Пошук шляхів до менопаузальної гормональної терапії та корекції бактеріального вагінозу на фоні клімактеричного синдрому

G.I. Reznichenko; N.Y. Reznichenko

doi:10.18370/2309-4117.2021.58.73-78

Authors

G.I. Reznichenko Zaporizhzhya Medical Academy of Postgraduate Education of the MoH of Ukraine, Ukraine https://orcid.org/0000-0002-5721-622X
N.Y. Reznichenko Zaporizhzhya Medical Academy of Postgraduate Education of the MoH of Ukraine, Ukraine https://orcid.org/0000-0002-5448-7833

DOI:

https://doi.org/10.18370/2309-4117.2021.58.73-78

Keywords:

menopause, bacterial vaginosis, treatment, quality of life

Abstract

Study objective: optimization of the treatment of climacteric syndrome (CS) and improvement of the life quality in women with bacterial vaginosis (BV) during menopause.
Materials and methods. 58 women with natural menopause were examined, 38 of whom were diagnosed with BV. To correct the CS patient used the drug 17β-estradiol Divigel transdermal in combination with micronized progesterone orally. Patients with BV were divided into 2 subgroups: 15 women received standard treatment with metronidazole gel
(comparison subgroup), 23 women additionally used Lactagel (main subgroup). The control group included 20 patients with CS without BV. The severity of CS was assessed with MRS scale. Microscopic and bacteriological examination of vaginal discharge was performed to determine the infectious agent, and the species composition of pathogens was determined with a polymerase chain reaction. BV was diagnosed according to Amsel criteria. CQLS questionnaire was used to assess the quality of life of patients with BV. The treatment effectiveness was assessed after 1 and 3 months from the start of treatment.
Results. Divigel in women with uterus in combination with oral micronized progesterone has shown high efficiency in the CS correction within a month from the start of treatment. The most significant was the decrease in neurovegetative and psychoemotional symptoms after 3 months from the start of treatment. Lactagel in the therapy of patients with BV on the background of CS allowed increasing the lactobacilli content to the value in patients without BV, restoring the normal vaginal biotope and preventing of the disease recurrence, in contrast to the subgroup of patients who received standard treatment. Lactagel made it possible to improve the life quality of patients to an average level and to increase the overall level of life satisfaction, in contrast to the subgroup with standard treatment where these levels have remained low.
Conclusions. Developed approaches to menopausal hormone therapy and BV therapy against the background of natural menopause allows optimizing treatment, improving the life quality of patients, which allows recommending them for widespread use in clinical practice.

Author Biographies

G.I. Reznichenko, Zaporizhzhya Medical Academy of Postgraduate Education of the MoH of Ukraine

MD, professor, Department of Obstetrics and Gynecology

N.Y. Reznichenko, Zaporizhzhya Medical Academy of Postgraduate Education of the MoH of Ukraine

MD, professor, Department of General Practice – Family Medicine, Dermatovenereology with a course in psychiatry

