POSSIBILITIES OF LOW-DOSE LOCAL ESTRIOL THERAPY IN POSTMENOPAUSAL WOMEN WITH VULVOVAGINAL ATROPHY

Background. The symptoms of vulvovaginal atrophy (VVA), such as vaginal dryness, itching, burning, and dyspareunia, are observed in 40-57% of postmenopausal women. Vulvovaginal symptoms can also affect the aspects of women’s lives beyond physical health and subjective feelings. A number of studies have shown that VVA negatively affects the quality of life and sexual health of women. Local menopausal hormone therapy (MHT) is the gold standard treatment for the symptoms of VVA. There is now a trend towards low-dose local estrogen therapy in European countries. Objective. To investigate the efficiency of low-dose local estriol MHT in postmenopausal patients with VVA, by using subjective and objective criteria. Subjects and methods. Initially, the study enrolled 136 women aged 40 to 75years, whose menopause duration was 1 to 20 years. All the patients underwent cytological examination for VVA. The latter was diagnosed in 84 patients. Of them, 44 patients formed a treatment group. The follow-up lasted 3 months. Block randomization was used to divide the study participants into 2 groups of 22 people each. Group 1 used a drug composed of estriol 0.5 mg (Ovipal Clio); Group 2 had an agent containing the freeze-dried culture of Lactobacillus casei L. rhamnosus Doderleini 341 mg, estriol 0.2 mg, and progesterone 2.0 mg (Trioginal). Treatment regimens with the equal cycle estriol dose amounting to 9.8 mg were developed for both patient groups (Group 1 received estriol 0.5 mg every other day for 3 weeks, then 0.5 mg once weekly for 9 weeks; Group 2 had the freeze-dried culture of Lactobacillus casei L. rhamnosus Doderleini 341 mg, estriol 0.2 mg, and progesterone 2.0 mg daily for 2 weeks, then every other day for 10 weeks). The studies encompassed questionnaire surveys, cytological examination of the vaginal wall, followed by the estimation of the vaginal epithelium maturation index (VEPI), vaginal pH, and vaginal health index (VHI). Results. The 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 atrophy symptoms. Conclusion. Low-dose local estriol therapy contributed to the restoration of the vaginal epithelium, as confirmed by statistically significant increases in VEPI and VHI and a reduction in pH values. Low-dose local MHT led to a gradual reduction in the symptoms of vaginal atrophy, which had a positive impact on menopausal patients’ sexual function and quality of life.

vulvovaginal atrophy, local estrogens, vaginal dryness, quality of life, postmenopause