Genitourinary syndrome of lactation

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Abstract

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.

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About the authors

Inna A. Apolikhina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Author for correspondence.
Email: i_apolikhina@oparina4.ru
ORCID iD: 0000-0002-4581-6295

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, 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)

Russian Federation, Moscow; Moscow

Tatiana A. Teterina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: palpebra@inbox.ru
ORCID iD: 0000-0003-0990-2302

PhD, obstetrician-gynecologist, USD

Russian Federation, Moscow

Zhasmina Zh. Suleimanova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: zhasmin020@mail.ru

оbstetrician-gynecologist

Russian Federation, Moscow

Anastasia R. Devyatkina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: grinasta26@mail.ru
ORCID iD: 0009-0006-1742-7555

Resident

Russian Federation, Moscow

Albina R. Gasanova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: alba.gsn.96@mail.ru
ORCID iD: 0009-0008-2488-8418

Resident

Russian Federation, Moscow

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2. Fig. 1. Dynamics of changes in IVZ and pH in women of the study groups before and after the use of vaginal lyophilisate of acidophilic lactobacilli 1 x 10s CFU in combination with 0.03 mg estriol

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3. Fig. 2. Dynamics of pain level according to VAS in women of the study groups before and after the use of vaginal lyophilisate of acidophilic lactobacilli 1 x 108 CFU in combination with 0.03 mg estriol

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4. Fig. 3. Patient A., 38 years old, with HUL C 3 months after delivery. Before treatment and 3 months later during maintenance therapy with vaginal lyophilisate of acidophilic lactobacilli 1 x 108 CFU in combination with 0.03 mg estriol

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5. Fig. 4. Patient H., 32 years old, with GULS 2.5 months after delivery. Before treatment and 3 months later during maintenance therapy with vaginal lyophilisate of acidophilic lactobacilli 1 x 108 CFU in combination with 0.03 mg estriol

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