Genitourinary syndrome of menopause (GSM) is associated with a decrease in which hormone?

• A. Increased progesterone
• B. Decreased estrogen
• C. Decreased prolactin
• D. Increased testosterone

Answer: (B)

Genitourinary syndrome of menopause (GSM) is primarily linked to the decline in estrogen levels that occur during menopause. Estrogen plays a critical role in maintaining the health of the vaginal and urinary tissues. As estrogen levels decrease, women may experience symptoms such as vaginal dryness, dyspareunia (painful intercourse), urinary urgency, and atrophy of the urethral and vaginal epithelium, which are characteristic of GSM.

The reduction in estrogen not only affects the vaginal tissue but also has broader implications on the genitourinary tract, leading to inflammation and changes in normal flora. This further exacerbates the symptoms associated with GSM. Management of GSM often involves estrogen replacement therapies or other treatments aimed at alleviating these specific symptoms related to the decline in estrogen.

While other hormones like progesterone, prolactin, and testosterone may have their own roles in the body, they do not have the same direct and significant impact on the pathophysiology of GSM as estrogen does. Therefore, the decrease in estrogen is the principal factor contributing to the symptoms and signs of genitourinary syndrome of menopause.