The genitourinary syndrome of menopause (GSM) and the potential pathogenesis mechanism开题报告

1. 研究目的与意义（文献综述包含参考文献）

I.INTRODUCTION The increasing life expectancy, especially for women has resulted in many women go through menopause. Menopause is a transitional period characterized by hormonal changes which can lead to a host of symptoms, such as changes in weight, fluctuations in mood, etc. Genitourinary syndrome of menopause (GSM) is a chronic condition that affects the vagina, vulva, pelvic floor tissues and lower urinary tract. Previously referred to as vulvovaginal atrophy (VVA) or atrophic vaginitis, GSM is characterized by vulvovaginal pain and discomfort, pain during sex, decreased libido and urinary tract issues. In the years leading up to and including menopause, the ovaries reduce their production of estrogen. Estrogen is a sex hormone that plays role in puberty, menstruation, insulin sensitivity, glucose metabolism and bone health. After menopause and in those who may have hormonal imbalances not related to menopause, the production of estrogen from the ovaries is extremely low. The low estrogen levels are the primary cause for the symptoms of genitourinary syndrome of menopause. Formerly, menopause has been discussed only by women approaching middle age, but actually thats a mistake. The more openly menopause is talked about, it can leads to the less stress menopausal people. GSM as the symptoms experienced by menopausal people has become an interesting topic to be learned and discussed. GSM primarily affects the genitals and urinary tract which can cause a variety of symptoms, including vaginal dryness, vaginal itching or burning, pelvic pain or pressure, increased discharge, painful intercourse, reduced lubrication, loss of libido, painful urination, decreased arousal, bleeding during or after sex, painful orgasms, increased urinary urgency and frequency, urinary incontinence, urinary tract infections and bladder dysfunction. Many symptoms of GSM are also found in other conditions that affect the genitals or urinary tract, which make it difficult to diagnose this condition. However, the most commonly reported symptoms of GSM are vaginal dryness and painful intercourse. So far, GSM remains largely underdiagnosed in the menopausal population. GSM can have a significant effect on the quality of life, but due to a lack of awareness and screening, the syndrome is often underdiagnosed. However, several effective treatments exist. GSM can also occur for other reasons, such as primary ovarian insufficiency, which causes the ovaries to stop functioning as they normally do before the age of 40, surgically induced menopause, which involves removing the ovaries in a procedure known as an oophorectomy, postpartum and breastfeeding-related hormone imbalances, cancer treatment which may affect the function of the ovaries or cause sudden hormonal shifts, medications such as gonadotropin-releasing hormone agonists or aromatase inhibitors. For the medical treatments for GSM, there is no permanent cure for GSM, but various hormonal and nonhormonal treatments can reduce the symptoms. For instance hormon therapy, for more disruptive symptoms, doctors often recommend hormone therapy. This replaces the estrogen that the body is no longer producing. Hormone replacement therapy is known as the effective way to treat GSM symptoms. Some options include, low-dose estradiol-releasing intravaginal tablets, lower-dose estrogen vaginal inserts, intravaginal dehydroepiandrosterone (DHEA) or prasterone, vaginal DHEA inserts, oral ospemifene as a selective estrogen receptor modulator. Some people are concerned that estrogen replacement therapies may be unsafe and increase the risk of certain cancers. However, local estrogen therapy is well-researched and safe for most people. Beside this, pelvic floor physical therapy can also be a good option. Some people with GSM may benefit from this, in addition to other treatments. Pelvic floor physical therapy, sometimes called PFPT, can help strengthen muscles in the pelvic floor. It may prevent urinary incontinence or leakage and improve sexual function for people with GSM. In addition, dilation therapy and topical treatment can also be consider to reduce the symptoms of GSM. As it is more accurate and inclusive term that describes various menopausal symptoms, thus it is important to increase the knowledge and understanding of GSM and the potential pathogenesis mechanism.II. BACKGROUNDThe genitourinary syndrome of menopause (GSM) firstly introduced in 2014 by a consensus of the International Society for the Study of Womens Sexual Health and the North American Menopause Society. GSM previously known as vulvovaginal atrophy or atrophic vaginitis is the term that describes the changes caused by the lack of estrogens during menopause. GSM symptoms may be present in 15% of premenopausal women due to hypoestrogenic state, however mostly present in the older age women. The diagnosis of GSM may prove to be challenging as the clinical manifestations of GSM are mild and nonspecific in approximately 50% of postmenopausal women. Through observational study, it