Non-hormonal therapies for vulvovaginal atrophy: Clinical cases
- Authors: Motovilova T.B.1,2, Sirotina L.Z.1,2, Trifonova O.I.2, Kruglova I.A.3, Varnavskaya A.D.1, Kazakova K.V.1
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Affiliations:
- Privolzhsky Research Medical University
- Clinic of Modern Technologies “Sadko” LLC
- City Clinical Hospital №35
- Issue: Vol 27, No 1 (2025)
- Pages: 87-91
- Section: CLINICAL CASE
- URL: https://journals.rcsi.science/2079-5831/article/view/290989
- DOI: https://doi.org/10.26442/20795696.2025.1.203132
- ID: 290989
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Abstract
Menopause is associated with a deficiency of sex hormones, which significantly impacts a woman's physical and psycho-emotional state. In particular, the blood supply to the genitourinary system organs deteriorates, and the synthesis of connective tissue fibers of elastin and collagen is disrupted, resulting in atrophy of epithelial and muscle structures. Over time, microbiocenosis changes due to atrophic processes in the genitourinary system. These processes cause the development of genitourinary syndrome of menopause (GSM). The traditional pathogenetic method of treatment of GSM manifestations is local hormone therapy with estriol-containing drugs. However, there is a large cohort of women who have contraindications for hormonal agents or are unwilling to use them. A promising non-hormonal therapy option is a combination of agents containing phytoestrogens, hyaluronic acid, cytokines and antimicrobial peptides in the form of suppositories (Superlymph) and a dosed cream (Estrogial Plus), which have synergistic reparative, moisturizing, antioxidant, and antimicrobial effects. The article presents clinical cases of effective and safe use of a combination of non-hormonal agents in patients with GSM, which improved their quality of life and was confirmed by objective clinical and laboratory data.
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##article.viewOnOriginalSite##About the authors
Tatiana B. Motovilova
Privolzhsky Research Medical University; Clinic of Modern Technologies “Sadko” LLC
Author for correspondence.
Email: tmshka@mail.ru
ORCID iD: 0000-0002-3795-2852
D. Sci. (Med.)
Russian Federation, Nizhny Novgorod; Nizhny NovgorodLiya Z. Sirotina
Privolzhsky Research Medical University; Clinic of Modern Technologies “Sadko” LLC
Email: tmshka@mail.ru
ORCID iD: 0000-0001-5081-1053
Аssistant
Russian Federation, Nizhny Novgorod; Nizhny NovgorodOksana I. Trifonova
Clinic of Modern Technologies “Sadko” LLC
Email: tmshka@mail.ru
ultrasound doctor
Russian Federation, Nizhny NovgorodIrina A. Kruglova
City Clinical Hospital №35
Email: tmshka@mail.ru
clinical laboratory diagnostics doctor
Russian Federation, Nizhny NovgorodAnastasiya D. Varnavskaya
Privolzhsky Research Medical University
Email: tmshka@mail.ru
ORCID iD: 0009-0009-8767-4414
Student
Russian Federation, Nizhny NovgorodKseniia V. Kazakova
Privolzhsky Research Medical University
Email: tmshka@mail.ru
ORCID iD: 0009-0002-1849-5817
Student
Russian Federation, Nizhny NovgorodReferences
- Sarmento ACA, Costa APF, Vieira-Baptista P, et al. Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. Front Reprod Health. 2021;3:779398. doi: 10.3389/frph.2021.779398
- Chen YS, Wang XJ, Feng W, Hua KQ. Advanced glycation end products decrease collagen I levels in fibroblasts from the vaginal wall of patients with POP via the RAGE, MAPK and NF-κB pathways. Int J Mol Med. 2017;40(4):987-98. doi: 10.3892/ijmm.2017.3097
- Guler Z, Roovers JP. Role of Fibroblasts and Myofibroblasts on the Pathogenesis and Treatment of Pelvic Organ Prolapse. Biomolecules. 2022;12(1). doi: 10.3390/biom12010094
- Waetjen LE, Crawford SL, Gajer P, et al. Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation. Menopause. 2023;30(11):1073-84. doi: 10.1097/GME.0000000000002263
- Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018;25(11):1321-30. doi: 10.1097/GME.0000000000001236
- Shardell M, Gravitt PE, Burke AE, et al. Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages. J Gerontol A Biol Sci Med Sci. 2021;76(9):1542-50. doi: 10.1093/gerona/glab120
- de Oliveira NS, de Lima ABF, de Brito JCR, et al. Postmenopausal Vaginal Microbiome and Microbiota. Front Reprod Health. 2021;3:780931. doi: 10.3389/frph.2021.780931
- Hamoda H, Panay N, Pedder H, et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020;26(4):181-209. doi: 10.1177/2053369120957514
- Angelou K, Grigoriadis T, Diakosavvas M, et al. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. doi: 10.7759/cureus.7586
