Genitourinary syndrome of lactation
Apolikhina I.A., Teterina Т.А., Suleymanova Zh.Zh., Devyatkina A.R., Gasanova A.R.
Background: Genitourinary syndrome of lactation (GSL) is a new term that represents a complex of symptoms similar to those observed in postmenopausal women. GSL is characterized by atrophic changes in the urogenital tract and imbalance in the vaginal microbiome, which may be caused by decreased estrogen levels during lactation.
Objective: To evaluate the efficacy and tolerability of lyophilized Lactobacillus acidophilus (1×108 CFU) in combination with 0.03 mg estriol in women with GSL.
Materials and methods: The study included 24 women aged 26 to 38 years (mean age: 32±2.6 years) with GSL two to three months following childbirth. Of the participants, 13/24 (54.2%) were primiparous, while 11/24 (45.8%) were multiparous. The spontaneous vaginal delivery rate was 42% (10). All women were recommended to take vaginal lyophilizate of Lactobacillus acidophilus (1×108 CFU) in combination with 0.03 mg estriol: one tablet intravaginally at bedtime daily for 12 days, then one tablet twice a week for up to three months.
Results: Before treatment, the average Vaginal Health Index (VHI) of the women in the study was 19±0.6 and there were no differences between the groups according to the mode of delivery. Following a period of one month during which the vaginal lyophilizate of Lactobacillus acidophilus (1×108 CFU) was administered in combination with 0.03 mg of estriol, a decrease in vaginal pH and an increase in VHI was observed in all subjects participating in the study. These positive dynamics persisted for a further three months in patients undergoing supportive therapy. No side effects or adverse events were noted.
Conclusion: The pilot studies on the use of ultra-low-dose estriol in combination with probiotics in patients with GSL demonstrate the high efficacy and safety of the combination therapy; longer-term use throughout the lactation period is likely to be possible. A particular point of interest for this study was the potential for dyspareunia correction in patients with GSL. The severity of pain during intercourse was assessed using the visual analogue scale (VAS); the women reported a decrease in pain, probably due to improved lubrication after ultralow-dose estriol supplementation.
Authors’ contributions: Apolikhina I.A. – editing the article; Teterina T.A., Suleymanova Zh.Zh., Devyatkina A.R. – collecting publications, processing and analysis of materials, writing the text, translating articles; Gasanova A.R. – collecting publications, translating articles, writing the text.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Apolikhina I.A., Teterina Т.А., Suleymanova Zh.Zh., Devyatkina A.R., Gasanova A.R.
Genitourinary syndrome of lactation.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (1): 98-105 (in Russian)
https://dx.doi.org/10.18565/aig.2024.320
Keywords
postpartum period
lactational amenorrhea
genitourinary syndrome of lactation (GSL)
vaginal microbiome
lactobacilli
estriol
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Received 16.12.2024
Accepted 10.01.2025
About the Authors
Inna A. Apolikhina, Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), i_apolikhina@oparina4.ru, https://orcid.org/0000-0002-4581-6295Tatiana A. Teterina, PhD, obstetrician-gynecologist, USD, Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, +7(963)961-67-44, palpebra@inbox.ru,
https://orcid.org/0000-0003-0990-2302
Zhasmina Zh. Suleimanova, оbstetrician-gynecologist, Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, zhasmin020@mail.ru
Anastasia R. Devyatkina, Resident, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia,
117997, Russia, Moscow, Oparina str., 4, +7(495)531-44-44, grinasta26@mail.ru, https://orcid.org/0009-0006-1742-7555
Albina R. Gasanova, Resident, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia,
117997, Russia, Moscow, Oparina str., 4, +7(495)531-44-44, alba.gsn.96@mail.ru, https://orcid.org/0009-0008-2488-8418
Corresponding author: Tatiana A. Teterina, palpebra@inbox.ru
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