Evaluation of the effectiveness of the combined use of photodynamic therapy and platelet-rich plasma in the genitourinary syndrome of menopause

Background. Menopause is a normal physiological event for middle-aged women. In about 50% of cases, the genitourinary syndrome of menopause (GSM) develops which significantly impairs the quality of life and definitely requires treatment. In recent years, photodynamic therapy (PDT) has been actively used to correct involutive skin changes, and the PRP-therapy method, the use of autologous platelet-rich blood plasma, is used as the advanced methods of rejuvenation. The effectiveness of PRP therapy looks promising, and the risks of this procedure with correct use are minimal. Objective. Evaluation of the efficacy and safety of PDT in combination with PRP in the treatment of GSM. Methods. This study included 15 patients diagnosed with genitourinary syndrome of menopause (involutive changes in the vulva). PDT procedures (photosensitizer chlorin E6 in the form of 1% gel was used) and plasmotherapy were performed only 10 times (each type of procedure 5 times) alternately once a week. The PDT AFS «Harmony» device (wavelength - 660 nm) was used as a radiation source. To assess the effectiveness of this therapy, the following scales were used: VHI (vaginal health index), VAS (visual analogue scale), and DLQI (Dermatology Life Quality Index). We also developed a scale for assessing VICV (visual involutive changes of the vulva) with assessment of 7 indicators: color/depigmentation, desquamation, skin texture to the touch, vascular pattern, hair-covering in the labia majora, flattening and wrinkling of the skin, cracks/erosion. Results. After alternating the course of PDT procedures with PRP-therapy, the patients noted a significant regression of itching, which completely disappeared in 11 patients; in the rest it significantly decreased. The symptoms of dryness completely disappeared in 6 patients, and decreased to insignificant value in the rest. After the completion of the course of procedures, a decrease in skin dryness on average up to 3 points was noted. Itching completely regressed in 6 out of 9 patients. Dyspareunia decreased significantly in 4 patients and disappeared completely in 6 patients. Significant changes were also observed when assessing the VHI in relation to the integrity of the epithelium (on average 4.93 points), indicators of moisture and transudate (4.73 each) and Ph-metry (4.4 points). The elasticity indicators did not change compared to the initial values. No serious side effects were detected during the entire period of treatment and after it. Conclusion. The use of PDT in combination with PRP-therapy in this study showed high efficacy in the form of a significant regression of the main complaints, such as itching and dryness, as well as an improvement in visual indicators of changes in the vulvar area. These procedures are safe in the treatment of GSM (no complications were observed during and after therapy). The new developed VICV scale will provide a more effective approach to the diagnosis of involutive changes in the vulva, as well as allow to prescribe the correct therapy depending on the severity of symptoms.

genitourinary syndrome of menopause, involutive changes in the vulva, photodynamic therapy, platelet-rich plasma, chlorin E6