Genitourinary Syndrome of Menopause (GSM): Clinical Rationale for PRP and Protein Concentrate

Key insights from an educational webinar with Carolyn DeLucia, MD 

Understanding Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM), previously referred to as vulvovaginal atrophy or urogenital atrophy, describes a constellation of vaginal, urinary, and sexual symptoms associated with hypoestrogenic states, most commonly postmenopause.

According to Dr. DeLucia, GSM is highly prevalent, affecting a majority of postmenopausal women, though many do not report symptoms unless directly asked. Unlike vasomotor symptoms such as hot flashes, GSM tends to progress over time, driven by sustained estrogen deficiency and reduced blood flow to genital tissues.

Key anatomical and physiologic changes discussed include:

• Decreased collagen, elastin, and vascularity

• Thinning and fragility of vaginal epithelium

• Loss of glycogen, contributing to elevated vaginal pH

• Increased susceptibility to recurrent UTIs, bacterial vaginosis, and yeast infections

• Reduced pelvic floor strength and tissue tone

These changes may contribute to symptoms such as vaginal dryness, dyspareunia, urinary urgency or stress incontinence, reduced sensation, and diminished sexual function often with a significant impact on quality of life.

Patient Communication and Clinical Evaluation

Dr. DeLucia discussed the importance of proactive, sensitive patient communication while also highlighting that many patients do not volunteer sexual or urinary concerns unless clinicians create a safe and intentional space to ask.

Clinical history may include:

• Pain with penetration or entry

• Decreased lubrication or sensation

• Urinary leakage with coughing, sneezing, or urgency

• Vaginal laxity or structural changes following childbirth

• Orgasmic dysfunction or reduced sexual satisfaction

Understanding which symptoms are most impactful for the patient helps guide both counseling and procedural planning.

Regenerative Options in GSM: Where PRP Fits

The webinar reviewed a range of therapeutic tools used in GSM management, including:

• Local vaginal estrogen and DHEA

• Energy-based devices (e.g., radiofrequency)

• Autologous fat transfer (with noted invasiveness and risk considerations)

• Platelet-rich plasma (PRP) and PRP with protein concentrate (PC)

PRP was discussed as an autologous biologic therapy, derived from the patient’s own blood, processed in-office, and reintroduced to targeted tissues. Because PRP is autologous, it is categorized as an autograft, distinct from allograft or perinatal tissue-derived products.

PRP: Mechanism and Tissue Response

Dr. DeLucia emphasized that while PRP has been used for decades in orthopedics and other specialties, its mechanisms are still being actively studied. PRP contains platelets rich in alpha granules, which release growth factors and cytokines involved in tissue signaling.

Growth factors discussed included:

• Platelet-derived growth factor (PDGF)

• Insulin-like growth factor (IGF)

• Transforming growth factor-β (TGF-β)

• Vascular endothelial growth factor (VEGF)

• Fibroblast growth factors

Collectively, these signals are associated with cell proliferation, differentiation, collagen synthesis, and angiogenesis, with angiogenesis highlighted as a key factor in genital tissue health.

PRP Therapy: What to Expect Over Time

A structured timeline for tissue response was outlined:

• ~3 days: Acute tissue response related to volume and injection

• 1–3 weeks: Relative lull as early biologic processes begin

• 3 weeks–3 months: Active tissue remodeling and growth phase

• ~12 weeks: Peak observed response in many patients

Clear patient education around this timeline was emphasized to support realistic expectations.

The Benefits of PRP With Protein Concentrate

The webinar also explored PRP combined with protein concentrate, using APEX processing technology.

Protein concentrate is derived from platelet-poor plasma (PPP), a fraction typically discarded in standard PRP preparation. Using a specialized filtration process, excess plasma water is removed, allowing concentration of naturally occurring anti-inflammatory and regulatory proteins such as:

• Alpha-2-macroglobulin (A2M)

• Platelet Derived Growth Factor (PDGF)

• Soluble cytokine receptors

This concentrated protein fraction may then be recombined with PRP to enrich the biologic environment delivered to tissue.

Personalized Injection Plan for Your Needs

Injection location was described as indication-dependent, with examples including:

• Clitoral tissue for orgasmic dysfunction

• Suburethral/anterior vaginal wall for stress urinary incontinence

• Vaginal walls for dryness or dyspareunia

• Introital and perineal regions for entry pain or scar-related discomfort

Pain-management strategies discussed included topical anesthetics, local anesthetic infiltration, ice, and patient-controlled nitrous oxide, depending on tissue sensitivity and indication.

Review of Clinical Evidence

Multiple studies were reviewed, including:

• Pilot and randomized controlled trials evaluating PRP for vulvovaginal atrophy

• Studies demonstrating improvement in validated scores such as the Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI)

• Reviews assessing PRP in GSM, stress urinary incontinence, pelvic organ prolapse, and lichen sclerosus

Across studies, PRP was consistently described as promising, minimally invasive, and generally well tolerated, with authors uniformly noting the need for larger, standardized trials.

Key Takeaways

• GSM is a progressive condition driven by estrogen deficiency and reduced genital blood flow

• PRP is an autologous biologic therapy being actively studied for GSM-related symptoms

• Protein concentrate may further enrich PRP by concentrating anti-inflammatory plasma proteins

• Clinical evidence to date suggests potential benefit, while emphasizing the need for continued research

• Patient selection, counseling, and expectation-setting are critical components of care

Continue the Learning

This article highlights key clinical concepts discussed during an educational webinar hosted by APEX Biologix. For a deeper, case-based discussion, clinicians are invited to view the full on-demand webinar featuring Dr. Carolyn DeLucia.  Access is available through the APEX Resource Library, built exclusively for healthcare professionals seeking evidence-guided education and practical clinical insights.

References

Angelou K., et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020;12(7):e7586. doi:10.7759/cureus.7586

Faubion, K., et al. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609

Paganelli, A., et al. Platelet-rich plasma (PRP) and adipose-derived stem cell (ADSC) therapy in the treatment of genital lichen sclerosus: a comprehensive review. Int J Mol Sci. 2023;24(22):16107-16107. doi:10.3390/ijms242216107

Disclaimer

This article summarizes content from an educational webinar and reflects the clinical perspectives shared during that session. It is intended for informational and educational purposes only and does not constitute medical advice or treatment recommendations. PRP applications may vary by jurisdiction, training, and regulatory guidance. Clinicians should evaluate available evidence, patient-specific factors, and applicable regulations before implementing any regenerative therapy.