Вульвовагинальная атрофия в пери- и постменопаузе: актуальность проблемы и влияние на качество жизни

Оразов М.Р., Силантьева Е.С., Радзинский В.Е., Михалева Л.М., Хрипач Е.А., Долгов Е.Д. Вульвовагинальная атрофия в пери- и постменопаузе: актуальность проблемы и влияние на качество жизни. Гинекология. 2022;24(5):408–412. DOI: 10.26442/20795696.2022.5.201854
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

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Orazov MR, Silantyeva ES, Radzinsky VE, Mikhaleva LM, Khripach EA, Dolgov ED. Vulvovaginal atrophy in the peri- and post-menopause: relevance and impact on quality of life. Gynecology. 2022;24(5):408–412.
DOI: 10.26442/20795696.2022.5.201854

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Аннотация

Вульвовагинальную атрофию (ВВА) выявляют более чем у 50% женщин в постменопаузе, а в 40–49 лет соответствующие признаки имеют 15–19%. Атрофические изменения в женской мочеполовой системе связаны с гипоэстрогенией, в результате которой происходит дефектный синтез коллагена и эластина за счет снижения функциональной активности фибробластов. Несмотря на то что симптоматика генитоуринарного менопаузального синдрома существенно ухудшает качество жизни, сами женщины редко предъявляют жалобы на урогенитальные симптомы, считая их нормальным состоянием для периода старения. Мы выполнили поиск научных публикаций в базах данных CochraneLibrary, PubMed, Science Direct, ELibrary по ключевым словам vulvovaginal atrophy/вульвовагинальная атрофия, genitourinary syndrome of menopause /генитоуринарный менопаузальный синдром, quality of life/качество жизни, epidemiology/эпидемиология, postmenopausal age/постменопаузальный возраст за 2012–2022 годы. Выполненный анализ литературы позволил сделать вывод, что распространенность ВВА чрезвычайно высока, но недооценена в связи с редкой обращаемостью пациенток с соответствующими жалобами за медицинской помощью. Генитоуринарный менопаузальный синдром оказывает резко негативное влияние на качество жизни пациенток, но лечение получают далеко не все женщины, которым такая терапия показана. Одна из причин отказа от гормонального лечения – страх пациенток перед системным действием гормональных препаратов. Необходим поиск альтернативных негормональных методов терапии.
Цель. Провести анализ и систематизировать накопленные за последние 10 лет научные данные об эпидемиологии ВВА, ее влиянии на качество жизни пациенток, о сложностях при диагностике и лечении этого заболевания.

Ключевые слова: вульвовагинальная атрофия, генитоуринарный менопаузальный синдром, заболеваемость, качество жизни, обзор

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Vulvovaginal atrophy (VVA) is detected in more than 50% of postmenopausal women, and at 40–49 years of age, 15-19% of women have relevant signs. Atrophic changes in the female urogenital system are associated with hypoestrogenism, which results in the defective synthesis of collagen and elastin due to reduced functional activity of fibroblasts. Although the symptoms of genitourinary syndrome of menopause significantly impair the quality of life, women rarely seek medical help for urogenital symptoms, considering them a normal condition for the period of aging. We searched Cochrane Library, PubMed, Science Direct, and ELibrary databases for the keywords vulvovaginal atrophy, genitourinary syndrome of menopause, quality of life, epidemiology, and postmenopausal age for 2012–2022. The literature review suggests that the prevalence of VVA is extremely high but underestimated due to the infrequent seeking of medical care by female patients with relevant symptoms. The genitourinary syndrome of menopause dramatically impacts patients' quality of life, but not all women eligible for treatment receive it. One of the reasons for refusing hormonal treatment is patients' fear of the systemic effects of hormonal drugs. There is an unmet need for alternative non-hormonal therapies. The objective is to analyze and systematize the scientific data accumulated over the past ten years on the epidemiology of VVA, its impact on patients' quality of life, and the challenges in diagnosing and treating the disease.

