The modern world still faces a number of demographic challenges, one of which is the continued increase in number and percentage of older population. This phenomenon poses numerous challenges to the global healthcare system, which requires significant economic and organizational investments in the health care delivery. Genitourinary syndrome of menopause (GSM) is one of the most common and pressing age-associated disorders. Current epidemiological data point to the extremely high prevalence rates for this nosology, which increases progressively as female reproductive aging proceeds according to the STRAW+10 scale. The studies have shown that at least one in two women experiences urogenital atrophy during their lifetime. Generalized atrophic syndrome in the urogenital region triggers a combination of typical symptoms, including vulvovaginal, urological, and sexual ones. Regardless of the clinical phenotype, GSM is associated with a significant decrease in women’s QoL overall and social maladjustment. Furthermore, it has now been proven that GSM is a significant predictor of the development of various phenotypes of pelvic floor muscular incompetence up to pelvic organ prolapse. In this regard, timely diagnosis and targeted/proven therapy are crucial steps to improve quality of life and maintain female reproductive health over the long horizon. This article aims to review available research literature in the context of GSM mainstreaming (from epidemiology to clinical presentation), as well as to highlight current approaches to the management of GSM based on the national and international guidelines of the British Menopause Society (2025). A literature search was conducted in international databases such as PubMed, Google Scholar, and Elsevier. The search for papers was performed using the following keywords: genitourinary syndrome of menopause, vulvovaginal atrophy, clinical symptoms, and treatment of GSM. A total of 56 papers were selected for the narrative review, the most relevant of which

The present article contains the most actual version of Russian national clinical recommendations (Version of year 2025) "Menopause and climacteric period among females" In case of ignoring timely sex steroid replacement therapy menopause can decrease chances for achieving healthy longevity and ageing. This document has been provided by members of Russian Society of Obstetricicians and Gynaecologists (RSOG). The next revision is planned for year 2027 or earlier. The document has been approved by scientific practical council of the Russian Ministry of Health.

Symptoms of the genitourorinar menopausal syndrome appear simultaneously with vasomotor symptoms when menopause and even in perimenopause: soreness, itching and dryness in the vagina, dyspareunia, etc. This is due to the developmental atrophic changes in the urogenital tract, which sharply reduces the quality of life and is a risk factor for the development of recurrent infections of the genitourinary system. More than 65% of women in postmenopause without systemic menopausal hormonal therapy (MGT) suffer from manifestations of urogenital atrophy. This article discusses all modern methods of treating HUMS, describes various methods of treatment, their effectiveness, duration of application. As the first line of therapy, non -hormonal lubricants are recommended. With an average and severe degree of vulvovaginal atrophy and in the absence of contraindications, local intravaginal administration of estriol is used. The new promising methods of treatment with the State Unitary Enterprise are also described: Ospemicifen-oral, active selective selective modhertator of estrogen receptors (SERM), laser therapy, dehydroepiapianrosterone. Conclusions . Genitouine menopausal syndrome – an underestimated common disease, but the frequency of use of local estrogens is low. Treatment should be continued for a long time to prevent relapse of the symptoms of Hums. Vaginal moisturizers can be used both in monotherapy and in combination with estriol.

Scleroatrophic lichen (SAL) is a chronic inflammatory disease of the skin and mucous membranes of unknown etiology. The pathogenesis of SAL is very complex and has not been sufficiently studied to date. The most likely theory is that the disease is autoimmune due to a genetic predisposition. Changes in the vulva, characteristic of SAL, are often an accidental finding due to an asymptomatic course in the initial phase of the disease. Nevertheless, timeous diagnosis of the disease by biopsy is important, as it is often associated with high risks of intraepithelial neoplasia or vulvar cancer. Clinical manifestations of SAL significantly reduce the quality of life of women, therefore, known treatment methods are primarily aimed at reducing them. However, most of the treatment methods used do not have the proper effectiveness, long-term effect, and do not restrain the progressive atrophy and fibrosis of vulvar tissues. The methods of personalized and cellular therapy proposed and considered in the review have not been sufficiently studied from the standpoint of long-term results of treatment of SAL. Heterogeneous collagen-containing compositions of SpheroGEL in various forms of execution, according to the results of numerous conducted in vitro, in vivo and randomized clinical trials, make it possible to carry out regenerative therapy of sebum, significantly reduce the severity of its symptoms and improve the aesthetic perception of patients’ own vulva.

