Treatment Of Atrophic Vaginitis Research Articles

Clinical Effect Analysis of Metronidazole and Estrogen Combined Treatment of Atrophic Vaginitis

Clinical Effect Analysis of Metronidazole and Estrogen Combined Treatment of Atrophic Vaginitis

Aloe Vera; A new treatment for atrophic vaginitis, A randomized double-blinded controlled trial

Aim of the studyVaginal atrophy is of the most common problems during menopause with significant psychosocial and medical consequences. Estrogen as an approved therapy for vaginal atrophy can be associated with adverse effects and several contraindications in menopause patients. The aim is to compare the effect of Aloe Vera vaginal cream with commercially available estrogen vaginal cream for management of vaginal atrophy in menopause females. Materials and methodsThis is a double-blinded randomized controlled trial on 60menopause female with complaints of vaginal atrophy symptoms. Subjects were randomly allocated in two groups of 30 patients, named as estrogen and Aloe Vera groups. Vaginal health index (VHI), maturity value (MV), vaginal cytologic smear, transvaginal sonography (TVS) and severity of symptoms related to vaginal atrophy were assessed before and after 6-weeks of vaginal cream administration. ResultsComparison of MV before and after treatment revealed that superficial cells were significantly increased after administration of both vaginal cream (6.67 VS 54.33 in Aloe Vera group; 4.33 VS 59.67 in estrogen group). In addition, VHI (13.83 vs 20.13 in Aloe Vera group; 13.97 vs 19.93 in estrogen group) and symptoms of vaginal atrophy (3.63 vs 1.10 in Aloe Vera group; 3.90 vs 0.66 in estrogen groups) were also significantly improved after treatment in both groups. There was no significant difference between groups after treatment except for fluid volume with a superiority in Aloe Vera group (P-value = 0.004) ConclusionAloe Vera vaginal cream can be as effective as estrogen vaginal cream in the management of vaginal atrophy in menopause females.

Features of functional activity of vaginal epitelium in local treatment of atrophic vaginites

Atrophic vaginitis is the most common vaginal disease in the peri- and postmenopausal period. The timely prescription of pathogenetic therapy and the observation of patients by a gynecologist is a necessary component to achieve positive dynamics in such patients, which will significantly improve the quality of life of women who have entered menopause. Objective – to evaluate the clinical and microbiological efficacy and safety of the use of Climon vaginal gel in the treatment of atrophic age-related vaginitis. Material and methods. To solve this problem, we examined and treated 60 menopausal women diagnosed with atrophic vaginitis. The clinical and microbiological efficacy of the therapy were evaluated. The time of disappearance of objective and subjective symptoms of inflammatory process, features of functional activity of vaginal epithelium, influence of the drug on the state of normal vaginal microflora have been studied. The study was conducted in accordance with international regulations. Results. As a result of the study, it was found that the combined vaginal Climon gel due to the action of the constituent components is effective against conditionally pathogenic microorganisms - causative agents of aerobic vaginitis, promotes the regeneration of epithelium, has anti-inflammatory, antibacterial and fungicidal effect. The Climon gel does not have an immunosuppressive effect on the vaginal epithelium, thus restoring the functional activity of the epithelium after treatment with this drug is faster than after treatment with other agents. Rapid healing of microcracks, mucous membrane moistening, disappearance of clinical symptoms of vaginitis and improvement of quality of life of patients after the treatment were noted. Conclusions. High efficacy of the combined vaginal Climon gel with respect to a wide range of microflora was noted, high therapeutic activity and safety in use in patients with atrophic age-related vaginitis was demonstrated. The climax is well tolerated and does not cause resistance of the microflora. The drug can be used in gynecology for the purpose of regeneration of the mucosa in inflammatory processes of the vagina (bacterial vaginosis, candidiasis), as well as for the prevention of long-term use of glucocorticosteroids, antibacterial agents, after carrying out surgical interventions, in the presence of symptoms and radiotherapy.

Пошук нових методів лікування та профілактики атрофічного вагініту у період постменопаузи

Пошук нових методів лікування та профілактики атрофічного вагініту у період постменопаузи

Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials.

