Menopause pp 91-107 | Cite as

Genitourinary Syndrome of the Menopause: Vaginal Health and Microbiota



The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital and sexual symptoms but also urinary symptoms related to a decreased estrogen level in menopause.

Since the GSM may have a 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 and the role played by the vaginal microbiota in the vaginal health.


Genitourinary syndrome of the menopause Vaginal atrophy Vaginal microbiota Vaginal health Vaginal atrophy 


  1. 1.
    Cornellana MJ. Atrofia vaginal, una enfermedad crónica con repercusión en la calidad de vida. Revista iberoamericana de revisiones en menopausia. 2007;9(2):2.Google Scholar
  2. 2.
    Portman DJ, Gass ML. Vulvovaginal atrophy terminology consensus conference panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. 2014;79(3):349–54. doi: 10.1016/j.maturitas.2014.07.013.CrossRefPubMedGoogle Scholar
  3. 3.
    Menoguia Salud vaginal. Asociación Española para el Estudio de la Menopausia. 2014. ISBN: 978-84-940319-5-3.Google Scholar
  4. 4.
    Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003;62:45–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Cancelo MJ, Beltrán D, Calaf J, Campillo F, Cano A, Guerra JA, Neyro JL. Protocolo Sociedad Española de Ginecología y Obstetricia de diagnóstico y tratamiento de las infecciones vulvovaginales. Prog Obst Gynecol. 2013;56(5):278–84.CrossRefGoogle Scholar
  6. 6.
    Döderlein ASG. Das Scheidensekret und seine bedeutung für das puerperalfieber. Leipzig: O. Durr; 1892.Google Scholar
  7. 7.
    Miller EA, Beasley DE, Dunn RR, Archie EA. Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique? Front Microbiol. 2016;7:1936. doi: 10.3389/fmicb.2016.01936.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Álvarez-Olmos MI, Barousse MM, Rajan L, Van Der Pol BJ, Fortenberry D, Orr D, et al. Vaginal lactobacilli in adolescents: presence and relationship to local and systemic immunity, and to bacterial vaginosis. Sex Trans Dis. 2004;31:393–400.CrossRefGoogle Scholar
  9. 9.
    Zhou X, Bent S, Schneider M, Davis C, Islam M, Forney L. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology. 2004;150:2565–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Li J, McCormick J, Bocking A, Rei G. Importance of vaginal microbes in reproductive health. Reprod Sci. 2012;19(3):235–42.CrossRefPubMedGoogle Scholar
  11. 11.
    Gajer P, Brotman RM, Bai G, Sakamoto J, Schütte UM, Zhong X, Koenig SS, Fu L. Temporal dynamics of the human vaginal microbiota. Sci Transl Med. 2012;4(132):132RA52.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    MacPhee RA, Hummelen R, Bisanz JE, Miller WL, Reid G. Probiotic strategies for the treatment and prevention of bacterial vaginosis. Expert Opin Pharmacother. 2010;11(18):2985–95.CrossRefPubMedGoogle Scholar
  13. 13.
    Boyd MA, Antonio MA, Hillier SL. Comparison of API 50 CH strips to whole-chromosomal DNA probes for identification of Lactobacillus species. J Clin Microbiol. 2005;43:5309–11.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hyman R, Fukushima M, Diamond L, Kumm J, Giudice L, Davis R. Microbes on the human vaginal epithelium. Proc Natl Acad Sci U S A. 2005;102:7952–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Reid G, Burton J, Devillard E. The rationale for probiotics in female urogenital healthcare. Med Gen Med. 2004;29:6–49.Google Scholar
  16. 16.
    Costello EK, Stagaman K, Dethlefsen L, Bohannan BJ, Relman DA. The application of ecological theory toward an understanding of the human microbiome. Science. 2012;336(6086):1255–62. doi: 10.1126/science.1224203.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kenyon CR, Osbak K. Recent progress in understanding the epidemiology of bacterial vaginosis. Curr Opin Obstet Gynecol. 2014;26(6):448–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Stamey TA. The role of introital enterobacteria in recurrent urinary infections. J Urol. 1973;109:467–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Cancelo Hidalgo MJ, de la Fuente P. Perception ans attitude of spanish gynaecologists towards women with integral perineal symptomatology (IPS). In: 8th European Congress on MenoReid G, Bruce AW. Urogenital infections in women: can probiotics help? World J Urol. 2003;24:28–32. pause (EMAS) London, 16–20 May 2009.Google Scholar
