. OBJECTIVE: To evaluate the short-term effectiveness and acceptability of Erbium in yttrium aluminum-garnet crystal Laser (Er:YAG) as a non-invasive, non-ablative photothermal therapy for the treatment of GSM. METHODS: Prospective longitudinal study performed in 28 postmenopausal women suffering from GSM. All participants were treated intravaginally with Er:YAG laser in 3 applications performed every 30 days. Symptoms (vaginal dryness and dyspareunia) were evaluated by a visual-analogic scale (VAS) and the vaginal health index score (VHIS). After therapy, the women were asked to evaluate the acceptability of the intervention. RESULTS: Er:YAG laser treatment was effective to improve symptoms (vaginal dryness and dyspareunia; p<0.01) at all the study period, as well the VHIS (8.2 ± 1.3 at baseline vs. 19.2 ± 0.4 after treatment; p<0.01). Satisfaction with the procedure was reported as excellent or good by 93.4% of women. CONCLUSION: Our pilot study shows that the Er:YAG treatment in postmenopausal women with GSM is effective, feasible, and safe. Further larger, long-term and controlled studies are required to confirm this data.

The Recent Review of the Genitourinary Syndrome of Menopause

The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function, but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections). The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased estrogen level in menopause. Since the GSM may have a profound negative impact on the quality of life of postmenopausal women, women should be made aware of these problems and treated with an appropriate effective therapy. Thus, in this review we introduce new terminology and discuss the importance of comprehension of GSM and the necessity of active treatment of this syndrome in postmenopausal women.