Polycystic ovary syndrome (PCOS) is a widespread disease characterized by excessive androgen production, ovarian dysfunction and polycystic ovarian morphology, as well as multiple metabolic disorders. The interrelated effects of hyperandrogenism, obesity, and insulin resistance contribute to the development of hyperglycemia, dyslipidemia, adipokine imbalance, increased inflammatory activity, and the development of oxidative stress in women with PCOS. The listed factors have a detrimental effect on the state of the vascular wall, as a result of which the activity of its components, in particular, the endothelium, changes. Endothelial dysfunction is one of the first steps in the pathogenesis of cardiovascular diseases (CVD). Assessment of the risk of developing CVD and their prevention in the population of women with CVD are mandatory measures. Lifestyle change should be the first step in achieving this goal. In addition, it is necessary to keep in mind the available pharmaceutical support options.

Генитоуринарный менопаузальный синдром (ГУМС) – сложное состояние, связанное с развитием атрофических и дистрофических процессов в эстрогензависимых тканях и структурах нижней трети мочеполовой системы (мочевой пузырь, уретра, влагалище, связки и мышцы тазового дна). Наиболее частыми симптомами ГУМС являются вульвовагинальные жалобы: сухость во влагалище, диспареуния. Молодые женщины, которые сталкиваются с симптомами вульвовагинальной атрофии (ВВА), – это пациентки с нарушением менструальной функции (при синдроме поликистозных яичников, функциональной аменорее), с рецидивирующей вульвовагинальной инфекцией, дистрофическими заболеваниями вульвы и влагалища, а также соматически отягощенные женщины. Послеродовый период, период грудного вскармливания, а также различные диеты, интенсивные физические нагрузки, депрессии, стрессы могут привести к гипоэстрогении и появлению вагинальных симптомов. Прием оральных контрацептивов, прогестагенов, глюкокортикостероидов, агонистов гонадотропин-рилизинг-гормона, цитостатиков, антиэстрогенных или антинеопластических препаратов для лечения рака молочной железы и любой полихимиотерапии, а также антигистаминных препаратов, антидепрессантов сопряжен с сухостью влагалища. Симптомы значительно снижают качество жизни пациенток, но при этом часто не полностью диагностируются и не лечатся из-за недостаточной информированности пациентов и ограниченной осведомленности специалистов. Своевременное и активное выявление проблемы, современные возможности коррекции и профилактики вагинальной сухости в реальной клинической практике позволят купировать ее проявления и улучшить сексуальную функцию пациенток. При таких состояниях, как рак молочной железы, пациенткам противопоказано применение любых эстрогенов, в том числе локальных форм эстриола. Кроме того, женщины по разным причинам могут отказываться от гормональной терапии, в том числе и от интравагинальных форм. Актуальным является поиск эффективных негормональных средств в отношении симптомов ВВА, которые можно подобрать под каждый конкретный клинический случай. Цель исследования – оценить применение двух средств в виде крема дозированного Эстрогиал и Эстрогиал Плюс, в состав которых входят гиалуроновая кислота и экстракты клевера, календулы, хмеля для уменьшения интенсивности симптомов ВВА умеренной и выраженной степени у пациенток с ГУМС. В состав Эстрогиала Плюс входит в 1,5 раза больше гиалуроновой кислоты. Материал и методы. В исследовании участвовали 75 пациенток с симптомами ВВА умеренной и выраженной степени. Первую группу составили 25 пациенток с ВВА в возрасте 45–54 лет (средний возраст – 47 ± 5,3 года), получавших крем дозированный Эстрогиал интравагинально 1 раз в сутки в течение 21 дня. Во вторую группу вошли 25 пациенток в постменопаузе длительностью от 5 до 15 лет с ВВА в возрасте 55–65 лет (средний возраст – 57 ± 8,4 года), получавших крем дозированный Эстрогиал Плюс интравагинально 1 раз в сутки в течение 21 дня. Третью (контрольную) группу составили 25 пациенток в пери- и постменопаузе (45–65 лет, 51 ± 9,7 года), отказавшихся от лечения и не получавших никакой терапии. Крем вводился во влагалище. Продолжительность исследования составила 28 дней. На визитах 0, 1, 2 и 3 проводилась оценка выраженности симптомов ГУМС умеренной и выраженной степени в виде сухости, жжения и зуда, диспареунии, кровотечения из влагалища после полового акта, рецидивирующих выделений из половых путей по визуально-аналоговой шкале (ВАШ). Результаты. У пациенток первой и второй групп оценка по ВАШ на визите 0 соответствовала 7-8 ± 0,35 балла, на визите 3 – 3,5 ± 0,42 балла, что свидетельствует о хорошей увлажняющей способности двух кремов дозированных. У пациенток контрольной группы оценка по ВАШ на визите 0 также соответствовала 7-8 ± 0,35 балла, а к визиту 3 увеличилась до 8,5 ± 0,54 балла, что свидетельствует об усугублении симптомов ГУМС средней и тяжелой степени тяжести в отсутствие соответствующей терапии. В соответствии с протоколом исследования, на визитах 0, 2 и 3 проводилось определение рН влагалища. У пациенток первой группы среднее значение рН влагалища на визите 0 составило 5,524 ± 0,451, на визите 2 – 4,993 ± 0,332, на визите 3 – 4,677 ± 0,241, у пациенток второй группы – 5,575 ± 0,558, 4,997 ± 0,342, 4,753 ± 0,427, у пациенток третьей группы – 5,543 ± 0,451, 5,993 ± 0,423 и 6,194 ± 0,352 соответственно. Таким образом, применение кремов Эстрогиал и Эстрогиал Плюс способствовало