Генитоуринарный менопаузальный синдром: современный подход к лечению

Мазитова М.И., Мардиева Р.Р. Генитоуринарный менопаузальный синдром: современный подход к лечению. Гинекология. 2020; 22 (6): 16–20. DOI: 10.26442/20795696.2020.6.200485

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Mazitova M.I., Mardieva R.R. Genitourinary syndrome of menopause: a modern approach to treatment. Gynecology. 2020; 22 (6): 16–20. DOI: 10.26442/20795696.2020.6.200485

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Аннотация

Продолжительность жизни за последние полвека значительно увеличилась, и к 2025 г. примерно каждый шестой человек на Земле будет старше 60 лет. Таким образом, возрастные заболевания приобретают все большую актуальность. Это касается и климактерического синдрома у женщин в пери- и постменопаузе. Средний возраст наступления менопаузы составляет 50–52 года. Ежегодно у 25 млн женщин в мире наступает менопауза, и лишь у 10% из них она протекает без патологических проявлений. Генитоуринарный менопаузальный синдром – второй по частоте маркер наступления климактерия. Урогенитальные расстройства являются достаточно распространенной нозологией (что подтверждают многочисленные исследования), однако далеко не каждая женщина считает необходимым заявлять о своих проблемах врачу, принимая их за естественные проявления старения. Увеличение продолжительности жизни и омоложение населения, несомненно, связаны с общественно-социальным развитием и достижениями медицины, цель которой состоит также в продлении срока здоровой и качественной жизни. Проведенные в последние десятилетия исследования по изучению атрофических гипоэстрогенных изменений урогенитального тракта позволят пересмотреть отношение к генитоуринарному менопаузальному синдрому и подобрать адекватное лечение разным группам пациенток. Однако из-за неготовности женщин заявлять о симптомах, связанных с вульвовагинальной атрофией, и отсутствия активного интереса к этому вопросу врачей – в первую очередь гинекологов – данная проблема остается нерешенной.

Ключевые слова: менопауза, климактерический синдром, генитоуринарный менопаузальный синдром, эстриол.

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Life expectancy over the past half century has increased significantly and by 2025 approximately one in six people on Earth will be over 60 years old, thus, age-related diseases become even more relevant, this also applies to menopausal syndrome in postmenopausal women. The average age of menopause is 50–52 years. In the world 25 million women annually experience menopause and only 10% of them have no pathological manifestations. Genitourinar menopausal syndrome is the second most common marker of menopause. Urogenital disorders are a fairly common nosology, which is confirmed by numerous studies, but not every woman considers it necessary to report a problem to a doctor, considering this a natural course of aging. The increase in life expectancy and rejuvenation of the population is undoubtedly associated with socio-social development and the achievement of medicine, the purpose of which is also to increase the extension of the term of a healthy and quality life. Studies conducted in recent decades to study atrophic hypoestrogenic changes in the urogenital tract will allow us to reconsider our attitude to genitourinar menopausal syndrome and to select appropriate treatment for various groups of patients. But the inability of women, at times, to declare their symptoms associated with vulvovaginal atrophy, and the lack of active interest in this issue by doctors, especially gynecologists, leaves this problem unresolved.

Key words: menopause, menopausal syndrome, genitourinary syndrome of menopause, estriol.