  20. 20.
    Hodgins MB, Spike RC, Mackie RM, MacLean AB. An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina. Br J Obstet Gynaecol. 1998;105:216–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Blakeman PJ, Hilton P, Bulmer JN. Oestrogen and progesterone receptor expression in the female lower urinary tract, with reference to oestrogen status. BJU Int. 2000;86:32–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Arnold JJ, Hehn LE, Klein DA. Common questions about recurrent urinary tract infections in women. Am Fam Physician. 2016;93(7):560–9.PubMedGoogle Scholar
  23. 23.
    The North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20:888–902.CrossRefGoogle Scholar
  24. 24.
    Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014;17:3–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: results from an international survey on vaginal atrophy. Maturitas. 2010;67:233–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Freedman MA. Quality of life and menopause: the role of estrogen. J Womens Health (Larchmt). 2002;11:703–18.CrossRefGoogle Scholar
  27. 27.
    Palacios S, Cancelo MJ, Castelo Branco C, Llaneza P, Molero F, Sanchez Borrego R. Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perception. Climacteric. 2017;20(1):55–61. doi: 10.1080/13697137.2016.1262840.CrossRefPubMedGoogle Scholar
  28. 28.
    Raz R. Urinary tract infection in postmenopausal women. Korean J Urol. 2011;52:801–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Goldstein I, Dicks B, Kim NN, Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med. 2013;1(2):44–53. doi: 10.1002/sm2.17.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Palacios S, Cancelo MJ. Guía práctica de asistencia del síndrome urogenital de la menopausia (SEGO). Actualización 2015. Madrid: SEGO, España.Google Scholar
  31. 31.
    Johnston SL, Farrell SA, Bouchard C, Farrell SA, Beckerson LA, Comeau M, Johnston SL, Lefebvre G, Papaioannou A, SOGC Joint Committee-Clinical Practice Gynaecology and Urogynaecology. The detection and management of vaginal atrophy. J Obstet Gynaecol Can. 2004;26(5):503–15.CrossRefPubMedGoogle Scholar
  32. 32.
    O’Connell TX, Nathan LS, Satmary WA, Goldstein AT. Non-neoplastic epithelial disorders of the vulva. Am Fam Physician. 2008;77(3):321–6.PubMedGoogle Scholar
  33. 33.
    Bachmann GA, Notelovitz M, Kelly SJ, et al. Long-term nonhormonal treatment of vaginal dryness. Clin Pract Sex. 1992;8:12.Google Scholar
  34. 34.
    Palacios S, Mejias A. An update on drugs for the treatment of menopausal symptoms. Expert Opin Pharmacother. 2015;16(16):2437–47. doi: 10.1517/14656566.2015.1085508.CrossRefPubMedGoogle Scholar
  35. 35.
    Origoni M, Cimmino C, Carminati G, Iachini E, Stefani C, Girardelli S, Salvatore S, Candiani M. Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study. Eur Rev Med Pharmacol Sci. 2016;20(20):4190–5.PubMedGoogle Scholar
  36. 36.
    Salvatore S, Nappi RE, Zerbinati N, Calligaro A, Ferrero S, Candiani M, Leone Roberti Maggiore U. A 12-week treatment with fractional CO2 laser for vulvo-vaginal atrophy: a pilot study. Climacteric. 2014;17:363–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas. 2016;91:42–50. doi: 10.1016/j.maturitas.2016.05.015.CrossRefPubMedGoogle Scholar
  38. 38.
    Leiblum S, Bachmann G, Kemmann E, et al. Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. JAMA. 1983;249:2195.CrossRefPubMedGoogle Scholar
  39. 39.
    Palacios S, Coronado PJ. Treatment of menopausal symptoms. New era with new options or new options for menopausal symptoms after 15 years of WHI study. Minerva Ginecol. 2016;14.Google Scholar