появлению нормальных значений pH и нормализации микробиоценоза влагалища. Заключение. Проведенное исследование показало, что основным преимуществом кремов Эстрогиал и Эстрогиал Плюс является их выраженное увлажняющее действие, способствующее облегчению симптомов вагинальной атрофии: сухости, жжения/зуда, диспареунии, кровотечения из влагалища после полового акта, уменьшению рецидивирующих выделений из половых путей. Отмечается эффективное действие крема Эстрогиал Плюс у женщин старшей возрастной группы или у женщин с симптомами ГУМС выраженной степени. Крем дозированный Эстрогиал оказывал достаточный эффект в группе пациенток в возрасте 45–54 года с умеренной степенью ВВА. Genitourinary menopausal syndrome (GUMS) is a complex condition associated with the development of atrophic and dystrophic processes in estrogen-dependent tissues and structures of the lower third of the genitourinary system (bladder, urethra, vagina, ligaments and muscles of the pelvic floor). The most common symptoms of GUMS are vulvovaginal complaints: vaginal dryness, dyspareunia. Young women who experience symptoms of vulvovaginal atrophy (VVA) are patients with menstrual dysfunction (polycystic ovary syndrome, functional amenorrhea), with recurrent vulvovaginal infection, dystrophic diseases of the vulva and vagina, as well as somatically burdened women. The postpartum period, the period of breastfeeding, as well as various diets, intense physical activity, depression, and stress can lead to hypoestrogenism and the appearance of vaginal symptoms. Taking oral contraceptives, progestogens, glucocorticosteroids, gonadotropin-releasing hormone agonists, cytostatics, antiestrogenic or antineoplastic drugs for the treatment of breast cancer and any polychemotherapy, as well as antihistamines, antidepressants is associated with vaginal dryness. The symptoms significantly reduce the quality of life of patients, but are often not fully diagnosed and treated due to lack of patient awareness and limited awareness of specialists. Timely and active identification of the problem, modern possibilities for correction and prevention of vaginal dryness in real clinical practice will make it possible to stop its manifestations and improve the sexual function of patients. In conditions such as breast cancer, the use of any estrogens, including local forms of estriol, is contraindicated for patients. In addition, women, for various reasons, may refuse hormonal therapy, including intravaginal forms. It is urgent to search for effective non-hormonal drugs for the symptoms of VVA, which can be selected for each specific clinical case. The purpose of the study is to evaluate the use of two products in the form of a dosed cream, Estrogial and Estrogial Plus, which contain hyaluronic acid and extracts of clover, calendula, and hops to reduce the intensity of symptoms of moderate and severe VVA in patients with GUMS. Estrogial Plus contains 1.5 times more hyaluronic acid. Material and methods. The study involved 75 patients with moderate to severe symptoms of VVA. The first group consisted of 25 patients with VVA aged 45–54 years (average age 47 ± 5.3 years), who received dosed Estrogial cream intravaginally once a day for 21 days. The second group included 25 postmenopausal patients lasting from 5 to 15 years with VVA aged 55–65 years (average age 57 ± 8.4 years), who received dosed cream Estrogial Plus intravaginally once a day for 21 days. The third (control) group consisted of 25 peri- and postmenopausal patients (45–65 years, 51 ± 9.7 years), who refused treatment and did not receive any therapy. The cream was inserted into the vagina. The duration of the study was 28 days. At visits 0, 1, 2 and 3, the severity of symptoms of moderate and severe GUMS was assessed in the form of dryness, burning and itching, dyspareunia, vaginal bleeding after sexual intercourse, recurrent discharge from the genital tract using a visual analogue scale (VAS). Results. In patients of the first and second groups, the VAS score at visit 0 corresponded to 7-8 ± 0.35 points, at visit 3 – 3.5 ± 0.42 points, which indicates the good moisturizing ability of the two dosed creams. In patients of the control group, the VAS score at visit 0 also corresponded to 7-8 ± 0.35 points, and by visit 3 it increased to 8.5 ± 0.54 points, which indicates a worsening of symptoms of moderate and severe GUMS in the absence of appropriate therapy. In accordance with the study protocol, vaginal pH was determined at visits 0, 2 and 3. In patients of the first group, the average vaginal pH value at visit 0 was 5.524 ± 0.451, at visit 2 – 4.993 ± 0.332, at visit 3 – 4.677 ± 0.241, in patients of the second group – 5.575 ± 0.558, 4.997 ± 0.342, 4.753 ± 0.427, patients of the third group – 5.543 ± 0.451, 5.993 ± 0.423 and 6.194 ± 0.352, respectively. Thus, the use of Estrogial and Estrogial Plus creams contributed to the appearance of normal pH values and normalization of vaginal microbiocenosis. Conclusion. The study showed that the main advantage of Estrogial and Estrogial Plus creams is their pronounced moisturizing effect, which helps alleviate the symptoms of vaginal atrophy: dryness, burning/itching, dyspareunia, bleeding from the vagina after sexual intercourse, and reducing recurrent discharge from the genital tract. Estrogial Plus cream is effective in women of the older age group or in women with severe symptoms of GUMS.

