(463) The Increasing & Lethal Spectrum of the Genitourinary Syndrome of Menopause
Authors: Dominguez-Bali A , Dominguez-Bali C , Diaz S C 
Published: May 2023

Abstract

Introduction
In 2014, the Genitourinary Syndrome of Menopause replaced the previous concept of vaginal and genital atrophy. The spectrum of this syndrome includes and is not limited to atrophy, dryness, recurrent UTI, dyspareunia, anal incontinence, pelvic organ prolapse, vaginal stenosis, labial fusion, and/or vulvar obliteration. However, with time and the continuous exposure to women who have reached more advanced ages, such as centenarians, the spectrum of the GSM has been increasingly showing new entities and disorders never described before.

Objective
To update and expand the literature on the spectrum of GSM affecting the well-being, sexual functioning, and quality of life of postmenopausal women including the new observations seen in centenarians.

Methods
Multiple peer reviewed articles of both cohort and observational studies were evaluated to assess the increased spectrum of GSM symptoms in the centenarian women population.

Results
Nearly 60% of women in menopause experience GSM. Despite a vast majority of signs and symptoms, only 7% of providers ask women about this condition implying that GSM continues to be underdiagnosed and undertreated. In the early extreme of the spectrum of GSM, we show the new finding of the presence of false abnormal cervical dysplasia in women who have never had an abnormal PAP smear and have maintained a stable sexual relationship with their partner. This misconstrue is due to early vaginal and cervical atrophy which produces cells that, under the microscope, are very similar to dysplastic cells to the pathologist. This scenario is frequently seen in more than 80% of cases with those epidemiological characteristics, which is extremely easy to resolve with 4 months of regular local estrogen therapy. In the other extreme of the spectrum of GSM, in the elderly, the combination of lack of HRT and sex for prolonged periods of times produced the partial or total obliteration of the labia majora or minora with fusion in several women. Thus, preventing the exit of urine through the urethra with significant retention of fluid affecting the urinary bladder, ureters, and kidneys. Finally, having been exposed to the care of centenarian women in home care (women over 90 years old), we have realized that a significant number of them died with the diagnosis of pneumonia. However, when reviewing the analyzed cases retrospectively, we found that the real diagnosis was undiagnosed recurrent UTIs with poor clinical manifestations (which is common in these types of patients). The algorithm goes as follows: undiagnosed recurrent UTIs with poor clinical manifestations such as fever, leukocytosis, and poor verbal manifestations due to the age of patients, that progress to sepsis and the pneumonia that has been the part that really draws the attention of the physician.

Conclusions
The new findings of this review highlight the clinical implications when analyzing the two extremes of the spectrum of GSM throughout women’s lives. In all these cases, local or systemic HRT was never used. Appropriate management of GSM will enhance the quality of life and sexual function of these women.

Disclosure
No