The definition of Genitourinary Syndrome of Menopause (GSM) is the decline of estrogens during menopause results in symptoms and clinical signs from both systems. Estrogen and other hormones production decrease after menopause because the ovaries lose their effectiveness, leading to mucosal atrophy, reduced vaginal moisture, dysuria, urgency, recurrent infection, burning, pruritus and dyspareunia.

The treatment included vaginal estrogen supplement, vaginal hyaluronic acid supplement, vaginal laser, platelet rich plasma, etc. Observational cohort study will be used for study design, and questionnaire, pelvic examination, vaginal pap smear with maturation index (MI), vaginal pH, and other methods will be used for evaluation of the effectiveness and side effects.

Inclusion Criteria:

• Women with menopause
• Patients with symptoms of genitourinary syndrome of menopause

Exclusion Criteria:

• Genitourinary bleeding or infection without definitive diagnosis
• Coagulopathy
• Allergy to medication or therapy related with the treatment
• Chronic disease that might influence outcome
• Using medication that might influence outcome in 30 days
• Using hormone or steroid within 8 weeks

Menopause for one year Age above 45 with symptoms of GSM