ObjectivesAtrophic vaginitis (AV), which is common in postmenopausal women, is characterized by vaginal dryness, dyspareunia, and discomfort. There are a variety of therapeutic agents for the treatment of AV, besides hormone replacement therapy. We performed this systematic review to compare the effectiveness of various therapies for symptom improvement in AV patients.MethodsWe searched the Cochrane Library, EMBASE, MEDLINE, and other literature (Google Scholar, Web of Science, and hand search) for studies published between January 2010 and March 2015. AV was evaluated by the following outcomes: vaginal pH, dyspareunia, vaginal dryness, or cytological change (endometrial thickness, percentages of superficial cells and parabasal cells). They measured treatment efficacy with various outcomes pertaining to AV symptoms.ResultsMeta-analysis suggested that ospemifene was effective against dyspareunia, vaginal dryness, endometrial thickness, and percentage changes in superficial and parabasal cells. Vaginal pH was most affected by soy isoflavone vaginal gel. Ospemifene was effective for AV symptoms.ConclusionsThis systematic review compared the effects of several therapeutic agents on symptoms of AV through a network meta-analysis. This study provides objective evidence for clinical treatment and efficacy management in AV.

Chitosan Ascorbate Nanoparticles for the Vaginal Delivery of Antibiotic Drugs in Atrophic Vaginitis.

The aim of the present work was the development of chitosan ascorbate nanoparticles (CSA NPs) loaded into a fast-dissolving matrix for the delivery of antibiotic drugs in the treatment of atrophic vaginitis. CSA NPs loaded with amoxicillin trihydrate (AX) were obtained by ionotropic gelation in the presence of pentasodium tripolyphosphate (TPP). Different CSA:TPP and CSA:AX weight ratios were considered and their influence on the particle size, polydispersion index and production yield were investigated. CSA NPs were characterized for mucoadhesive, wound healing and antimicrobial properties. Subsequently, CSA NPs were loaded in polymeric matrices, whose composition was optimized using a DoE (Design of Experiments) approach (simplex centroid design). Matrices were obtained by freeze-drying aqueous solutions of three hydrophilic excipients, polyvinylpirrolidone, mannitol and glycin. They should possess a mechanical resistance suitable for the administration into the vaginal cavity and should readily dissolve in the vaginal fluid. In addition to antioxidant properties, due to the presence of ascorbic acid, CSA NPs showed in vitro mucoadhesive, wound healing and antimicrobial properties. In particular, nanoparticles were characterized by an improved antimicrobial activity with respect to a chitosan solution, prepared at the same concentration. The optimized matrix was characterized by mechanical resistance and by the fast release in simulated vaginal fluid of nanoparticles characterized by unchanged size.

Changes in Vaginal pH After Treatment for Atrophic Vaginitis With a CO2 Laser [4A

Changes in Vaginal pH After Treatment for Atrophic Vaginitis With a CO2 Laser [4A

Depantol drug in the treatment of atrophic colpitis in women in perimenopausal period

In the treatment of aging atrophic vaginitis is widely used hormone replacement therapy. However, from 30% to 67% of women in the menopausal and perimenopausal period not using hormone replacement therapy.The action of non-hormonal drugs used in the treatment of atrophic vaginitis, should be aimed at maintaining the level of lactobacillus and improve the regenerative capacity of the vaginal epithelium. Such properties have a drug depantol. This drug has not only the antibacterial activity but also stimulates the regeneration of the mucous membranes, normalizes cell metabolism, accelerates mitosis, increases the strength of collagen fibers.A study to assess the efficacy of the depantol in atrophic colpitis in perimenopausal women was performed.There were observed 52 patients with a diagnosis atrophic colpitis. All women were perimenopausal age surveyed ranged from 44 to 52 years old. Depantol prescribed 1 suppository 2 times a day for 20 days. The treatment was repeated after 2 weeks: twice in the same regime for 10 days. The efficacy of the therapy was evaluated according colpocytologic, microbiological research and determines the pH level.Dryness of the vagina after treatment was observed in 19.2% of women, whereas before the treatment – in 84.6%. Dyspareunia after treatment observed rarely (5.2%), and its frequency prior to depantol use was 69.2%. Contact spotting after treatment were also absent. Majority of patients had reducing the amount of vaginal discharge. The index of maturity vaginal epithelium after therapy rose to 75–80 points in comparison with the 65–70 points before treatment.Thus, the study showed that the drug depantol in perimenopausal women with atrophic colpitis provides a positive effect and significant antiseptic regenerative activity on vaginal epithelium, which allows recommending its wider use in clinical practice.

