Preview

Title

Advanced search

Local Hormonal Therapy for Genitourinary Menopausal Syndrome

https://doi.org/10.31550/1727-2378-2023-22-5-95-100

Abstract

   Aim: To justify the viability and safety of local hormonal therapy with oestrogens in genitourinary syndrome of menopause.

   Key points. The overall ageing of the population results in an increased number of women who have problems during menopause associated with gradual reduction and switching-off of ovarian function and cessation of oestrogen generation by ovaries. Local changes at the pelvic level (urethra, bladder, vagina) are described as genitourinary syndrome of menopause. The most effective therapies for the syndrome include local hormonal therapy with oestrogens, including oestriol which is of interest due to its specific targeted action and lack of proliferative effect on endometrium and mammary glands. The use of oestriol eliminates a number of problems caused by oestrogen insufficiency: it minimises or eliminates dyspareunea, dryness and itching in vagina and lower section of the urogenital tract, inappropriate urination, enuresis, and recurring vulvovaginitis and cystitis.

   Conclusion. It has been proven that the local use of oestriol is efficient and safe for the management of genitourinary syndrome of menopause. The selection of a specific medicinal product should be evidence-based and should take into account the route of administration and pharmacological properties, including preparation of the active ingredient, and excipients contributing to the overall efficiency and safety.

About the Authors

S. V. Yureneva
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov
Russian Federation

117997; 4 Academician Oparin Str.; Moscow



G. Yu. Knorring
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

127473; 20 Delegatskaya St., build. 1; Moscow



References

1. Tkacheva O.N., Dobrokhotova Yu.E., Dudinskaya E.N., Kotovskaya Yu.V. et al. Prevention of early ageing in women. Methodical recommendations. М.; 2018. 52 p. (in Russian)

2. Ulumbekova G.E., Khudova I.Yu. Demographic, social and economic effects of menopause hormonal therapy. Healthcare Management: News, Views, Education. Bulletin of VSHOUZ. 2020;6(4):23–53. (in Russian). DOI: 10.24411/2411-8621-2020-14002

3. Prilepskaya V.N. Genitourinary menopausal syndrome: the potential of estriol. Gynecology. 2018;20(1):5–8. (in Russian). DOI: 10.26442/2079-5696_20.1.5-8

4. Andreeva E.N., Sheremetyeva E.V. The role of estriol in the treatment of atrophy of the mucous membrane of the lower genitourinary tract in postmenopausal women. Problems of Endocrinology. 2022;68(6):157–63. (in Russian). DOI: 10.14341/probl13198

5. Serov V.N., Zharov E.V., Perepanova T.S., Khazan P.L. et al. Modern pathogenetic therapy of urogenital disorders in postmenopausal women. M.; 2008. (in Russian)

6. Yakushevskaya O.V. Menopause and genitourinary health: optimal support and correction of disorders. Medical Council. 2022;16:136–41. (in Russian). DOI: 10.21518/2079-701X-2022-16-16-1

7. Maciejewska-Jeske M., Szeliga A., Męczekalski B. Consequences of premature ovarian insufficiency on women's sexual health. Prz. Menopauzalny. 2018;17(3):127–30. DOI: 10.5114/pm.2018.78557

8. Kershaw V., Jha S. Female sexual dysfunction. Obstet. Gynecol. 2022;24(1):12–23. DOI: 10.1111/tog.12778

9. Serov V.N., Zharov E.V. Therapy for urogenital disorders after surgical menopause. Obstetrics and Gynecology. 2011;7(2):73–7. (in Russian)

10. Nappi R.E., Palacios S., Bruyniks N., Particco M. et al. 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

11. Shifren J.L. Genitourinary syndrome of menopause. Clin. Obstet. Gynecol. 2018;61(3):508–16. DOI: 10.1097/GRF.0000000000000380

12. Makatsariya A.D., Blinov D.V., Bitsadze V.O., Khizroeva J.Kh. 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: 10.17749/2313-7347.2019.13.3.227-238

13. Kulakov V.I., Vikhlyaeva E.M., eds. Menopausal syndrome. Clinic, diagnosis, prevention and hormone replacement therapy. M.; 1996. 66 p. (in Russian)

