Негормональные терапевтические возможности при вульвовагинальной атрофии. Разбор клинических случаев

Мотовилова Т.М., Сиротина Л.З., Трифонова О.Ю., Круглова И.А., Варнавская А.Д., Казакова К.В. Негормональные терапевтические возможности при вульвовагинальной атрофии. Разбор клинических случаев. Гинекология. 2025;27(1):1–5. DOI: 10.26442/20795696.2025.1.203132

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

________________________________________________

Motovilova TM, Sirotina LZ, Trifonova OIu, Kruglova IA, Varnavskaya AD, Kazakova KV. Non-hormonal therapies for vulvovaginal atrophy: Clinical cases. Gynecology. 2025;27(1):1–5. DOI: 10.26442/20795696.2025.1.203132

Читать PDF

Аннотация

Период менопаузы ассоциирован с дефицитом половых гормонов, что оказывает существенное влияние на физическое и психоэмоциональное состояние женщины. В частности, ухудшается кровоснабжение органов мочеполовой системы, нарушается синтез соединительнотканных волокон эластина и коллагена, в результате чего наступает атрофия эпителиальных и мышечных структур. С течением времени на фоне атрофических процессов в мочеполовой системе изменяется микробиоценоз. Данные процессы становятся причиной развития проявлений генитоуринарного менопаузального синдрома (ГУМС). Традиционный патогенетический метод коррекции проявлений ГУМС – локальная гормонотерапия препаратами эстриола. Однако есть большая когорта женщин, которые имеют противопоказания к применению гормональных препаратов или не желают их использовать. Перспективной негормональной опцией терапии является комбинация средств, содержащих фитоэстрогены, гиалуроновую кислоту, цитокины и антимикробные пептиды, в форме суппозиториев (Суперлимф) и дозированного крема (Эстрогиал Плюс), которые оказывают синергичный репаративный, увлажняющий, антиоксидантный и антимикробный эффекты. В статье приведены клинические случаи успешного и безопасного применения комбинации негормональных средств у пациенток с ГУМС, что позитивно отразилось на их качестве жизни и подтверждено объективными клинико-лабораторными данными.

Ключевые слова: генитоуринарный менопаузальный синдром, вульвовагинальная атрофия, фитоэстрогены, гиалуроновая кислота, антимикробные пептиды, цитокины, Эстрогиал Плюс, Суперлимф

________________________________________________

Menopause is associated with a deficiency of sex hormones, which significantly impacts a woman's physical and psycho-emotional state. In particular, the blood supply to the genitourinary system organs deteriorates, and the synthesis of connective tissue fibers of elastin and collagen is disrupted, resulting in atrophy of epithelial and muscle structures. Over time, microbiocenosis changes due to atrophic processes in the genitourinary system. These processes cause the development of genitourinary syndrome of menopause (GSM). The traditional pathogenetic method of treatment of GSM manifestations is local hormone therapy with estriol-containing drugs. However, there is a large cohort of women who have contraindications for hormonal agents or are unwilling to use them. A promising non-hormonal therapy option is a combination of agents containing phytoestrogens, hyaluronic acid, cytokines and antimicrobial peptides in the form of suppositories (Superlymph) and a dosed cream (Estrogial Plus), which have synergistic reparative, moisturizing, antioxidant, and antimicrobial effects. The article presents clinical cases of effective and safe use of a combination of non-hormonal agents in patients with GSM, which improved their quality of life and was confirmed by objective clinical and laboratory data.

Keywords: genitourinary syndrome of menopause, vulvovaginal atrophy, phytoestrogens, hyaluronic acid, antimicrobial peptides, cytokines, Estrogial Plus, Superlymph

