ALGORITHMS OF LOCAL THERAPY WITH ULTRA-LOW DOSES OF ESTRIOL AND LACTOBACILLI IN OBSTETRIC AND GYNECOLOGICAL PRACTICE
Apolikhina I.A., Boldyreva A.A.
For citation: Apolikhina I.A., Boldyreva A.A. Algorithms of local therapy with ultra-low doses of estriol and lactobacilli in obstetric and gynecological practice. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; 6 (Suppl.): 18-24 (in Russian)
https://dx.doi.org/10.18565/aig.2026.197
References
1. Kwon M.S., Lee H.K. Host and microbiome interplay shapes the vaginal microenvironment. Front. Immunol. 2022; 13: 919728. https://dx.doi.org/10.3389/ fimmu.2022.919728
2. Jenkins D.J., Woolston B.M., Hood-Pishchany M.I., Pelayo P., Konopaski A.N., Quinn Peters M. et al. Bacterial amylases enable glycogen degradation by the vaginal microbiome. Nat. Microbiol. 2023; 8(9): 1641-52. https://dx.doi.org/10.1038/s41564-023-01447-2
3. Kaufman M.R., Ackerman A.L., Amin K.A., Coffey M., Danan E., Faubion S.S. et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J. Urol. 2025; 214(3): 242-50. https://dx.doi.org/10.1097/JU.0000000000004589
4. Faubion S., Crandall C.J., Davis L., El Khoudary S., Hodis H., Lobo R.A. et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022; 29(7): 767-94. https://dx.doi.org/10.1097/GME.0000000000002028
5. Srinivasan S., Hua X., Wu M.C., Proll S., Valint D.J., Reed S.D. et al. Impact of topical interventions on the vaginal microbiota and metabolome in postmenopausal women: A secondary analysis of a randomized clinical trial. JAMA Netw. Open. 2022; 5(3): e225032. https://dx.doi.org/10.1001/jamanetworkopen.2022.5032
6. Zeng Q., Shu H., Pan H., Zhang Y., Fan L., Huang Y. et al. Associations of vaginal microbiota with the onset, severity, and type of symptoms of genitourinary syndrome of menopause in women. Front. Cell. Infect. Microbiol. 2024; 14: 1402389. https://dx.doi.org/10.3389/fcimb.2024.1402389
7. Donders G.G.G., Akinosoglou K., Massie Z., Özçelik S. Review of current and emerging estrogen receptor agonists for vaginal atrophy. Expert Opin. Pharmacother. 2025; 26(3): 249-55. https://dx.doi.org/10.1080/14656566.2025.2451150
8. Jaisamrarn U., Triratanachat S., Chaikittisilpa S., Grob P., Prasauskas V., Taechakraichana N. Ultra-low-dose estriol and lactobacilli in the local treatment of postmenopausal vaginal atrophy. Climacteric. 2013; 16(3): 347-55. https://dx.doi.org/10.3109/13697137.2013.769097
9. Panay N., Fenton A., Hamoda H., Hillard T., Islam R.M., Pedder H. et al.; IMS Recommendations Writing Group. International Menopause Society (IMS) recommendations and key messages on women’s midlife health and menopause. Climacteric. 2025; 28(6): 634-56. https://dx.doi.org/10.1080/ 13697137.2025.2585487
10. National Institute for Health and Care Excellence (NICE). Menopause: identification and management. NICE guideline NG23. London: NICE; 2024. Available at: https://www.nice.org.uk/guidance/ng23
11. Briggs P., on behalf of the Medical Advisory Council of the British Menopause Society. Genitourinary Syndrome of Menopause (GSM): BMS Consensus Statement. London: British Menopause Society; 2025.
12. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020; 27(9): 976-92. https://dx.doi.org/10.1097/GME.0000000000001609
13. British Society for Sexual Medicine (BSSM). Position statement for management of genitourinary syndrome of the menopause. London: BSSM; 2024. Available at: https://www.bssm.org.uk
14. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Менопауза и климактерическое состояние у женщины. 2025. Доступно по: https://roag-portal.ru/recommendations_gynecology [Ministry of Health of the Russian Federation. Clinical guidelines. Menopause and climacteric condition in women. 2025. Available at: https://roag-portal.ru/recommendations_gynecology (in Russian)].
15. Инструкция по применению лекарственного препарата для медицинского применения «Гинофлор Э». Регистрационный номер: ЛСР-008765/09. Доступно по: https://gynoflor.ru/instruction/?ysclid=mqtd484p24854045998 [Instructions for use of the medicinal product for human use Gynoflor E. Registration number: LSR-008765/09. Available at: https://gynoflor.ru/instruction/?ysclid=mqtd484p24854045998 (in Russian)].
16. Moore K.H., Ognenovska S., Chua X.Y., Chen Z., Hicks C., El-Assaad F. et al. Change in microbiota profile after vaginal estriol cream in postmenopausal women with stress incontinence. Front. Microbiol. 2024; 15: 1302819. https://dx.doi.org/10.3389/fmicb.2024.1302819
17. Perelmuter S., Burns R., Shearer K., Grant R., Soogoor A., Jun S. et al. Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms. Sex. Med. Rev. 2024; 12(3): 279-87. https://dx.doi.org/10.1093/sxmrev/qeae034
18. Smith P.E., McLaughlin E.M., Pandya L.K., Hade E.M., Lynch C.D., Hudson C.O. A pilot randomized controlled trial of vaginal estrogen on postpartum atrophy, perineal pain, and sexual function. Int. Urogynecol. J. 2022; 33(12): 3383-90. https://dx.doi.org/10.1007/s00192-022-05149-x
19. Аполихина И.А., Тетерина Т.А., Сулейманова Ж.Ж., Девяткина А.Р., Гасанова А.Р. Генитоуринарный лактационный синдром. Акушерство и гинекология. 2025; 1: 98-105. https://dx.doi.org/10.18565/aig.2024.320 [Apolikhina I.A., Teterina Т.А., Suleymanova Zh.Zh., Devyatkina A.R., Gasanova A.R. Genitourinary syndrome of lactation.Obstetrics and Gynecology. 2025; (1): 98-105 (in Russian). https://dx.doi.org/10.18565/aig.2024.320].
20. Muzny C.A., Laniewski P., Schwebke J.R., Herbst-Kralovetz M.M. Host-vaginal microbiota interactions in the pathogenesis of bacterial vaginosis. Curr. Opin. Infect. Dis. 2020; 33(1): 59-65. https://dx.doi.org/10.1097/QCO.0000000000000620
21. Verwijs M.C., Agaba S.K., Darby A.C., van de Wijgert J.H.H.M. Impact of oral metronidazole treatment on the vaginal microbiota and correlates of treatment failure. Am. J. Obstet. Gynecol. 2020; 222(2): 157.e1-157.e13. https://dx.doi.org/10.1016/j.ajog.2019.08.008
22. Abavisani M., Sahebi S., Dadgar F., Peikfalak F., Keikha M. The role of probiotics as adjunct treatment in the prevention and management of gynecological infections: an updated meta-analysis of 35 RCT studies. Taiwan J. Obstet. Gynecol. 2024; 63(3): 357-68. https://dx.doi.org/10.1016/j.tjog.2024.03.004
23. Amabebe E., Anumba D.O.C. The vaginal microenvironment: the physiologic role of Lactobacilli. Front. Med. (Lausanne). 2018; 5: 181. https://dx.doi.org/10.3389/ fmed.2018.00181
Received 03.06.2026
Accepted 25.06.2026
About the Authors
Inna A. Apolikhina, Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8-2, apolikhina@inbox.ru, https://orcid.org/0000-0002-4581-6295Anastasia A. Boldyreva, obstetrician-gynecologist, Junior Researcher at the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, boldyreva.anastasi@gmail.com, https://orcid.org/0009-0003-4679-3229