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1. United Nations, 2004. Population Trends. UK National Statistics 2005; 120.
2. Peterson G. Grey dawn: how the coming age wave will transform Americ – and the World. New York: Random House, 1999.
3. Salwowska NM, Bebenek KA, Żądło DA, Wcisło-Dziadecka DL. Physiochemical properties and application of hyaluronic acid: A systematic review. J Cosmet Dermatol 2016; 15: 520–6.
4. Belova A. Starost' otodvigaetsia. Chastnaia sobstvennost'. 2001; 26 (271) (in Russian).
5. Khamoshina M.B., Bril' Iu.A. Menopauzal'nye rasstroistva: variativnost' terapevticheskikh podkhodov. Inform. biul. 2014; 5–6 (in Russian).
6. Balan V.E., Kovaleva L.A., Tikhomirova E.V. Genitourinarnyi ili urogenital'nyi sindrom: vozmozhnosti dlitel'noi terapii. Med. sovet. 2016; 12: 98–101 (in Russian).
7. Menopauzal'naia gormonoterapiia i sokhranenie zdorov'ia zhenshchin v zrelom vozraste. Klinicheskie rekomendatsii, 2015 (in Russian).
8. Nappi RE, Martini E, Cucinella L et al. Front endocrinol (lausanne) addressing vulvovaginal atrophy (VVA). Genitourinary syndrome of menopause (GSM) for healthy aging in women 2019; 21: 561.
9. Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: results from an international survey on vaginal atrophy. Maturitas 2010; 6: 233–8.
10. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the vaginal health: insights, views & attitudes survey. Menopause 2013; 20: 1043.
11. Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol 2015; 58: 476–91.
12. Nappi RE, Palacios S, Panay N et al. Vulvar and vaginal atrophy in four European countries: Evidence from the European. Climacteric 2016; 19: 188–97.
13. Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric 2016; 19: 151–61.
14. Alvisi S, Gava G, Orsili I et al. Vaginal health in menopausal Women. Medicina (Kaunas) 2019; S 55.
15. Farrell AE. Genitourinary syndrome of menopause. Aust Fam Physician 2017; 46 (7): 481–4.
16. Mudrakovskaia E.V., Gorelik S.G., Kolpakova N.A., Zhuravleva Ia.V. Aktual'naia problema zhenshchin v postmenopauze. Urogenital'nye rasstroistva. 2012; 10 (1) (in Russian).
17. Пушкарь Д.Ю. Гиперактивный мочевой пузырь у женщин. М.: МЕДпресс-информ, 2003.
18. Gomberg V.G. Osobennosti lecheniia nederzhaniia mochi u pozhilykh zhenshchin. Urologiia segodnia. 2010; 3 (in Russian).
19. Raz R. Urinary tract infection in postmenopausal women. Korean
J Urol 2011; 52: 801.
20. Jannini EA, Nappi RE. Couplepause: a new paradigm in treating sexual dysfunction during menopause and andropause. Sex Med Rev 2018; 6: 384–95.
21. Balica A, Schertz K, Wald-Spielman D et al. Transabdominal sonography to measure the total vaginal and mucosal thicknesses. Clin Ultrasound 2017; 461–4.
22. Herbenick D, Reece M, Hensel D et al. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study. J Sex Med 2011; 8: 202–12.
23. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause 2017; 24: 728–53.
24. Cox P, Panay N. Vulvovaginal atrophy in women after cancer. Climacteric 2019; 14: 1–7.
25. Jokar A, Davari T, Asadi N et al. Comparison of the hyaluronic acid vaginal cream and conjugated estrogen used in treatment of vaginal atrophy of menopause women: a randomized controlled clinical trial. Int J Commun Bas Nurs Midwifery 2016; 4: 69–78.
26. BMS – сonsensus statement Joan Pitkin; on behalf of the British Menopause Society Medical Advisory Council Post Reproductive Health. 2018; 24 (3): 133–8.
27. Treatment of vaginal atrophy with estriol and lactobacilli combination: a clinical review. Climacteric 2018.
28. Crandall CJ, Hovey KM, Andrews CA et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause 2018; 25: 11–20.
29. Baber R.Dzh., Panai N., Fenton A.; i rabochaia gruppa IMS. Rekomendatsii IMS 2016 po zdorov'iu zhenshchin zrelogo vozrasta i menopauzal'noi gormonal'noi terapii. 2016 (in Russian).
30. Capobianco G, Wenger JM, Meloni GB et al. Triple therapy with Lactobacilli acidophili, estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women. Arch Gynecol Obstet 2014.
31. Pitsouni E, Grigoriadis T, Douskos A et al. Efficacy of vaginal therapies alternative to vaginal estrogens on sexual function and orgasm of menopausal women: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2018; 229: 45–56.
32. Grant MD, Marbella A, Wang AT et al. Menopausal symptoms: сomparative. Effectiveness of therapies. In AHRQ сomparative effectiveness reviews. Agency for Healthcare Research and Quality (US) USA, 2015.
33. Kagan R, Williams RS, Pan K et al. A randomized, placebo and active controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause 2010; 17: 281–9.
34. Salvatore S, Athanasiou S, Candiani M. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol 2015; 27: 504–8.
35. Gambacciani M, Levancini M, Russo E et al. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric 2018; 21: 148–52.
36. Food and drug admnistration. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures: FDA safety communication. 2018 (accessed on 16 September, 2019). https://www.fda.gov/medical-devices/
37. The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice; Farrell R. ACOG. Committee opinion No. 659. Obstet Gynecol 2016; 127: 93–6.

Авторы

М.И. Мазитова1, Р.Р. Мардиева*1,2

1 Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ГАУЗ «Городская клиническая больница №7», Казань, Россия
*rezedamardieva@gmail.com

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Madina I. Mazitova1, Rezeda R. Mardieva*1,2

1 Kazan State Medical Academy – branch of Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 City Clinical Hospital №7, Kazan, Russia
*rezedamardieva@gmail.com

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