The New, Undescribed, and Lethal Components of the Genitourinary Syndrome of Menopause [ID 1465]

INTRODUCTION: Genitourinary syndrome of menopause (GSM) is widely recognized by physicians, but new findings highlight serious potential consequences of untreated GSM. These include false abnormal Pap smears, vulvovaginal obliteration leading to renal damage, and undiagnosed recurrent urinary tract infections (UTIs) in the geriatric population, which may result in sepsis, pneumonia, and death. METHODS: We examined the occurrence of false abnormal Pap smears, cases of total vulvovaginal obliteration, and recurrent UTIs in geriatric patients without hormone replacement therapy (HRT). The potential for misdiagnosis and overtreatment was analyzed in the context of GSM-induced atrophic changes. RESULTS: In over 80% of perimenopausal and menopausal cases with false abnormal Pap smears (ASCUS, LGSIL, HGSIL), vaginal estrogen successfully treated the atrophic cells mimicking dysplastic cells. This intervention prevented unnecessary colposcopy, biopsies, and surgeries. Severe GSM in patients without HRT led to total vulvovaginal obliteration, resulting in urinary retention, urocolpos, bilateral megaloureters, hydronephrosis, and renal insufficiency. In nursing home populations, the lack of HRT was associated with recurrent UTIs, leading to sepsis, pneumonia, and death, outcomes rarely observed in patients receiving HRT. CONCLUSIONS/IMPLICATIONS: Untreated GSM can have lethal consequences, particularly in the elderly, where lack of hormone therapy contributes to recurrent UTIs and subsequent life-threatening complications. The use of vaginal estrogen can prevent misdiagnosis and unnecessary invasive procedures due to false abnormal Pap smears. Our findings emphasize the importance of HRT in preventing severe GSM-related complications and improving patient outcomes.