Systematic review: treatment of atrophic vaginitis in breast cancer patients treated with aromatase inhibitors

The objective of this study was to determine the body image and sexual life of patients who treated with chemotherapy after mastectomy. The research was carried out between 5th September and 30th December 2014 at Ordu State Hospital in the chemotherapy unit as a cross-sectional and descriptive study. The data was collected with questionnaire including descriptive feature and The Medical Outcomes Body Image scale and Sexual Experiences scale. Statistical analyseswere evaluated via Statistical Package for Social Sciences (SPSS) software program 15.0 for data entry and analysis. 33 female patients accepted participating in the study. The mean age of the women was 48.69, and all women married. 54.5% of women were primary school graduates. The mean age of the women husbands were 51.45% and 45.5% primary and secondary school graduates. Ofwomen treatedwith chemotherapywere body image average 88.03, sexual experiences scale average 17.03. These two results show that, inwomen receiving chemotherapy due to mastectomy had found to be in moderate (88.03±23.80), and their about sexual experiences have proved to be a little reluctant (17.03±10.40).

The comparison between the effects of hyaluronic acid vaginal suppository and vitamin E on the treatment of atrophic vaginitis in menopausal women

Background: Urogenital atrophy is a common problem after menopause and quality of life in post-menopauseis seriously affected by the symptoms associated with vaginal atrophy. The aim of this study was to compare the effectiveness of the vaginal suppository of hyaluronic acid and vitamin E in atrophic vaginitis treatment. Materials and Methods: This randomized double-blind clinical trialwas carried out in Ahvaz (Iran) from August to December 2010. Forty postmenopausal women with symptoms of vaginal atrophy were randomly allocatedto two groups to take vaginal suppositories of either 5 mg hyaluronic acid sodium salt (n=20) or 1 mg vitamin E (n=20) for 8 weeks. The symptoms of vaginal atrophy were evaluated by a self-assessed 4-point scaleand the composite score was determined asnone, mild, moderate, and severe in four periods. Results: The results showed that the symptoms were relieved significantly in both groups (P<0.001).The relief of symptoms was significantly superior in the hyaluronic acid group compared with the vitamin E group (P<0.05). Conclusion: Although both hyaluronic acid and vitamin E relieved the vaginal symptoms, improvements were greater in the hyaluronic acid group. Therefore,hyaluronic acid vaginal suppository is suggested for women with vaginal atrophy who do not want to or cannot take local estrogen treatment.

Fractional CO2 laser treatment for atrophic vaginitis in breast cancer patients using aromatase inhibitors

Fractional CO2 laser treatment for atrophic vaginitis in breast cancer patients using aromatase inhibitors

Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue.

Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

Female sexual dysfunction.

Female sexual dysfunction is a common patient concern. After providing an overview regarding the various types of female sexual dysfunction, we will focus on history taking and treatment options for desire, arousal, orgasm, and pain disorders. Testosterone therapy and management of selective serotonin reuptake inhibitor-associated sexual dysfunction are reviewed. Treatments for atrophic vaginitis are appraised. Patient cases lead the discussion, providing the reader with clinically relevant information.

