Position statement by Experts of the Polish Menopause and Andropause Society, and the Polish Society of Aesthetic and Reconstructive Gynaecology on the medicinal product Intrarosa®

Introduction

A set of menopause-related symptoms affecting the external genitalia and lower urinary tract is discussed in contemporary scientific literature under the name of urogenital atrophy (UGA) or vulvovaginal atrophy (VVA) [1]. In 2014, a team of experts from two scientific associations – The North American Menopause Society (NAMS) and The International Society for the Study of Women’s Sexual Health (ISSWSH) – proposed a new terminology for postmenopausal atrophic symptoms, replacing the terms VVA and UGA with the term genitourinary syndrome of menopause (GSM) [2]. The change was motivated by the belief that this set of symptoms requires a more holistic therapeutic approach falling outside the scope of interest of gynaecologists and urologists only. The signs and symptoms of GSM are summarised in the Table 1.
The diagnosis of GSM is based primarily on the patient’s medical history and the findings of physical examinations, of which the most important one is the speculum examination. Additional examinations confirming the diagnosis of GSM include:
• vaginal pH > 5,
• an increase in the number of parabasal cells,
• a decrease in the number of superficial cells in maturation index (MI).
A common feature shared by the symptoms which make up the syndrome is their causal relationship with age-related reductions in both peripheral and local concentrations of sex steroids, particularly oestrogens and androgens [3-5].
Androgens and oestrogens produce both separate and synergistic effects on vaginal morphology and function. The most important types of vaginal effects produced by oestrogens involve vaginal elasticity and pH level. The impact of androgens is related predominantly to such aspects of vaginal physiology as innervation and contractility of vaginal walls. The common androgenic and oestrogenic area of activity relates to the structure and function of the lamina propria and muscular layer of vaginal walls, as well as its vascular perfusion [3, 4, 6].
The wide spectrum of GSM-associated symptoms is attributable to a particularly high density of oestrogen and androgen receptors within the external genitalia and the lower urinary tract. Changes caused by hormonal deficiencies are accompanied by a decrease in the tissue content of collagen and elastin, epithelial thinning due to the loss of the superficial layer, dysfunction of smooth muscle cells, and an increase in connective tissue density. Consequences...


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