意大利绝经学会（SIM）与意大利第三年龄妇科学会（SIGiTE）关于绝经泌尿生殖综合征诊断与治疗的推荐意见

文献信息

中文摘要

绝经泌尿生殖综合征（GSM）是一种与雌激素和雄激素缺乏相关的慢性疾病，累及外阴、阴道、尿道和膀胱，显著损害生活质量、性健康及排尿功能。尽管其患病率高，GSM仍常被漏诊和治疗不足。这些推荐意见由意大利绝经学会（SIM）与意大利第三年龄妇科学会（SIGiTE）制定，为GSM的诊断和管理提供更新的循证指导。推荐意见通过全面的文献综述和专家共识过程形成，证据分级依据牛津循证医学中心标准。诊断应同时依据患者报告的有困扰症状和体格检查中发现的客观临床体征。阴道健康指数和阴道前庭营养健康评分等评估工具可协助评估疾病严重程度并监测治疗反应。管理应根据症状严重程度、患者偏好、禁忌证和治疗目标进行个体化。阴道润滑剂和保湿剂是轻度症状女性的首选一线方案，而局部低剂量雌激素治疗仍是中度至重度GSM女性的首选治疗。阴道DHEA、奥培米芬和盆底物理治疗可在特定临床情况下考虑。新兴疗法，包括能量器械、注射治疗以及含透明质酸的阴道氧疗，可能在特定患者中作为额外选择，但仍需进一步证据。乳腺癌幸存者需特别考虑，对其非激素治疗仍为一线，而低剂量阴道激素治疗可在多学科评估后考虑。

英文摘要

Genitourinary syndrome of menopause (GSM) is a chronic condition associated with estrogen and androgen deficiency that affects the vulva, vagina, urethra, and bladder, significantly impairing quality of life, sexual wellbeing, and urinary function. Despite its high prevalence, GSM remains frequently underdiagnosed and undertreated. These recommendations, developed by the Italian Society of Menopause (SIM) and the Italian Society of Gynecology of the Third Age (SIGiTE), provide updated evidence-based guidance for the diagnosis and management of GSM. The recommendations were formulated through a comprehensive literature review and expert consensus process, with evidence graded according to the Oxford Centre for Evidence-Based Medicine criteria. Diagnosis should rely on both patient-reported bothersome symptoms and objective clinical signs identified during physical examination. Assessment tools such as the Vaginal Health Index and Vestibular Trophic Health Score may assist in evaluating disease severity and monitoring treatment response. Management should be individualized according to symptom severity, patient preferences, contraindications, and treatment goals. Vaginal lubricants and moisturizers represent the preferred first-line option for women with mild symptoms, whereas local low-dose estrogen therapy remains the treatment of choice for women with moderate to severe GSM. Vaginal DHEA, ospemifene, and pelvic floor physical therapy may be considered in selected clinical settings. Emerging therapies, including energy-based devices, injectable treatments, and vaginal oxygen with hyaluronic acid, may represent additional options in selected patients, although further evidence is needed. Special consideration is required for breast cancer survivors, for whom nonhormonal therapies remain first-line, while low-dose vaginal hormonal therapies may be considered after multidisciplinary evaluation.