The role of local estriol therapy in comprehensive management of women with genitourinary menopausal syndrome: clinical observation series

Genitourinary menopausal syndrome (GUMS) manifests through a variety of clinical symptoms, such as dyspareunia, dryness of the vaginal and vulvar mucosa, and may also be associated with urinary incontinence and pelvic organ prolapse. These conditions significantly affect the quality of life for women during menopause, contributing to their social isolation and psycho-emotional disorders. Modern approaches to GUMS treatment include the use of local hormonal drugs (mainly estriol at standard dose of 0.5 mg), such as, e.g., the original drug Ovestin in combination with surgical interventions, minimally invasive lasers, and urogynecological pessaries. Local anesthetic EMLA (lidocaine and prilocaine fix dose combination) as a safe medicine can be used prior to invasive procedures. Here, we examine clinical cases illustrating different treatment approaches for patients with various GUMS manifestations, including pelvic organ prolapse and stress urinary incontinence. In the first case, a sling urethropexy was performed with preceding estriol-based therapy that allowed to prevent postoperative complications and improve rehabilitation. In the second case, a combination of local and systemic hormonal therapy, along with a selective β3-agonist, led to markedly improved condition in a patient with overactive bladder, reducing the frequency of urination urges. A separate discussion focuses on a patient with dyspareunia, for whom fractional photothermolysis in conjunction with local hormonal therapy resulted in significant improvement in the condition of the vaginal mucosa and alleviated pain syndrome during sexual intercourse. Thus, it is necessary to follow an individualized approach to GUMS treatment by highlighting the importance of a multidisciplinary strategy that combines surgical and medical therapies with physical rehabilitation. Local hormonal therapy, the use of fractional CO2-lasers, and other methods can substantially enhance the quality of life for postmenopausal women, and the importance of these issues in clinical practice warrants further discussion and research. Providing patients with clear information about available treatment options empowers them to actively engage in managing own health, ultimately contributing to an improved quality of life.

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