Therapy for vulvovaginal atrophy in postmenopausal women: Clinical and pathogenetic aspects
Symptoms of vulvovaginal atrophy (VVA) disturb as high as 57% of postmenopausal women. A number of investigations have shown that VVA not only negatively impacts quality of life, but also adversely affects the sexual health of women. Local hormone therapy (HT) with estrogen is the gold standard for treating the symptoms of VVA. Currently, there is a trend towards the use of low-dose local estrogens in European countries.Yureneva S.V., Glazunova A.V., Eprikyan E.G., Donnikov A.E., Ezhova L.S.
Objective. To investigate the time course of vaginal atrophic changes in postmenopausal patients with VVA receiving low-dose local HT regimens, by using subjective and objective criteria.
Subjects and methods. 44 patients with VVA were selected for the investigation. The follow-up lasted 3 months. Block randomization was used to divide the study participants into 2 groups of 22 people in each. Group 1 used a drug composed of estriol at a dose of 0.5 mg; Group 2 had the agent containing the freeze-dried culture of Lactobacillus casei L. rhamnosus Doderleini 341 mg, estriol 0.2 mg, and progesterone 2.0 mg. Treatment regimens with the equal estriol cycle dose amounting 9.8 mg were developed for both patients groups. The studies encompassed a questionnaire-based survey of patients, cytological examination of the vaginal wall, followed by estimation of the vaginal epithelial maturation index (VEMI), vaginal pH, vaginal health index (VHI), and PCR diagnosis of vaginal biocenosis.
Results. A full treatment cycle was completed by 91% of the women in Group 1 and by 95.5% in Group 2. After the therapy, the patients of both groups reported alleviation or relief of vaginal symptoms. The low-dose local estriol therapy regimen contributed to the restoration of the vaginal epithelium, as confirmed by statistically significant increases in VEMI and VHI, by a reduction in pH values, as well as by an elevation in the amount of lactobacilli and by normalization of vaginal biocenosis. When the low-dose local HT regimen was used, the symptoms of vaginal atrophy gradually reduced.
Conclusion. Analysis of complaints according to the scale designed by D. Barlow showed a statistically significant decrease in the intensity of symptoms only in Group 2, the participants of which took a combined drug containing estriol, lactobacilli, and progesterone. There was also more efficient recovery of lactobacilli and normalization of the vaginal microflora during therapy with the combined drug.
Keywords
vulvovaginal atrophy
local estrogens
vaginal dryness
quality of life
postmenopause
lactobacilli
Supplementary Materials
- Table 1. Clinical and anamnestic indicators in the supervised groups
- Fig. 1. Research design
- Fig. 2. The distribution of patients in the 1 st and 2 nd groups, depending on the severity of vulvovaginal atrophy before and after treatment of vaginal maturation index (%)
- Fig. 3. Dynamics of the index of vaginal health in treatment groups
- Fig. 4. Dynamics of complaints in the supervised groups
- Fig. 5. The frequency detecting normotsenoza treatment groups
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Received 21.04.2017
Accepted 28.04.2017
About the Authors
Yureneva Svetlana Vladimirovna, MD, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79161797400. E-mail: syureneva@gmail.com
Glazunova Angelina Vladislavovna, postgraduate of gynecological endocrinology department, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79261124925. E-mail: lianochka185@yandex.ru
Yeprikyan Yelena Galustovna, postgraduate of gynecological endocrinology department, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79153843020. E-mail: eldo989@rambler.ru
Donnikov Andrey Evgenievich, Ph.D., Laboratory of Molecular Genetic Methods, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79036845247. E-mail: a_donnikov@oparina4.ru
Yezhovа Larisa Sergeevna, PhD, 1st pathoanatomical department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79154882383
For citations: Yureneva S.V., Glazunova A.V., Eprikyan E.G., Donnikov A.E., Ezhova L.S. Therapy for vulvovaginal atrophy in postmenopausal women: Clinical and pathogenetic aspects. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (6): 143-50. (in Russian)
http://dx.doi.org/10.18565/aig.2017.6.143-50
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