Синдром поликистозных яичников (СПЯ) — наиболее распространенное эндокринное заболевание у женщин репродуктивного возраста. СПЯ характеризуется олиго/ановуляцией, гиперандрогенией, поликистозной морфологией яичников. Чаще всего данный синдром рассматривается как патология репродуктивной системы, однако он имеет множество метаболических проявлений. Инсулинорезистентность, дислипидемия, системное субклиническое воспаление характерны для СПЯ. Указанные факторы объясняют высокий риск развития сердечно-сосудистой патологии у женщин данной популяции. Важной ступенью патогенеза сердечно-сосудистых заболеваний (ССЗ) является развитие эндотелиальной дисфункции. Понимание механизмов ее развития дает возможность проведения диагностики до клинической манифестации сердечно-сосудистой патологии, формирования групп риска, разработки мероприятий, предупреждающих развитие ССЗ, или проведения терапии на самых ранних этапах, что является максимально эффективным.

In recent years, the frequency of operations for genital prolapse and urinary incontinence has been steadily increasing. Neurogenic disorders of urination can be the first manifestations of the disease of extragenital pathology. Neurogenic bladder is bladder dysfunction (lethargy or spasticity) caused by neurogenic damage. Any disease in which the afferent or efferent innervation of the bladder is damaged can lead to a neurogenic bladder.Purpose. To study the features of urinary disorders in women with severe extragenital diseases and to improve the methods of rehabilitation of patients after reconstructive plastic surgery for various types of urinary incontinence.Materials and methods. 153 patients aged 50-70 years (mean age 55.1 ± 6.3 years) and duration of postmenopause from 2 to 5 years (7.6 ± 4.1 years) were examined at the outpatient department of the of Moscow Regional Research Institute of Obstetrics and Gynecology, Russian Federation, who applied for various manifestations of urination disorders. All patients were offered the method of biofeedback in combination with electrical stimulation of the pelvic floor muscles as a treatment. When overactive detrusor therapy was detected, therapy was combined with medicamentous (solifenacin 5 mg [Vesicar] or myrobegron 50 mg [Betmiga] in the morning) in combination with estriol (cream or suppositories) 0.5 mg intravaginally 2 times a week. In the presence of symptoms of climacteric syndrome in the absence of contraindications, menopausal hormonal therapy was prescribed.Results. Subjectively, 150 (98.1 %) patients noted an improvement in their condition, 3 (1.9 %) patients did not notice the effect of treatment. The results showed a significant improvement in all OABSS and bladder diary scores, including frequency of urination during the day and at night, urgency and number of urge incontinence episodes, and urine volume. Analysis of the -hour pad test showed that the volume of urine lost, which averaged 16.5 g before treatment, was negative after treatment in patients who noted the effect. In 2 patients who did not notice the effect, no changes were found. Investigation of the intraurethral pressure profile in 23 (17.6 %) women before treatment revealed insufficiency of the internal sphincter of the urethra, leading to urinary incontinence during stress. After treatment, in 19 (82.6 %) patients, the insufficiency of the internal sphincter was not determined. In 3 (13.0 %) patients, intraurethral pressure remained in the range of 60 to 80 cm of water column and did not lead to urinary incontinence during stress. In 1 (4.3 %) patient, the insufficiency of the urethral closure persisted, which required repeated surgery.Conclusions. In patients with severe extragenital diseases against the background of vulvovaginal atrophy, an overactive bladder and a mixed form of urinary incontinence prevail. Extragenital pathology of various origins, especially concerning various parts of the central nervous system, obesity and diabetes significantly worsens the course of urination disorders in both conservative and surgical and combined treatment and requires additional treatment methods: pelvic floor muscle training, biofeedback therapy in combination with electrical stimulation of the pelvic floor muscles, local hormonal therapy, the use of M-anticholinergics, B-adrenomimetics.