Полный текст

Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Sarmento ACA, Costa APF, Vieira-Baptista P, et al. Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. Front Reprod Health. 2021;3:779398. DOI:10.3389/frph.2021.779398
2. Chen YS, Wang XJ, Feng W, Hua KQ. Advanced glycation end products decrease collagen I levels in fibroblasts from the vaginal wall of patients with POP via the RAGE, MAPK and NF-κB pathways. Int J Mol Med. 2017;40(4):987-98. DOI:10.3892/ijmm.2017.3097
3. Guler Z, Roovers JP. Role of Fibroblasts and Myofibroblasts on the Pathogenesis and Treatment of Pelvic Organ Prolapse. Biomolecules. 2022;12(1). DOI:10.3390/biom12010094
4. Waetjen LE, Crawford SL, Gajer P, et al. Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation. Menopause. 2023;30(11):1073-84. DOI:10.1097/GME.0000000000002263
5. Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018;25(11):1321-30. DOI:10.1097/GME.0000000000001236
6. Shardell M, Gravitt PE, Burke AE, et al. Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages. J Gerontol A Biol Sci Med Sci. 2021;76(9):1542-50. DOI:10.1093/gerona/glab120
7. de Oliveira NS, de Lima ABF, de Brito JCR, et al. Postmenopausal Vaginal Microbiome and Microbiota. Front Reprod Health. 2021;3:780931. DOI:10.3389/frph.2021.780931
8. Hamoda H, Panay N, Pedder H, et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020;26(4):181-209. DOI:10.1177/2053369120957514
9. Angelou K, Grigoriadis T, Diakosavvas M, et al. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. DOI:10.7759/cureus.7586
10. Макацария А.Д., Блинов Д.В., Бицадзе В.О., Хизроева Д.Х. Лечение эстриолом вульвовагинальной атрофии в постменопаузе: обновление научных данных. 2014–2018 гг. Акушерство, Гинекология и Репродукция. 2019;13(3):227-38 [Makatsariya AD, Blinov DV, Bitsadze VO, Khizroeva JKh. Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018. Obstetrics, Gynecology and Reproduction. 2019;13(3):227-38 (in Russian)]. DOI:10.17749/2313-7347.2019.13.227-238
11. Diedrich CM, Kastelein AW, Verri FM, et al. Effects of topical estrogen therapy on the vaginal microcirculation in women with vulvovaginal atrophy. Neurourol Urodyn. 2019;38(5):1298-304. DOI:10.1002/nau.23977
12. Galli V, Golia D'Augè T, DI Pierro F, et al. Safety and efficacy of a class II medical device based on highly purified and standardized plant extracts in the management of post-menopausal patients with vulvar and vaginal atrophy: a single-center prospective observational study. Minerva Obstet Gynecol. 2024;76(4):343-52.
DOI:10.23736/S2724-606X.23.05409-X
13. Pingarrón Santofímia C, Lafuente González P, Guitiérrez Vélez MDC, et al. Long-term use of ospemifene in clinical practice for vulvo-vaginal atrophy: end results at 12 months of follow-up. Gynecol Endocrinol. 2022;38(7):577-82. DOI:10.1080/09513590.2022.2083103
14. Abedi P, Zohrabi I, Ansari S, et al. The Impact of Oxytocin Vaginal Gel on Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Marital Ther. 2020;46(4):377-84. DOI:10.1080/0092623X.2020.1738606
15. Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10):1124-10. DOI:10.1097/GME.0000000000001122
16. Saleh DM, Abdelghani R. Clinical evaluation of autologous platelet rich plasma injection in postmenopausal vulvovaginal atrophy: A pilot study. J Cosmet Dermatol. 2022;21(10):4269-25. DOI:10.1111/jocd.14873
17. Waghe T, Acharya N, Karnik M, et al. Role of Platelet-Rich Plasma in Genitourinary Syndrome of Menopause. Cureus. 2024;16(1):e53316. DOI:10.7759/cureus.53316
18. Rosner-Tenerowicz A, Zimmer-Stelmach A, Zimmer M. The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy. Ginekol Pol. 2021. DOI:10.5603/GP.a2021.0140
19. Pinheiro C, Costa T, Amorim de Jesus R, et al. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Womens Health. 2021;21(1):379. DOI:10.1186/s12905-021-01518-8
20. Адамян Л.В., Ашрафян Л.А., Андреева Е.Н., и др. Менопауза и климактерическое состояние у женщины. Клинические рекомендации. М. 2021 [Adamian LV, Ashrafian LA, Andreeva EN, et al. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. Moscow. 2021 (in Russian)].
21. European Medicines Agency. CHMP summary of positive opinion for senshio [cited 01 Oct 2019]. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/huma.... Accessed: 20.11.2023
22. Прилепская В.Н., Назарова Н.М., Девяткина А.Р., и др. Возможности и перспективы локального применения гиалуроновой кислоты при вульвовагинальной атрофии у женщин репродуктивного возраста. Гинекология. 2024;26(3):254-9 [Prilepskaya VN, Nazarova NM, Devyatkina AR, et al. Potential and perspectives of local application of hyaluronic acid in vulvovaginal atrophy in women of reproductive age: A review. Gynecology. 2024;26(3):254-9 (in Russian)]. DOI:10.26442/20795696.2024.3.202932
23. Garantziotis S, Savani RC. Hyaluronan biology: A complex balancing act of structure, function, location and context. Matrix Biol. 2019;78-9:1-10. DOI:10.1016/j.matbio.2019.02.002
24. Dinicola S, Pasta V, Costantino D, et al. Hyaluronic acid and vitamins are effective in reducing vaginal atrophy in women receiving radiotherapy. Minerva Ginecol. 2015;67(6):523-31.
25. Sayahi M, Keramat A, Nourimand F, Mohammadzadeh H. Is there a difference between the effects of phytoestrogens and non-phytoestrogens medicinal plants on sexual health? A systematic review and meta-analysis. Int J Reprod Biomed. 2023;21(11):881-900. DOI:10.18502/ijrm.v21i11.14652
26. Cheilari A, Vontzalidou A, Makropoulou M, et al. Isoflavonoid Profiling and Estrogen-Like Activity of Four Genista Species from the Greek Flora. Molecules. 2020;25(23). DOI:10.3390/molecules25235507
27. Simader E, Beer L, Laggner M, et al. Tissue-regenerative potential of the secretome of γ-irradiated peripheral blood mononuclear cells is mediated via TNFRSF1B-induced necroptosis. Cell Death Dis. 2019;10(10):729. DOI:10.1038/s41419-019-1974-6
28. Vorstandlechner V, Copic D, Klas K, et al. The Secretome of Irradiated Peripheral Mononuclear Cells Attenuates Hypertrophic Skin Scarring. Pharmaceutics. 2023;15(4). DOI:10.3390/pharmaceutics15041065