Causes of and treatment for atrophic vaginitis

Vaginal dryness is a common, underdiagnosed condition that is easily treated, says Suneeta Kochhar

English

The aim of this study was to compare the effectiveness of the vaginal tablet of hyaluronic acid and vitamin E in the treatment of atrophic vaginitis. This randomized, double-blind comparisonstudy was carried out on 40 postmenopausal women with symptoms of vaginal atrophy at number one health educational center of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran from August to December 2010. The women were randomized in two groups to take vaginal tablets containing 5 mg hyaluronic acid sodium salt (n = 20) or 1 mg vitamin E (n = 20) for 8 weeks. The symptoms of vaginal atrophy were evaluated by a self-assessed 4-point scale. Vaginal pH and maturation value were measured and compared in both groups.The results showed that the symptoms were relieved significantly in both the treatment groups (p < 0.001). The relief of symptoms was significantly superior in hyaluronic acid group (0.15) compared to vitamin E group (0.65) (p < 0.05). A significant decrease in vaginal pH were detected in both treatment groups after treatment without difference between the two groups (HA group, pH = 4.975, vitamin E, pH = 5.125). The vaginal maturation values were also significantly improved at both treatment groups (p < 0.001). The mean maturation value was significantly higher in hyaluronic acid group (60.52) compared to vitamin E group (24.50) (p < 0.001). Hyaluronic acid and vitamin E provided relief of vaginal symptoms, decreased vaginal pH and increased maturation of vaginal epithelium, but improvement was greater in hyaluronic acid group. Hence, hyaloronic acid vaginal tablet is suggested for women with vaginal atrophy who do not want to or cannot take local estrogen treatment. Keywords: Menopause, vaginal atrophy, maturation value, hyaluronic acid, vitamin E

The comparison of hyaluronic acid vaginal tablets in the treatment of atrophic vaginitis

We read the study titled ‘‘The comparison of hyaluronic acid vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial’’ by Dr. Murat Ekin et al. published in Arch Gynecol Obstet (2011) 283:539–543 with interest. It is reported in the study that hyaluronic acid-containing vaginal tablets can be effective as an alternative treatment agent for the treatment of atrophic vaginitis in post-menopausal women who cannot use local estrogen. There are some issues which attracted our attention in the material methodology part. It is reported in Table 3, where pre-treatment epithelial atrophy levels of the groups are compared, that about 1/4 (23.8%) of the women in the hyaluronic acid vaginal tablet group (group 2) had severe epithelial atrophy, while none of the cases included in the estradiol vaginal tablet group had severe epithelial atrophy. The authors showed in the table that a statistically significant difference (p 0.012) occurred in the epithelial atrophy signs of the groups in the basal examination. Similar proportional differences between the two groups are manifest in Table 4 where vaginal pH evaluation results are presented as well. Although it is indicated in the title that the study is a randomized trial, there is no explanatory information about the method by which the patients allocated to study and control groups were randomized. The fact that the groups were not homogeneous in terms of vaginal epithelial atrophy signs before treatment suggests a failure of proper randomization in the allocation to study and control groups. The bias in the patient allocation at the beginning of the treatment will affect the evaluation of the treatment outcomes in the study and control group patients who are already small in number. In other words, the results may be expected to favor the group receiving estrogen, which had a better basal condition. We believe that we can make a better evaluation of the study results, if the authors would illuminate the aforementioned issues.

Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis

In this open-label, randomized, multiple-dose, two-treatment crossover study, 24 postmenopausal women with moderate to severe atrophic vaginitis received 0.3 mg conjugated estrogens daily for 14 days: 7 days orally (0.3 mg tablet) and 7 days vaginally (0.5 g cream). Steady-state plasma concentrations of E2 and estrone were one-third lower after vaginal versus oral administration of conjugated estrogens.

