Микробиота влагалища в период менопаузального перехода: роль лактобактерий

Доброхотова Ю.Э., Шадрова П.А., Комагоров В.И. Микробиота влагалища в период менопаузального перехода: роль лактобактерий. Гинекология. 2021; 23 (3): 214–221. DOI: 10.26442/20795696.2021.3.200905

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Dobrokhotova YuE, Shadrova PA, Komagorov VI. Vaginal microbiota during the menopausal transition: the role of lactobacilli. Gynecology. 2021 23 (3): 214–221. DOI: 10.26442/20795696.2021.3.200905

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Аннотация

Физиологическое угасание функции яичников в период менопаузального перехода зачастую приводит к развитию неблагоприятных симптомов, связанных с вульвовагинальной атрофией, рецидивирующими инфекциями мочевыводящих путей и диспареунией. В настоящее время риски и польза от назначения менопаузальной гормональной терапии в купировании последствий эстрогенодефицита активно обсуждаются в научном сообществе. Исследование микробиоты влагалища в динамике позволило взглянуть глубже на процесс развития симптомов генитоуринарного менопаузального синдрома и связать отдельные микро-организмы с конкретными нежелательными проявлениями. Связь между рецидивирующими инфекциями мочевыводящих путей в период менопаузы и физиологическим замещением микробиоты на условно-патогенную флору с развитием неприятных симптомов вынуждает врачей прибегать к необоснованным курсам антибактериальной терапии. Обзор посвящен обобщению сведений о микробиологических изменениях влагалища в перименопаузе, возможностям подбора оптимальной гормональной терапии в коррекции симптомов, использованию новых перспективных методов, в том числе менеджмента путем модуляции микробиоты влагалища.

Ключевые слова: менопауза, менопаузальная гормональная терапия, эстрогенодефицит, микробиота влагалища, пробиотики, генитоуринарный синдром, вульвовагинальная атрофия

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Physiological loss of ovarian function during the menopausal transition often leads to the development of unfavorable symptoms associated with vulvovaginal atrophy, recurrent urinary tract infections and dyspareunia. Currently, the scientific community is actively discussing the risks and benefits of prescribing menopausal hormone therapy to relieve the consequences of estrogen deficiency. The study of vaginal microbiota in dynamics made it possible to take a deeper look at the development of genitourinary menopausal syndrome and associate several microorganisms with specific undesirable manifestations. The link between recurrent urinary tract infections during menopause and physiological replacement of microbiota by opportunistic flora with the development of unpleasant symptoms resolves doctors to resort to irrational courses of antibiotic therapy. The review is devoted to the generalization of information on microbiological changes in the vagina during perimenopause, the possibilities of choosing the optimal hormone therapy for the correction of symptoms, the use of new promising methods, including management by modulating the vaginal microbiota.

Key words: menopause, menopausal hormone therapy, estrogen deficiency, vaginal microbiota, lactobacilli, genitourinary syndrome, vulvovaginal atrophy

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3. Oge T, Hassa H, Aydin Y, et al. The relationship between urogenital symptoms and climacteric complaints. Climacteric. 2013;16:646-52. DOI:10.3109/13697137.2012.756467
4. Kim HK, Kang SY, Chung YJ, et al. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015;21(2):65-71. DOI:10.6118/jmm.2015.21.2.65
5. Lamont R, Sobel J, Akins R, et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG. 2011;118(5):533-49. DOI:10.1111/j.1471-0528.2010.02840.x
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19. Drew O, Sherrard J. Sexually transmitted infections in the older woman. Menopause Int. 2008;14(3):134-5. DOI:10.1258/mi.2008.008020
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29. Thomas-White KJ, Hilt EE, Fok C, et al. Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016;27:723-33. DOI:10.1007/s00192-015-2847-x
30. Baber R, Panay N, Fenton A, et al. The IMS Writing Group 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109-50. DOI:10.3109/13697137.2015.1129166
31. Moore K, Dumoulin C, Bradley C, et al. Adult conservative management. Ed. P Abrams, L Cardozo, S Khoury, A Wein. International consultation on urinary incontinence. 5th ed. Plymbridge, UK: Health Publications Ltd., 2013; p. 1101-95.
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33. De Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013;16(2):203-4.
DOI:10.3109/13697137.2013.771520
34. Larsen B, Markovetz AJ, Galask RP. Relationship of vaginal cytology to alterations of the vaginal microflora of rats during the estrous cycle. Appl Environ Microbiol. 1977;33(3):556-62. DOI:10.1128/AEM.33.3.556-562.1977
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Авторы

Ю.Э. Доброхотова, П.А. Шадрова*, В.И. Комагоров

ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*shadrovapolina@hotmail.com

________________________________________________

Yulia E. Dobrokhotova, Polina A. Shadrova*, Vladimir I. Komagorov

Pirogov Russian National Research Medical University, Moscow, Russia
*shadrovapolina@hotmail.com

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