  40. 40.
    Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016;8:CD001500. doi: 10.1002/14651858.CD001500.pub3.Google Scholar
  41. 41.
    Cardozo L, Bachmann G, McClish D, et al. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol. 1998;92:722.PubMedGoogle Scholar
  42. 42.
    Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;4:CD001500.Google Scholar
  43. 43.
    Bachmann G, Lobo RA, Gut R, Nachtigall L, Notelovitz M. Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Obstet Gynecol. 2008;111(1):67–76.CrossRefPubMedGoogle Scholar
  44. 44.
    Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric. 2015;18(2):121–34. doi: 10.3109/13697137.2014.947254.CrossRefPubMedGoogle Scholar
  45. 45.
    Simon JA, Maamari RV. Ultra-low-dose vaginal estrogen tablets for the treatment of postmenopausal vaginal atrophy. Climacteric. 2013;16(Suppl 1):37–43. doi: 10.3109/13697137.2013.807606.CrossRefPubMedGoogle Scholar
  46. 46.
    Del Pup L, Di Francia R, Cavaliere C, Facchini G, Giorda G, De Paoli P, Berretta M. Promestriene, a specific topic estrogen. Review of 40 years of vaginal atrophy treatment: is it safe even in cancer patients? Anticancer Drugs. 2013;24(10):989–98. doi: 10.1097/CAD.0b013e328365288e.CrossRefPubMedGoogle Scholar
  47. 47.
    Palacios S, Castelo-Branco C, Cancelo MJ, Vázquez F. Low-dose, vaginally administered estrogens may enhance local benefits of systemic therapy in the treatment of urogenital atrophy in postmenopausal women on hormone therapy. Maturitas. 2005;50(2):98–104.CrossRefPubMedGoogle Scholar
  48. 48.
    Farrell R, American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, ACOG Committee Opinion No. 659. The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016;27(3):e93–6. doi: 10.1097/AOG.0000000000001351.Google Scholar
  49. 49.
    Mendoza N, Abad P, Baró F, Cancelo MJ, Llaneza P, Manubens M, Quereda F, Sánchez-Borrego R. Spanish Menopause Society position statement: use of tibolone in postmenopausal women. Menopause. 2013;20(7):754–60. doi: 10.1097/GME.0b013e31827b18c5.CrossRefPubMedGoogle Scholar
  50. 50.
    D'Anna R, Cannata ML, Atteritano M, Cancellieri F, Corrado F, Baviera G, Triolo O, Antico F, Gaudio A, Frisina N, Bitto A, Polito F, Minutoli L, Altavilla D, Marini H, Squadrito F. Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 1-year randomized, double-blind, placebo-controlled study. Menopause. 2007;14(4):648–55.CrossRefPubMedGoogle Scholar
  51. 51.
    Cui Y, Zong H, Yan H, Li N, Zhang Y. The efficacy and safety of ospemifene in treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy: a systematic review and meta-analysis. J Sex Med. 2014;11(2):487–97.CrossRefPubMedGoogle Scholar
  52. 52.
    Taras TL, Wurz GT, DeGregorio MW. In vitro and in vivo biologic effects of Ospemifene (FC-1271a) in breast cancer. J Steroid Biochem Mol Biol. 2001;77(4–5):271–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Palacios S, Cancelo MJ. Clinical update on the use of ospemifene in the treatment of severe symptomatic vulvar and vaginal atrophy. Int J Women Health. 2016;8:617–26.CrossRefGoogle Scholar
  54. 54.
    DeGregorio MW, Zerbe RL, Wurz GT. Ospemifene: a first-in-class, non-hormonal selective estrogen receptor modulator approved for the treatment of dyspareunia associated with vulvar and vaginal atrophy. Steroids. 2014;90:82–93.CrossRefPubMedGoogle Scholar
  55. 55.
    Constantine G, Graham S, Portman DJ, Rosen RC, Kingsberg SA. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric. 2015;18(2):226–32.CrossRefPubMedGoogle Scholar
  56. 56.
    European Medicines Agency. Senshio Summary of Product Characteristics. EMA. (2015). Accessed 1 Dec 2016.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Obstetrics and Gynecology DepartmentUniversitary Hospital of Guadalajara (Spain), University of AlcaláMadridSpain

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