References

Yefimenko, O.A. “Modern concept of menopausal hormone therapy.” Medical aspects of women's health 6 (2020): 5–12.
Reznichenko, Y.G., Reznichenko, N.Y., Reznichenko, G.I., Yartseva, M.O. Correction of dysbiotic conditions in residents of industrial cities. Zaporizhzhya. Prosvita (2013): 148 p.
Reznichenko, Y.G., Reznichenko, N.Y., Reznichenko, G.I. Correction of dysbiotic conditions in the age aspect. Zaporіzhzhya. Prosvita (2017): 146 p.
Reznichenko, N.Y., Reznichenko, G.I., Dyudyun, A.D. “Nonspecific chronic vaginitis in women of the industrial center and ways of its correction.” Dermatology. Cosmetology. Sexopathology 1–2 (2019): 17–21.
Tatarchuk, T.F., Yefimenko, O.A., Islamova, A.O. “Menopause: a new view on the old problem.” Reproductive endocrinology 1 (2013): 7–12.
Tatarchuk, T.F., Zakharenko, N.F., Manoliak I.P. “Features of the manifestation of menopausal syndrome in women with endometriosis and possible ways of its correction.” Scientific Journal of the Ministry of Health of Ukraine 2.6 (2014): 71–8.
Tatarchuk, T.F., Islamova, A.O., Yefimenko, O.A. “Climacteric syndrome as the first clinical manifestation of menopause.” Reproductive endocrinology 1.21 (2015): 52–5.
Tatarchuk, T.F., de Villiers, T. “National consensus on the management of menopausal patients.” Women's Health 4 (2016): 17–27.
Chaban, O.S., Khaustova, O.O., Bezsheiko, V.G., Moskalenko, O.V. “Validation "Scales for assessing the quality of life".” Ukrainian Bulletin of Psychoneurology 25.1 (2017): 159–60.
Shikh, E.V. “Comparative clinical and pharmacological aspects of the use of oral and transdermal forms of estrogen.” Obstetrics and gynecology: news, opinions, training 1 (2016): 41–6.
American College of Obstetricians and Gynecologists. “ACOG Practice Bulletin No. 141: management of menopausal symptoms.” Obstet Gynecol 123.1 (2014): 202–16.
Amaya-Guio, J., et al. “Antibiotic treatment for the sexual partners of women with bacterial vaginosis.” Cochrane Database Syst Rev 10 (2016): CD011701.
Amos Pines. “Women’s Health Initiative and rate of hormone use: a study that impacted a whole generation.” Menopause 25.6 (2018): 586–8.
Amsel, R., Totten, P.A., Spiegel, C.A., Chen, K.C. “Nonspecific vaginitis: diagnostic criteria and microbial and epidemiological associations.” Am J Med 74 (1983): 14–22.
Archer, D.F., Schmelter, T., Schaefers, M., et al. “A randomized, double-blind, placebo-controlled study of the lowest effective dose of drospirenone with 17β-estradiol for moderate to severe vasomotor symptoms in postmenopausal women.” Menopause 21.3 (2014): 227–35.
Baber, R.J., Panay, N., Fenton, A. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 19.2 (2016): 109–50.
Balkus, J.E., Manhart, L.E., Lee, J., et al. “Periodic presumptive treatment for vaginal infections may reduce the incidence of sexually transmitted bacterial infections.” J Infect Dis 213 (2016): 1932–7.
Beral, V., Gaitskell, K., Hermon, C., et al.; Collaborative Group On Epidemiological Studies Of Ovarian Cancer. “Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies.” Lancet 385.9980 (2015): 1835–42.
De Villiers, T.J., Gass, M.L, Haines, C.J., et al. “Global consensus statement on menopausal hormone therapy.” Climacteric 16.2 (2013): 203–4.
Fait, T. “Menopause hormone therapy: latest developments and clinical practice.” Drugs Context 8 (2019): 212551.
Gaydos, C.A., Begaj, S., Schwebke, J. “Clinical validation of a test for the diagnosis of vaginitis.” Obstet Gynecol 130 (2017): 181–9.
Hanson, L., VandeVusse, L., Jerme, M., et al. “Probiotics for treatment and prevention of urogenital infections in women: a systematic review.” J Midwifery Womens Health 61 (2016): 339–55.
Mason, M.J., Winter ,A.J. “How to diagnose and treat aerobic and desquamative inflammatory vaginitis.” Sex Transm Infect 93 (2017): 8–10.
Moro, E., Esposti, E.D., Borghese, G., et al. “The impact of hormonal replacement treatment in postmenopausal women with uterine fibroids: a state-of-the-art review of the literature.” Medicina (Kaunas) 55.9 (2019): 549.
Panay, N., Anderson, R.A., Nappi, R.E., et al. “Premature ovarian insufficiency: an International Menopause Society White Paper.” Climacteric 23.5 (2020): 426–46.
Pinkerton, J.V., Aguirre, F.S., Blake, J., et al. “Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society.” Menopause 24.7 (2017): 728–53.
American College of Obstetricians and Gynecologists. “Practice Bulletin No.141: Management of Menopausal Symptoms.” Obstet Gynecol 123.1 (2014): 202–16.
Reznichenko, H., Henyk, N., Maliuk, V., et al. “Oral Intake of Lactobacilli Can Be Helpful in Symptomatic Bacterial Vaginosis: A Randomized Clinical Study.” Journal of Lower Genital Tract 24.3 (2020): 284–9.
Stuenkel, C.A., Davis, S.R., Gompel, A., et al. “Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline.” J Clin Endocrinol Metab 100.11 (2015): 3975–4011.