14. Salimova L.Ya., Shalaev O.N., Parsadanyan S.A., Omarova R.Z. Diagnostic significance of additional instrumental methods of examination of patients with pelvic organ prolapse. Bulletin of Peoples’ Friendship University. Series “Medicine”. 2013;S5:164–9. (in Russian)

15. Apresyan S.V., Dimitrova V. I., Slyusareva O.A. Prevention of complications of estrogen-dependent complications in preoperative preparation of women with genital prolapse and stress urinary incontinence. Medical Council. 2016;2:96–9. (in Russian). DOI: 10.21518/2079-701X-2016-2-96-99

16. Sukhikh G.T., Danilov A.Yu., Botasheva D.A. Role of immunohistochemical and genetic factors in specifying the etiology and patogenesis of genital prolapse in women. Russian Bulletin of Obstetrician-Gynecologist. 2012;12(2):47–50. (in Russian)

17. Dobrokhotova Yu.E., Nagieva T.S., Il'ina I.Yu., Slobodyanyuk B.A. et al. Estriol effect on vaginal mucosa collagen turnover in postpartum women after plastic surgery. Experimental and Clinical Pharmacology. 2019;82(8):17–21. (in Russian). DOI: 10.30906/0869-2092-2019-82-8-17-21

18. Panay N., Palacios S., Bruyniks N., Particco M. et al. Symptom severity and quality of life in the management of vulvovaginal atrophy in postmenopausal women. Maturitas. 2019;124(4):55–61. DOI: 10.1016/j.maturitas.2019.03.013

19. Calleja-Agius J., Brincat M.P. Urogenital atrophy. Climacteric. 2009;12(4):279–85. DOI: 10.1080/13697130902814751

20. Angelou K., Grigoriadis T., Diakosavvas M., Zacharakis D. et al. The genitourinary syndrome of menopause : an overview of the recent data. Cureus. 2020;12(4):e7586. DOI: 10.7759/cureus.7586

21. Baber R.J., Panay N., Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109–50. DOI: 10.3109/13697137.2015.1129166

22. Chushkov Yu.V., Kuznetsova I.V., Ishchenko A.I. A role for topical administration of estriol in optimizing outcome of surgical treatment in peri- and postmenopausal patients with female genital prolapse. Effective Pharmacotherapy. 2015;19:24–8. (in Russian)

23. Gliniewicz K., Schneider G.M., Ridenhour BJ., Williams CJ. et al. Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Front. Microbiol. 2019;10:193. DOI: 10.3389/fmicb.2019.00193

24. Ali E.S., Mangold C., Peiris A.N. Estriol: emerging clinical benefits. Menopause. 2017;24(9):1081–5. DOI: 10.1097/GME.0000000000000855

25. Dorr M.B., Nelson A.L., Mayer P.R., Ranganath R.P. et al. Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis. Fertil. Steril. 2010;94(6):2365–8. DOI: 10.1016/j.fertnstert.2010.03.076

26. Te West N.I.D., Day R.O., Hiley B., White C. et al. Estriol serum levels in new and chronic users of vaginal estriol cream: a prospective observational study. Neurourol. Urodyn. 2020;39(4):1137–44. DOI: 10.1002/nau.24331

27. Boron W.F., Boulpaep E.L. Medical physiology: a cellular and molecular approach. Elsevier — Saunders; 2003. 1300 p.

28. Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005;8(suppl.1):3–63. DOI: 10.1080/13697130500148875

29. Punnonen R., Vilska S., Grönroos M., Rauramo L. The vaginal absorption of oestrogens in postmenopausal women. Maturitas. 1980;2(4):321–6. DOI: 10.1016/0378-5122(80)90034-1

30. Bhupathiraju S.N., Grodstein F., Stampfer M.J., Willett W.C. et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause. 2018;26(6):603–10. DOI: 10.1097/GME.0000000000001284

31. Crandall C.J., Hovey K.M., Andrews C.A., Chlebowski R.T. 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(1):11–20. DOI: 10.1097/GME.0000000000000956