Keywords: vulvovaginal atrophy, genitourinary syndrome of menopause, incidence, quality of life, review

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Список литературы

1. Kingsberg SA, Krychman M, Graham S, et al. The Women’s EMPOWER Survey: Identifying Women’s Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med. 2017;14(3):413-24. DOI:10.1016/j.jsxm.2017.01.010
2. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. 2014;79(3):349-54. DOI:10.1016/j.maturitas.2014.07.013
3. Менопауза и климактерическое состояние у женщины. Клинические рекомендации. Режим доступа: http://www.consultant.ru/document/cons_doc_LAW_390969/8efd5f17af55cb35a770f73937590c642437b7eb/ Ссылка активна на 18.02.2022 [Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. Available at: http://www.consultant.ru/document/cons_doc_LAW_390969/8efd5f17af55cb35a770f73937590c642437b7eb/ Accessed: 18.02.2022 (in Russian)].
4. Peters KJ. What Is Genitourinary Syndrome of Menopause and Why Should We Care? Perm J. 2021;25:20.248. DOI:10.7812/TPP/20.248
5. Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013;10(7):1790-9. DOI:10.1111/jsm.12190
6. Nappi RE, Palacios S, Panay N, et al. Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey. Climacteric. 2016;19(2):188-97. DOI:10.3109/13697137.2015.1107039
7. Spadt SK, Larkin LC. Genitourinary syndrome of menopause: the unmet need. Menopause. 2021;28(4):444-6. DOI:10.1097/GME.0000000000001701
8. Nappi RE, Palacios S, Bruyniks N, et al. EVES Study investigators. The burden of vulvovaginal atrophy on women’s daily living: implications on quality of life from a face-to-face real-life survey. Menopause. 2019;26(5):485-91. DOI:10.1097/GME.0000000000001260
9. Islam RM, Bell RJ, Davis SR. Prevalence of sexual symptoms in relation to menopause in women in Asia: a systematic review. Menopause. 2018;25(2):231-8. DOI:10.1097/GME.0000000000000967
10. Cagnacci A, Carbone MM, Palma F; AGATA study. Prevalence and association between objective signs and subjective symptoms of vaginal atrophy: the AGATA study. Menopause. 2016;23(10):1139-45. DOI:10.1097/GME.0000000000000675
11. Selvi I, Baydilli N, Yuksel D, et al. Reappraisal of the Definition Criteria for "Genitourinary Syndrome of Menopause", and its Effect on Quality of Life in Turkish Postmenopausal Women. Urology. 2020;144:83-91. DOI:10.1016/j.urology.2020.07.025
12. Phillips NA, Bachmann GA. Genitourinary syndrome of menopause: Common problem, effective treatments. Cleve Clin J Med. 2018;85(5):390-8. DOI:10.3949/ccjm.85a.15081
13. Martin DH. The microbiota of the vagina and its influence on women’s health and disease. Am J Med Sci. 2012;343(1):2-9. DOI:10.1097/MAJ.0b013e31823ea228
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15. McCall-Hosenfeld JS, Jaramillo SA, Legault C, et al. Members of Women’s Health Initiative-Observational Study. Correlates of sexual satisfaction among sexually active postmenopausal women in the Women’s Health Initiative-Observational Study. J Gen Intern Med. 2008;23(12):2000-9. DOI:10.1007/s11606-008-0820-9
16. Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36-44. DOI:10.3109/13697137.2011.647840
17. Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013;10(9):2232-41. DOI:10.1111/jsm.12235
18. DiBonaventura M, Luo X, Moffatt M, et al. The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe. J Womens Health (Larchmt). 2015;24(9):713-22. DOI:10.1089/jwh.2014.5177
19. Moyneur E, Dea K, Derogatis LR, et al. Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia. Menopause. 2020;27(2):134-42. DOI:10.1097/GME.0000000000001450
20. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016;2016(8):CD001500. DOI:10.1002/14651858.CD001500.pub3
21. Li J, Li H, Zhou Y, et al. The Fractional CO2 Laser for the Treatment of Genitourinary Syndrome of Menopause: A Prospective Multicenter Cohort Study. Lasers Surg Med. 2021;53(5):647-53. DOI:10.1002/lsm.23346
22. Flint R, Cardozo L, Grigoriadis T, et al. Rationale and design for fractional microablative CO2 laser versus photothermal non-ablative erbium:YAG laser for the management of genitourinary syndrome of menopause: a non-inferiority, single-blind randomized controlled trial. Climacteric. 2019;22(3):307-11. DOI:10.1080/13697137.2018.1559806

