Urinary Genitourinary Syndrome (UGS)

Genito-Urinary Syndrome (GUS) affects approximately 60% of menopausal women and is characterized by a set of symptoms such as dryness, pruritus (itching), vulvar and vaginal burning, dyspareunia (pain during intercourse), urinary incontinence, vaginal and urinary infections. These symptoms are due to the decrease in oestrogen production that occurs during the menopause.

There are various therapeutic options such as local estrogens, desiadroandristerone, promestriene and non-hormonal moisturizers. More recent options include Ospemifene and the CO2/ Erbium Vaginal Laser.

Ospemifene is an oral selective estrogen receptor modulator (SERM) with an estrogenic action on receptors in the vulva and vagina, with no adverse effects on the endometrium or breast.

The Vaginal Laser acts on the surface of the vaginal mucosa by heating, leading to the formation of neocolegenium, neovascularization, an increase in the extracellular matrix and thickening of the vaginal mucosa. The laser has brought a treatment option to women with a history of a hormone-dependent tumor.

With so many therapeutic options, does it make sense to combine Ospemifene with Vaginal Laser? The answer, surprisingly, is yes, especially in the following groups:

• Women with marked atrophy and dyspareunia at the vestibular level. In these cases, the combination of laser and Ospemifene showed better results than the use of laser alone
• Women with very marked vulvar-vaginal atrophy whose initial approach with the vaginal laser may cause discomfort and even bleeding. It makes sense to take Ospemifene 4-6 weeks before laser treatment.
• Women with repeated urinary infections + marked vaginal atrophy. In this group we can achieve faster recovery from vaginal and urethral thickening and better hydration.

In fact, if the woman wishes, we can use Ospemifene in association with the laser before and during treatments, since Ospemifene stimulates the production of hyaluronic acid and mucopolysaccharides in the dermis, increasing the hydration of the vaginal mucosa. As the lasers used to treat vaginal atrophy (CO2/Erbium) have a great appetite for water, they end up being more effective when the tissues are more hydrated.