- Макацария А.Д., Блинов Д.В., Бицадзе В.О., Хизроева Д.Х. Лечение эстриолом вульвовагинальной атрофии в постменопаузе: обновление научных данных. 2014–2018 гг. Акушерство, Гинекология и Репродукция. 2019;13(3):227-38 [Makatsariya AD, Blinov DV, Bitsadze VO, Khizroeva JKh. Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018. Obstetrics, Gynecology and Reproduction. 2019;13(3):227-38 (in Russian)]. doi: 10.17749/2313-7347.2019.13.227-238
- Diedrich CM, Kastelein AW, Verri FM, et al. Effects of topical estrogen therapy on the vaginal microcirculation in women with vulvovaginal atrophy. Neurourol Urodyn. 2019;38(5):1298-304. doi: 10.1002/nau.23977
- Galli V, Golia D'Augè T, DI Pierro F, et al. Safety and efficacy of a class II medical device based on highly purified and standardized plant extracts in the management of post-menopausal patients with vulvar and vaginal atrophy: a single-center prospective observational study. Minerva Obstet Gynecol. 2024;76(4):343-52. doi: 10.23736/S2724-606X.23.05409-X
- Pingarrón Santofímia C, Lafuente González P, Guitiérrez Vélez MDC, et al. Long-term use of ospemifene in clinical practice for vulvo-vaginal atrophy: end results at 12 months of follow-up. Gynecol Endocrinol. 2022;38(7):577-82. doi: 10.1080/09513590.2022.2083103
- Abedi P, Zohrabi I, Ansari S, et al. The Impact of Oxytocin Vaginal Gel on Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Marital Ther. 2020;46(4):377-84. doi: 10.1080/0092623X.2020.1738606
- Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10):1124-10. doi: 10.1097/GME.0000000000001122
- Saleh DM, Abdelghani R. Clinical evaluation of autologous platelet rich plasma injection in postmenopausal vulvovaginal atrophy: A pilot study. J Cosmet Dermatol. 2022;21(10):4269-25. doi: 10.1111/jocd.14873
- Waghe T, Acharya N, Karnik M, et al. Role of Platelet-Rich Plasma in Genitourinary Syndrome of Menopause. Cureus. 2024;16(1):e53316. doi: 10.7759/cureus.53316
- Rosner-Tenerowicz A, Zimmer-Stelmach A, Zimmer M. The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy. Ginekol Pol. 2021. doi: 10.5603/GP.a2021.0140
- Pinheiro C, Costa T, Amorim de Jesus R, et al. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Womens Health. 2021;21(1):379. doi: 10.1186/s12905-021-01518-8
- Адамян Л.В., Ашрафян Л.А., Андреева Е.Н., и др. Менопауза и климактерическое состояние у женщины. Клинические рекомендации. М. 2021 [Adamian LV, Ashrafian LA, Andreeva EN, et al. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. Moscow. 2021 (in Russian)].
- European Medicines Agency. CHMP summary of positive opinion for senshio [cited 01 Oct 2019]. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/002780/WC500177633.pdf. Accessed: 20.11.2023
- Прилепская В.Н., Назарова Н.М., Девяткина А.Р., и др. Возможности и перспективы локального применения гиалуроновой кислоты при вульвовагинальной атрофии у женщин репродуктивного возраста. Гинекология. 2024;26(3):254-9 [Prilepskaya VN, Nazarova NM, Devyatkina AR, et al. Potential and perspectives of local application of hyaluronic acid in vulvovaginal atrophy in women of reproductive age: A review. Gynecology. 2024;26(3):254-9 (in Russian)]. doi: 10.26442/20795696.2024.3.202932
- Garantziotis S, Savani RC. Hyaluronan biology: A complex balancing act of structure, function, location and context. Matrix Biol. 2019;78-9:1-10. doi: 10.1016/j.matbio.2019.02.002
- Dinicola S, Pasta V, Costantino D, et al. Hyaluronic acid and vitamins are effective in reducing vaginal atrophy in women receiving radiotherapy. Minerva Ginecol. 2015;67(6):523-31.
- Sayahi M, Keramat A, Nourimand F, Mohammadzadeh H. Is there a difference between the effects of phytoestrogens and non-phytoestrogens medicinal plants on sexual health? A systematic review and meta-analysis. Int J Reprod Biomed. 2023;21(11):881-900. doi: 10.18502/ijrm.v21i11.14652
- Cheilari A, Vontzalidou A, Makropoulou M, et al. Isoflavonoid Profiling and Estrogen-Like Activity of Four Genista Species from the Greek Flora. Molecules. 2020;25(23). doi: 10.3390/molecules25235507
- Simader E, Beer L, Laggner M, et al. Tissue-regenerative potential of the secretome of γ-irradiated peripheral blood mononuclear cells is mediated via TNFRSF1B-induced necroptosis. Cell Death Dis. 2019;10(10):729. doi: 10.1038/s41419-019-1974-6
- Vorstandlechner V, Copic D, Klas K, et al. The Secretome of Irradiated Peripheral Mononuclear Cells Attenuates Hypertrophic Skin Scarring. Pharmaceutics. 2023;15(4). doi: 10.3390/pharmaceutics15041065
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