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1. Kingsberg SA, Krychman M, Graham S, et al. The Women’s EMPOWER Survey: Identifying Women’s Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med. 2017;14(3):413-24. DOI:10.1016/j.jsxm.2017.01.010
2. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. 2014;79(3):349-54. DOI:10.1016/j.maturitas.2014.07.013
3. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. Available at: http://www.consultant.ru/document/cons_doc_LAW_390969/8efd5f17af55cb35a770f73937590c642437b7eb/ Accessed: 18.02.2022 (in Russian).
4. Peters KJ. What Is Genitourinary Syndrome of Menopause and Why Should We Care? Perm J. 2021;25:20.248. DOI:10.7812/TPP/20.248
5. Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013;10(7):1790-9. DOI:10.1111/jsm.12190
6. Nappi RE, Palacios S, Panay N, et al. Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey. Climacteric. 2016;19(2):188-97. DOI:10.3109/13697137.2015.1107039
7. Spadt SK, Larkin LC. Genitourinary syndrome of menopause: the unmet need. Menopause. 2021;28(4):444-6. DOI:10.1097/GME.0000000000001701
8. Nappi RE, Palacios S, Bruyniks N, et al. EVES Study investigators. The burden of vulvovaginal atrophy on women’s daily living: implications on quality of life from a face-to-face real-life survey. Menopause. 2019;26(5):485-91. DOI:10.1097/GME.0000000000001260
9. Islam RM, Bell RJ, Davis SR. Prevalence of sexual symptoms in relation to menopause in women in Asia: a systematic review. Menopause. 2018;25(2):231-8. DOI:10.1097/GME.0000000000000967
10. Cagnacci A, Carbone MM, Palma F; AGATA study. Prevalence and association between objective signs and subjective symptoms of vaginal atrophy: the AGATA study. Menopause. 2016;23(10):1139-45. DOI:10.1097/GME.0000000000000675
11. Selvi I, Baydilli N, Yuksel D, et al. Reappraisal of the Definition Criteria for "Genitourinary Syndrome of Menopause", and its Effect on Quality of Life in Turkish Postmenopausal Women. Urology. 2020;144:83-91. DOI:10.1016/j.urology.2020.07.025
12. Phillips NA, Bachmann GA. Genitourinary syndrome of menopause: Common problem, effective treatments. Cleve Clin J Med. 2018;85(5):390-8. DOI:10.3949/ccjm.85a.15081
13. Martin DH. The microbiota of the vagina and its influence on women’s health and disease. Am J Med Sci. 2012;343(1):2-9. DOI:10.1097/MAJ.0b013e31823ea228
14. Parish SJ, Nappi RE, Krychman ML, et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013;5:437-47. DOI:10.2147/IJWH.S44579
15. McCall-Hosenfeld JS, Jaramillo SA, Legault C, et al. Members of Women’s Health Initiative-Observational Study. Correlates of sexual satisfaction among sexually active postmenopausal women in the Women’s Health Initiative-Observational Study. J Gen Intern Med. 2008;23(12):2000-9. DOI:10.1007/s11606-008-0820-9
16. Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36-44. DOI:10.3109/13697137.2011.647840
17. Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013;10(9):2232-41. DOI:10.1111/jsm.12235
18. DiBonaventura M, Luo X, Moffatt M, et al. The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe. J Womens Health (Larchmt). 2015;24(9):713-22. DOI:10.1089/jwh.2014.5177
19. Moyneur E, Dea K, Derogatis LR, et al. Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia. Menopause. 2020;27(2):134-42. DOI:10.1097/GME.0000000000001450
20. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016;2016(8):CD001500. DOI:10.1002/14651858.CD001500.pub3
21. Li J, Li H, Zhou Y, et al. The Fractional CO2 Laser for the Treatment of Genitourinary Syndrome of Menopause: A Prospective Multicenter Cohort Study. Lasers Surg Med. 2021;53(5):647-53. DOI:10.1002/lsm.23346
22. Flint R, Cardozo L, Grigoriadis T, et al. Rationale and design for fractional microablative CO2 laser versus photothermal non-ablative erbium:YAG laser for the management of genitourinary syndrome of menopause: a non-inferiority, single-blind randomized controlled trial. Climacteric. 2019;22(3):307-11. DOI:10.1080/13697137.2018.1559806

Авторы

М.Р. Оразов*1, Е.С. Силантьева2, В.Е. Радзинский1, Л.М. Михалева3, Е.А. Хрипач4, Е.Д. Долгов1

1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 Клинический госпиталь «Лапино-1» «Мать и дитя», Москва, Россия;
3 Научно-исследовательский институт морфологии человека им. акад. А.П. Авцына ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского», Москва, Россия;
4 Многопрофильный медицинский центр «DEKA Medical», Москва, Россия
*omekan@mail.ru

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Mekan R. Orazov*1, Elena S. Silantyeva2, Viktor E. Radzinsky1, Liudmila M. Mikhaleva3, Elizaveta A. Khripach4, Evgeny D. Dolgov1

1 People’s Friendship University of Russia (RUDN University), Moscow, Russia;
2 Clinical Hospital “Lapino-1” “Mother and Child”, Moscow, Russia;
3 Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery;
4 Multidisciplinary Medical Center “DEKA Medical”, Moscow, Russia
*omekan@mail.ru

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