Vaginal Estrogen Therapy for the Treatment of Atrophic Vaginitis

The prevalence of atrophic vaginitis (AV) is particularly high among postmenopausal women who experience decreased ovarian estrogen production. This common menopausal condition, which is often underreported and underdiagnosed, is caused by estrogen-related changes to the vaginal epithelium and can adversely affect quality of life. An accurate diagnosis of AV and its severity is important in choosing the appropriate treatment. Numerous formulations for estrogen therapy are available, and the safety and efficacy of these preparations for the treatment of AV have been evaluated in randomized controlled clinical trials. Although systemic administration of estrogen is effective in treating acute vasomotor symptoms typically associated with perimenopause and early menopause, standard doses may not be sufficient for the treatment of AV-related symptoms that generally arise after long-term estrogen deficiency. Thus, vaginal estrogen preparations (e.g., creams, tablets, rings) are more often recommended for women with moderate to severe AV. With any estrogen therapy, consideration of the potential adverse effects vs. associated benefits is necessary. Appropriate clinical intervention with vaginal estrogen formulations may safely offer postmenopausal women relief from undesirable symptoms and emotional distress associated with AV.

Receptor Isoforms That Mediate Estrogen and Progestagen Action in the Female Lower Urinary Tract

Bladder symptoms can be ameliorated by sex steroids but to our knowledge the mechanism of action is unknown. Previous studies of steroid receptor expression in the bladder did not indicate receptor subtype expression. We report the distribution of estrogen and progesterone receptor isoforms in the female lower urinary tract. Prospectively recruited women undergoing routine urogynecological or gynecological surgery provided cold cup biopsy samples from the bladder dome, trigone, and proximal and distal urethra. The samples were immediately frozen or fixed in formalin. After RNA extraction transcripts for estrogen receptor alpha and beta, and progesterone receptor A and B were noted on reverse transcriptase-polymerase chain reaction using isoform specific primers. The precise cellular localization of receptor proteins and their relative levels were assessed by immunochemistry in formalin fixed tissue sections with isoform specific antibodies. Nine premenopausal and 10 postmenopausal women were recruited into the study. Two postmenopausal women on hormone replacement therapy. Estrogen receptor alpha and beta, and progesterone receptor A and B transcripts were detected in whole bladder extracts. Nuclear estrogen receptor alpha immunoreactivity was present in squamous epithelium but absent from transitional epithelium. Estrogen receptor beta immunoreactivity was expressed in squamous and transitional cell epithelium. Nuclear progesterone receptor expression was present in urethral squamous epithelium only. Progesterone receptor expression was greater in premenopausal women and in postmenopausal women on estrogen. Estrogen receptor alpha and beta genes are transcribed in bladder tissue but only estrogen receptor beta is translated into protein, suggesting that the urothelium responds to endogenous estrogen via estrogen receptor beta. Progesterone receptor expression is confined to urethral squamous epithelium and the major isoform is progesterone receptor A.

Efficacy of Low-Dose Estradiol Vaginal Tablets in the Treatment of Atrophic Vaginitis

To evaluate the efficacy of two vaginal doses of estradiol (E2) compared with placebo in the treatment of atrophic vaginitis. In a multi-center, randomized, double-blind, parallel-group study, 230 postmenopausal women received treatment with 25 mcg or 10 mcg E2 or placebo for 12 weeks. Efficacy was measured through composite score of three vaginal symptoms and grading of vaginal health. Additional analyses included maturation of vaginal and urethral mucosa. Safety assessments included endometrial biopsy, adverse events, changes in laboratory tests, and physical examinations. After 12 weeks of treatment, all patients were switched to the open-label extension and received treatment with 25 mcg E2 up to week 52. Vaginal tablets with 25 mcg and 10 mcg E2 showed significant (P<.001) improvement in composite score of vaginal health. Other results with 10 mcg E2 were not entirely consistent with those for 25 mcg E2. Over 12 weeks, both active treatments resulted in greater decreases in vaginal pH than placebo. There were no significant differences between the 25 mcg and 10 mcg E2 groups in terms of improvements in maturation value or composite score of three vaginal symptoms. The efficacy was maintained to week 52 with 25 mcg E2. Vaginal tablets with 25 mcg and 10 mcg E2 provided relief of vaginal symptoms, improved urogenital atrophy, decreased vaginal pH, and increased maturation of the vaginal and urethral epithelium. Those improvements were greater with 25 mcg than with 10 mcg E2. Both doses were effective in the treatment of atrophic vaginitis. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00465192 and NCT00464971 I.