________________________________________________

1. Sarmento ACA, Costa APF, Vieira-Baptista P, et al. Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic. Front Reprod Health. 2021;3:779398. DOI:10.3389/frph.2021.779398
2. Chen YS, Wang XJ, Feng W, Hua KQ. Advanced glycation end products decrease collagen I levels in fibroblasts from the vaginal wall of patients with POP via the RAGE, MAPK and NF-κB pathways. Int J Mol Med. 2017;40(4):987-98. DOI:10.3892/ijmm.2017.3097
3. Guler Z, Roovers JP. Role of Fibroblasts and Myofibroblasts on the Pathogenesis and Treatment of Pelvic Organ Prolapse. Biomolecules. 2022;12(1). DOI:10.3390/biom12010094
4. Waetjen LE, Crawford SL, Gajer P, et al. Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation. Menopause. 2023;30(11):1073-84. DOI:10.1097/GME.0000000000002263
5. Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018;25(11):1321-30. DOI:10.1097/GME.0000000000001236
6. Shardell M, Gravitt PE, Burke AE, et al. Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages. J Gerontol A Biol Sci Med Sci. 2021;76(9):1542-50. DOI:10.1093/gerona/glab120
7. de Oliveira NS, de Lima ABF, de Brito JCR, et al. Postmenopausal Vaginal Microbiome and Microbiota. Front Reprod Health. 2021;3:780931. DOI:10.3389/frph.2021.780931
8. Hamoda H, Panay N, Pedder H, et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020;26(4):181-209. DOI:10.1177/2053369120957514
9. Angelou K, Grigoriadis T, Diakosavvas M, et al. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. DOI:10.7759/cureus.7586
10. Makatsariya AD, Blinov DV, Bitsadze VO, Khizroeva JKh. Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018. Obstetrics, Gynecology and Reproduction. 2019;13(3):227-38 (in Russian). DOI:10.17749/2313-7347.2019.13.227-238
11. Diedrich CM, Kastelein AW, Verri FM, et al. Effects of topical estrogen therapy on the vaginal microcirculation in women with vulvovaginal atrophy. Neurourol Urodyn. 2019;38(5):1298-304. DOI:10.1002/nau.23977
12. Galli V, Golia D'Augè T, DI Pierro F, et al. Safety and efficacy of a class II medical device based on highly purified and standardized plant extracts in the management of post-menopausal patients with vulvar and vaginal atrophy: a single-center prospective observational study. Minerva Obstet Gynecol. 2024;76(4):343-52.
DOI:10.23736/S2724-606X.23.05409-X
13. Pingarrón Santofímia C, Lafuente González P, Guitiérrez Vélez MDC, et al. Long-term use of ospemifene in clinical practice for vulvo-vaginal atrophy: end results at 12 months of follow-up. Gynecol Endocrinol. 2022;38(7):577-82. DOI:10.1080/09513590.2022.2083103
14. Abedi P, Zohrabi I, Ansari S, et al. The Impact of Oxytocin Vaginal Gel on Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Marital Ther. 2020;46(4):377-84. DOI:10.1080/0092623X.2020.1738606
15. Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10):1124-10. DOI:10.1097/GME.0000000000001122
16. Saleh DM, Abdelghani R. Clinical evaluation of autologous platelet rich plasma injection in postmenopausal vulvovaginal atrophy: A pilot study. J Cosmet Dermatol. 2022;21(10):4269-25. DOI:10.1111/jocd.14873
