DOI: https://doi.org/10.18370/2309-4117.2019.46.%p

Differentiated approach to the treatment of genitourinary syndrome in perimenopausal women

Ю. П. Вдовиченко, О. О. Єфіменко, Н. Ю. Педаченко, О. І. Яцина

Abstract


Objective. To compare the clinical efficacy of monotherapy with menopausal hormonal therapy (climonorm) in the treatment of genitourinary syndrome of menopause with the effectiveness of monotherapy by M-anticholinergic mirabegron (betmiga) and a combination of these drugs.

Materials and methods. The randomization method was used to form 3 groups of 30 persons each, to whom various types of treatment were applied: mirabegron exclusively, climonorm exclusively, and a combination of these drugs. To determine the severity of menopausal symptoms and its dynamics in the treatment process, the Menopause Rating Scale was used. The Barlow scale was used to assess the impact of vulvovaginal symptoms on the quality of life. To objectify complaints, an assessment of the vaginal mucosa was made in accordance with the vaginal health index. Uroflowmetry was performed on a Dantec installation: Urodyn 1000. Surveys of the subjects, evaluation of the vaginal health index and uroflowmetry were carried out before the start of treatment, as well as during 1, 3, 6 months of therapy.

Study results. The combination of menopausal hormonal therapy with mirabegron gave the highest rate of reduction of symptoms of climacteric syndrome – from 36.03 ± 0.35 to 11.61 ± 1.57 MRS points (p <0.05) for 3 months of treatment, and was also better reflected duration of urination (from 6.8 ± 0.5 to 8.6 ± 0.2 s) (p <0.05), volume of urination (from 103 ± 3.5 to 140.1 ± 4.1 ml) ( p <0.05) and the maximum flow rate of urine (from 36.1 ± 0.4 to 30.5 ± 0.4 ml/s) (p <0.05) for 1 month.

Conclusion. Systemic administration of combined menopausal hormonal therapy in combination with M-anticholinergics is effective in the treatment of genitourinary menopause syndrome. Algorithms for treating urinary incontinence and overactive bladder in perimenopausal women with genitourinary menopause syndrome as part of climacteric syndrome by prescribing systemic menopausal hormonal therapy require further development.


Keywords


urinary incontinence; vulvovaginal atrophy; perimenopause; menopausal hormone therapy; genitourinary syndrome of menopause

References


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Birkhaeuser, M., Genazzani, A.R., eds. Pre-Menopause, Menopause and Beyond: Volume 5: Frontiers in Gynecological Endocrinology. Springer (2018).

Caretto, M., et al. Menopause and Ageing. Reproductive Medicine for Clinical Practice. Springer, Cham (2018).

De Villiers, T., Pines, A., Panay, N., et al. “Updated 2013 International Menopause Society recommen-dations on menopausal hormone therapy and preventive strategies for midlife health.” Climacteric 16.3 (2013): 316–37.

ESHRE Capri Workshop Group. “Perimenopausal risk factors and future health.” Human reproduction update 17.5 (2011): 706–17.

Kingsberg, S.A., Woodard, T. “Female sexual dysfunction: focus on low desire.” Obstetrics & Gynecology 125.2 (2015): 477–86.

Nappi, R.E., Biglia, N., Cagnacci, A., et al. “Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group.” Gynecol Endocrinol 32.8 (2016): 602–6. DOI: 10.1080/09513590.2016.1183627

Nappi, R.E., Kokot-Kierepa, M. “Women's voices in the menopause: results from an international survey on vaginal atrophy.” Maturitas 67.3 (2010): 233–8.

Nappi, R.E., et al. “Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.” Climacteric 19.2 (2016): 188–97.

Romashchenko, O. V., et al. “Determination of the frequency of genitourinary syndrome of menopause (GSM) and female sexual dysfunctions.” Urology 22.2 (2018).

Waetjen, L.E., et al. “Association between menopausal transition stages and developing urinary incontinence.” Obstetrics and gynecology 114.5 (2009): 989.


GOST Style Citations


1.       Антипкін, Ю.Г. Що ми знаємо про жіночність майбутнього / Ю.Г. Антипкін, Т.Ф. Татарчук, О.О. Єфіменко та ін. // Репродуктивна ендокринологія. – 2018. – №40. – С. 10–14.

2.       Вдовиченко, Ю.П. Нарушение и принципы диагностики сексуальной функции женщин перименопаузального возраста / Ю.П. Вдовиченко, Е.Ю. Гурженко // Здоровье мужчины. – 2017. – №4 (63). – С. 84–94.

3.       Birkhaeuser, M., Genazzani, A.R., eds. Pre-Menopause, Menopause and Beyond: Volume 5: Frontiers in Gynecological Endocrinology. Springer (2018).

4.       Caretto, M., et al. Menopause and Ageing. Reproductive Medicine for Clinical Practice. Springer, Cham (2018).

5.       De Villiers, T., Pines, A., Panay, N., et al. “Updated 2013 International Menopause Society recommen-dations on menopausal hormone therapy and preventive strategies for midlife health.” Climacteric 16.3 (2013): 316–37.

6.       ESHRE Capri Workshop Group. “Perimenopausal risk factors and future health.” Human reproduction update 17.5 (2011): 706–17.

7.       Kingsberg, S.A., Woodard, T. “Female sexual dysfunction: focus on low desire.” Obstetrics & Gynecology 125.2 (2015): 477–86.

8.       Nappi, R.E., Biglia, N., Cagnacci, A., et al. “Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group.” Gynecol Endocrinol 32.8 (2016): 602–6. DOI: 10.1080/09513590.2016.1183627

9.       Nappi, R.E., Kokot-Kierepa, M. “Women's voices in the menopause: results from an international survey on vaginal atrophy.” Maturitas 67.3 (2010): 233–8.

10.     Nappi, R.E., et al. “Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.” Climacteric 19.2 (2016): 188–97.

11.     Romashchenko, O. V., et al. “Determination of the frequency of genitourinary syndrome of menopause (GSM) and female sexual dysfunctions.” Urology 22.2 (2018).

12.     Waetjen, L.E., et al. “Association between menopausal transition stages and developing urinary incontinence.” Obstetrics and gynecology 114.5 (2009): 989.





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