32. Hirschberg A.L., Bitzer J., Cano A., Ceausu I. et al. Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: an EMAS clinical guide. Maturitas. 2021;148:55–61. DOI: 10.1016/j.maturitas.2021.04.005

33. Apolikhina I.A., Yureneva S.V., Malyshkina D.A. Genitourinary syndrome of menopause: contemporary approaches to diagnosis and management. Obstetrics and Gynecology. 2020;12(suppl.):4–8. (in Russian)

34. Palacios S., Nappi R.E., Bruyniks N., Particco M. et al. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018;21(3):286–91. DOI: 10.1080/13697137.2018.1446930

35. The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976–92. DOI: 10.1097/GME.0000000000001609

36. Rueda C., Osorio A.M., Avellaneda A.C., Pinzón C.E. et al. The efficacy and safety of estriol to treat vulvovaginal atrophy in postmenopausal women : a systematic literature review. Climacteric. 2017;20(4):321–30. DOI: 10.1080/13697137.2017.1329291

37. Lethaby A., Ayeleke R.O., Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst. Rev. 2016; 2016(8):CD001500. DOI: 10.1002/14651858.CD001500.pub3

38. Mension E., Alonso I., Castelo-Branco C. Genitourinary syndrome of menopause: current treatment options in breast cancer survivors — systematic review. Maturitas. 2021;143(9):47–58. DOI: 10.1016/j.maturitas.2020.08.010

39. Li B., Duan H., Chang Y., Wang S. Efficacy and safety of current therapies for genitourinary syndrome of menopause: a Bayesian network analysis of 29 randomized trials and 8311 patients. Pharmacol. Res. 2021;164(9):105360. DOI: 10.1016/j.phrs.2020.105360

40. Lumsden M.A., Davies M., Sarri G. Diagnosis and management of menopause. The National Institute of Health and Care Excellence (NICE) guideline. JAMA Intern. Med. 2016;176(8):1205–6. DOI: 10.1001/jamainternmed.2016.2761

41. Kovaleva Yu.S., Zyablitskaya N.K. Micronization of corticosteroid drugs and their use in medicine. Effective Pharmacotherapy. 2020;16(27):16–20. (in Russian). DOI: 10.33978/2307-3586-2020-16-27-16-20

42. Chuchalin A.G., Belousov Yu.B., Yasnetsov V.V., eds. Federal guidelines for the use of medicines (formular system). М.; 2008. Vol. IX. 998 p. (in Russian)

43. Ustinov M.V., Chaplygin A.V. Micronization and other ways to improve the efficiency and safety of topical drugs in dermatology. Russian Journal of Clinical Dermatology and Venereology. 2019;18(4):418–26. (in Russian)

44. Emshanova S.V., Abramovich R.A., Potanina O.G. Influence form and size particles of sudstances on the finished dosage forms quality. Development and Registration of Medicines. 2014;2:50–63. (in Russian)

45. Novikov A.N. Probable mechanisms of endotheliotropic effects of micronized purified fraction of flavonoids. Eruditio Juvenium. 2013;86–91. (in Russian)

46. Ivanova D.B., Salova V.G., Kozlova Zh.M. The selection of the most suitable base for antifungal suppositories using Harrington desirability function. Medical & pharmaceutical journal “Pulse”. 2020;22(6):74–8. (in Russian). DOI: 10.26787/nydha-2686-6838-2020-22-6-74-78

47. Pankrusheva T.A., Zubova S.N., Medvedeva O.A., Nesterova A.V. et al. Suppositories for the treatment of bacterial vaginitis. Bulletin of the Voronezh State University. Series: Chemistry. Biology. Pharmacy. 2004;2:249–53. (in Russian)

48. Berezina G.R.; Shaposhnikov G.P., ed. Excipients in the technology of finished dosage forms : textbook allowance. Ivanovo; 2016. 80 p. (in Russian)


Review

For citations:


Yureneva S.V., Knorring G.Yu. Local Hormonal Therapy for Genitourinary Menopausal Syndrome. Title. 2023;22(5):95-100. (In Russ.) https://doi.org/10.31550/1727-2378-2023-22-5-95-100

Views: 30


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1727-2378 (Print)
ISSN 2713-2994 (Online)