This study aimed to evaluate the effect of isolated vitamin D (VD) supplementation on the metabolic syndrome (MetS) risk profile in postmenopausal women. Methods. In this double-blind, placebo-controlled trial, 160 postmenopausal women aged 50–65 years were randomized into two groups: VD group, supplementation with 1000 IU of vitamin D 3 per day (n = 80); or placebo group (n = 80). The intervention time was 9 months, and the women were assessed at baseline and endpoint. Clinical and anthropometric data were collected. Biochemical parameters, including total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, and insulin, were measured. The plasma concentration of 25-hydroxyvitamin D (25(OH)D) was measured by high-performance liquid chromatography. Results. After 9 months, there was a significant increase in the 25(OH)D levels for VD group (+45.4%; p < 0.001), and a decrease (–18.5%; p = 0.049) in the placebo group. In the VD group, a significant reduction was observed in triglycerides (–12.2%; p = 0.001), insulin (–13.7%; p = 0.008), and the homeostasis model assessment of insulin resistance (–17.9%; p = 0.007). In the placebo group, there was an increase in glucose (+6.2%; p = 0.009). Analysis of the risk adjusted for age, time since menopause, and body mass index showed that women supplemented with VD had a lower risk of MetS (odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.21–0.83), hypertriglyceridemia (OR = 0.43; 95% CI: 0.22–0.85), and hyperglycemia (OR = 0.23; 95% CI: 0.10–0.52) compared to the placebo group (p < 0.050). Conclusions. In postmenopausal women with VD deficiency, isolated supplementation with 1000 IU of vitamin D 3 for 9 months was associated with a reduction in the MetS risk profile. Women undergoing VD supplementation had a lower risk of MetS, hypertriglyceridemia, and hyperglycemia.

At the onset of menopause, the urogenital symptoms begin to develop simultaneously with vasomotor symptoms: vaginal soreness, itching and dryness, dyspareunia, etc. The development of atrophic changes in the urogenital tract greatly reduces the quality of life and is a risk factor for the development of recurrent urinary tract infections. More than 60% of postmenopausal women, who do not take systemic menopausal hormone therapy (MHT), suffer from vaginal atrophy experience symptoms.The article discusses and evaluates effectiveness of various therapies for genitourinary syndrome of menopause (GSM). Nonhormonal lubricating gels are recommended as the first-line therapy. Local intravaginal administration of estrogens is used in moderate to severe vulvovaginal atrophy and in the absence of contraindications. Women with estrogen-dependent cancers can use low doses of local estrogen against the background of Tamoxifen therapy. New promising therapies for GSM are presented: ospemifene, an oral active selective estrogen receptor modulator (SERM), laser therapy, dehydroepiandrosterone.Even though the urogenital atrophy is a common disease, administration frequency of local estrogens as therapy is low. Basic principles for treatment of urogenital atrophy include alleviation of symptoms and restoration of normal blood supply to the vaginal epithelium and urothelium wall and mucous membrane. The therapy should be initiated early and the response time to therapy will depend on the degree of baseline atrophy. Vaginal moisturizers and lubricants can be used in combination with or separately from natural estrogens in cases when patients have medical contraindications to estrogen treatment.