17. Waghe T, Acharya N, Karnik M, et al. Role of Platelet-Rich Plasma in Genitourinary Syndrome of Menopause. Cureus. 2024;16(1):e53316. DOI:10.7759/cureus.53316
18. Rosner-Tenerowicz A, Zimmer-Stelmach A, Zimmer M. The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy. Ginekol Pol. 2021. DOI:10.5603/GP.a2021.0140
19. Pinheiro C, Costa T, Amorim de Jesus R, et al. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Womens Health. 2021;21(1):379. DOI:10.1186/s12905-021-01518-8
20. Adamian LV, Ashrafian LA, Andreeva EN, et al. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. Moscow. 2021 (in Russian).
21. European Medicines Agency. CHMP summary of positive opinion for senshio [cited 01 Oct 2019]. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/huma.... Accessed: 20.11.2023
22. Prilepskaya VN, Nazarova NM, Devyatkina AR, et al. Potential and perspectives of local application of hyaluronic acid in vulvovaginal atrophy in women of reproductive age: A review. Gynecology. 2024;26(3):254-9 (in Russian). DOI:10.26442/20795696.2024.3.202932
23. Garantziotis S, Savani RC. Hyaluronan biology: A complex balancing act of structure, function, location and context. Matrix Biol. 2019;78-9:1-10. DOI:10.1016/j.matbio.2019.02.002
24. Dinicola S, Pasta V, Costantino D, et al. Hyaluronic acid and vitamins are effective in reducing vaginal atrophy in women receiving radiotherapy. Minerva Ginecol. 2015;67(6):523-31.
25. Sayahi M, Keramat A, Nourimand F, Mohammadzadeh H. Is there a difference between the effects of phytoestrogens and non-phytoestrogens medicinal plants on sexual health? A systematic review and meta-analysis. Int J Reprod Biomed. 2023;21(11):881-900. DOI:10.18502/ijrm.v21i11.14652
26. Cheilari A, Vontzalidou A, Makropoulou M, et al. Isoflavonoid Profiling and Estrogen-Like Activity of Four Genista Species from the Greek Flora. Molecules. 2020;25(23). DOI:10.3390/molecules25235507
27. Simader E, Beer L, Laggner M, et al. Tissue-regenerative potential of the secretome of γ-irradiated peripheral blood mononuclear cells is mediated via TNFRSF1B-induced necroptosis. Cell Death Dis. 2019;10(10):729. DOI:10.1038/s41419-019-1974-6
28. Vorstandlechner V, Copic D, Klas K, et al. The Secretome of Irradiated Peripheral Mononuclear Cells Attenuates Hypertrophic Skin Scarring. Pharmaceutics. 2023;15(4). DOI:10.3390/pharmaceutics15041065

Авторы

Т.М. Мотовилова*^1,2, Л.З. Сиротина^1,2, О.Ю. Трифонова², И.А. Круглова³, А.Д. Варнавская¹, К.В. Казакова¹

¹ФГБОУ ВО «Приволжский исследовательский медицинский университет», Нижний Новгород, Россия;
²ООО «Клиника Современных Технологий “Садко”», Нижний Новгород, Россия;
³ГБУЗ НО «Городская клиническая больница №35», Нижний Новгород, Россия
*tmshka@mail.ru

________________________________________________

Tatiana M. Motovilova*^1,2, Liya Z. Sirotina^1,2, Oksana Iu. Trifonova², Irina A. Kruglova³, Anastasiya D. Varnavskaya¹, Kseniia V. Kazakova¹

¹Privolzhsky Research Medical University, Nizhny Novgorod, Russia;
²Clinic of Modern Technologies “Sadko” LLC, Nizhny Novgorod, Russia;
³City Clinical Hospital №35, Nizhny Novgorod, Russia
*tmshka@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.