is found that vaginal dryness is the most prevalent and bothersome symptom which affects up to 93% of women who experience GSM and this symptom is characterized as being moderate to severe in intensity in 68% of the cases. Beside this, irritation, burning or itching of the vagina are other symptoms that women with GSM frequently complain about. Loss of libido and vagina bleeding during or after intercourse are also frequently reported. The evaluation and diagnosis of GSM are clinical and mostly established through medical history and physical pelvic examination. Some tests to assess the efficacy of therapies for GSM such as vaginal pH and the vaginal maturation index (VMI) are mainly used in research studies. The most of symptoms of GSM are commonly caused by the lack of estrogen. The lack of estrogen results in numerous changes in the female organism. There are three types of estrogens, such as estradiol, estrone and estriol. Estradiol prevails in premenopausal women, while estrone as a less effective form is the predominant estrogen in menopause. GSM comprises numerous unspecific symptoms and signs. However, a minimum number of signs or symptoms required for the diagnosis of the syndrome was not defined. Around the world, on average women live longer than men. It is estimated that these women live more than 30 years following natural menopause, which commonly occurs between 48 and 52 years. For this reason, the impact of potential conditions due to menopause associated hormonal deficiency influences the healthy longevity of women. With a prevalence ranging from 36 to 90%, GSM affects many peri- and post-menopausal women. A study involving 2045 British women aged 55-85 years, demonstrated that 50% of these women present urogenital symptoms at some time of menopause. Some of these women were seriously affected and these symptoms are extended duration and usually do not recede without appropriate treatment. Another Europian study state that 3000 women between the ages of 55-75 years evaluated the aspects of urogenital aging observed that a total of 30% of women experiment from symptoms from urogenital atrophy. Effects of urogenital symptoms on sexual activity were also reported, including a decreased prevalence of sexual activity with increasing age. Over 70 % of postmenopausal women were not sexually active, and more than 30% reported dyspareunia and vaginal dryness. The goal of this study is to increase the knowledge and understanding of GSM and the potential pathogenesis mechanism. Research Questions :1. What causes genitourinary syndrome of menopause (GSM) ?2. How does GSM affect womens quality of life ?3. What is the potential pathogenesis mechanism associated to GSM ?Research Objectives :Based on the research questions, followings are the research objectives of this research study.1. Get to know what causes genitourinary syndrome of menopause (GSM).2. Understanding the effects of GSM on womens quality of life.3. Get to know the potential pathogenesis mechanism associated to GSM.Research Structures :This research will be divided into five chapters1. IntroductionFirst chapter will be titled as introduction, which contains the research background, discusses the historical context of the subject, the research issues that will be addressed, research questions and research objectives.2. Literature Review Second chapter of this study will be based on the literature review. To obtain more informations about genitourinary syndrome of menopause and the potential pathogenesis mechanism.3. MethodologyThird chapter will be based on the methodology. Provides context for the research methodology, method and technique for the data collecting and data analysis.4. Results and AnalysisFourth chapter of this study includes the results obtained from the data collected and the analysis of the theoretical studies. The culmination of the study analysis shows compilation of the data obtained from a variety of sources.5. ConclusionThe last chapter will contain conclusion and recommendation. The final conclusion of this research will be based on the findings of the response from several data, as well as various advice on how to analyze this research case. References [1]. Portman D.J., Gass M.L. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Womens Sexual Health and the North American Menopause Society. Maturitas 79(3), 349-354 (2014).[2]. Gandhi J., Chen A., Dagur G., Suh Y., Smith N., Cali B., Khan S.A. Genitourinary syndrome of menopause: and overview of clinical manifestations, pathophysiology, etiology, evaluation and management. American journal of obstetrics and gynecology 215(6), 704-711 (2016).[3]. Moral E., Delgado J.L., Carmona F., et al. Genitourinary syndrome of menopause. 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2. 研究的基本内容、问题解决措施及方案

3 figures:(1) Classification of genitourinary syndrome of menopause (GSM);(2) The genitourinary syndrome of menopause (GSM) and the potential pathogenesis mechanism;(3) summary of GSM intervention.Requirements:(1) Search literatures and summarize the function of talin-1.(2) Submit a review of genitourinary syndrome of menopause (GSM).