Preview

Obstetrics, Gynecology and Reproduction

Advanced search

Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018

https://doi.org/10.17749/2313-7347.2019.13.3.227-238

Abstract

Due to the increase in life expectancy, today, most women live in a state of estrogen deficiency for more than a third of their life time. According to the recent document on the stages of aging of the female reproductive system (the STRAW+10 working group), there are three main stages that include the reproductive period, the menopausal transition, and postmenopause. One of the most common manifestations of postmenopause is vulvovaginal atrophy or genitourinary syndrome, which leads to a dramatic decrease in the woman’s quality of life. Up to 45 % of postmenopausal women suffer from this disorder, and 80 % of them experience a negative impact on their quality of life. The main symptoms of vulvovaginal atrophy are dryness, itching, burning, and dyspareunia. Caution must be exercised in relation to “silent” atrophy, which is not manifested by subjective complaints of vaginal mucosa atrophy, and can only be visualized by colposcopy. According to the recommendations of the International Menopause Society (IMS), updated in 2016, therapy should be started before the atrophic changes become irreversible; the treatment should continue for a long time to maintain the achieved therapeutic effect. If no symptoms other than vulvovaginal atrophy are noted, local estrogen therapy is indicated. Estriol has advantages over other medications due to its lower affinity for estrogen receptors. In earlier studies as well as those updated here (2014–2018), estriol applied topically as a vaginal cream or vaginal suppositories, has a selective effect on the urogenital tract and practically does not interfere with the proliferation of the uterine endometrium. The confirmed efficacy and safety of estriol allow for its permanent use, beginning with the starting dose and then switching to the maintenance one.

About the Authors

A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya – MD, PhD, Corresponding Member of RAS, Professor, Head of the Department of Obstetrics and Gynecology, Institute of Children's Health

Researcher ID: M-5660-2016. Scopus Author ID: 6602363216.

62 St. Zemlyanoi Val, Moscow 109004.



D. V. Blinov
Institute of Preventive and Social Medicine; Moscow Haass Medical – Social Institute; Lapino Clinical Hospital, GC «Mother and Child»
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Head of Medical and Scientific Affairs, Institute for Preventive and Social Medicine; Faculty Member, Department of Neurology, Psychiatry and Narcology, Moscow Haass Medical – Social Institute; Neurologist, Lapino Clinic Hospital, MD Medical Group

Researcher ID: E-8906-2017. RSCI: 9779-8290.

4–10 Sadovaya-Triumfalnaya St., Moscow 127006; 5, s. 1–1a, 2-ya Brestskaya St., Moscow 123056; 111, 1-e Uspenskoe shosse, Lapino, Moscow region, 143081.



V. O. Bitsadze
Sechenov University
Russian Federation

Victoria O. Bitsadze – MD, PhD, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health

Scopus Author ID: 6506003478.

62 St. Zemlyanoi Val, Moscow 109004.



J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva – MD, PhD, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health

62 St. Zemlyanoi Val, Moscow 109004.



References

1. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, DVD Edition. POP/DB/WPP/Rev.2017/MORT/F07-1, POP/DB/WPP/Rev.2017/ MORT/F07-2, POP/DB/WPP/Rev.2017/MORT/F07-3. Available at: https://population.un.org/WPP/Publications/.

2. Sherbakova E. The average life expectancy in Russia will steadily increase, but only in the last quarter of a century will it exceed the world average. [Srednyaya prodolzhitel'nost' zhizni v Rossii budet ustojchivo vozrastat', no tol'ko v poslednej chetverti veka prevysit srednemirovoe znachenie]. Demoscope Weekly, 2017. № 737–738. (In Russ.). Available at: http://www.demoscope.ru/weekly/2017/0737/barom04.php.

3. Nichols H.B., Trentham-Dietz A., Hampton J.M. et al. From menarche to menopause: trends among US Women born from 1912 to 1969. Am J Epidemiol. 2006;164(10):1003–11. DOI: 10.1093/aje/kwj282. PMID: 16928728.

4. Dratva J., Gómez Real F., Schindler C. et al. Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause. 2009;16(2):385–94. DOI: 10.1097/gme.0b013e31818aefef. PMID: 19034049.

5. Rueda C., Osorio A.M., Avellaneda A.C. 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. PMID: 28622049.

6. Guide for menopause. Eds. V.P. Smetnik, V.I. Kulakov. [Rukovodstvo po klimakteriju. Pod red. V.I. Kulakova, V.P. Smetnik]. Moskva: MIA, 2001. 685 s. (In Russ.).

7. Krymskaya M.L. Menopause. [Klimaktericheskij period]. Moskva: Medicina, 1989. 270 s. (In Russ.).

8. Serov V.N., Prilepskaya V.N., Ovsyannikova T.N. Guide to gynecological endocrinology. [Rukovodstvo po ginekologicheskoj endokrinologii]. Moskva: MEDpress-inform, 2008. 528 s. (In Russ.).

9. Prilepskaya V.N. Menopausal syndrome: innovations in menopausal therapy. [Klimaktericheskij sindrom: innovacii v menopauzal'noj terapii]. RMZh. Mat' i ditya. 2017;25(2):105–8. (In Russ.).

10. Prilepskaya V.N., Nazarenko E.G. Estriol in the therapy of various gynecological diseases. [Estriol v terapii razlichnyh ginekologicheskih zabolevanij]. Medicinskij sovet. 2017;(2):8–13. DOI: 10.21518/2079-701X-2017-2-8-13. (In Russ.).

11. Serov V.N., Zharov E.V., Perepanova T.S. et al. Modern pathogenetic therapy of urogenital disorders in postmenopausal women. A guide for doctors. [Sovremennaya patogeneticheskaya terapiya urogenital'nyh rasstrojstv v postmenopauze. Posobie dlya vrachej]. Moskva, 2008. (In Russ.).

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

13. Harlow S.D., Gass M., Hall J.E. et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–68. DOI: 10.1210/jc.2011-3362. PMID: 22344196.

14. Management of symptomatic vulvovaginal atrophy: 2013 position statement of the North American Menopause Society. Menopause. 2013;20(9):888–902. DOI: 10.1097/GME.0b013e3182a122c2. PMID: 23985562.

15. Sturdee D.W., Panay N. International Menopause Society Writing Group. Recommendations for the management of vaginal atrophy in postmenopausal women. Climacteric. 2010;13(6):509–22. DOI: 10.3109/13697137.2010.522875. PMID: 20883118.

16. Takahashi T.A., Johnson K.M. Menopause. Med Clin North Am. 2015;99(3):521–34. DOI: 10.1016/j.mcna.2015.01.006. PMID: 25841598.

17. Blake J. Menopause: evidence-based practice. Best Pract Res Clin. Obstet Gynaecol. 2006;20(6):799–839. DOI: 10.1016/j.bpobgyn.2006.07.001. PMID: 17084674.

18. Portman D.J., Gass M.L. Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Climacteric. 2014;17(5):557–63. DOI: 10.1097/GME.0000000000000329. PMID: 25160739.

19. Glazunova A.V., Yureneva S.V. Prevalence of vulvovaginal atrophy and its impact on quality of life in women. The issues of terminology and the safety of local hormonal therapy. [Rasprostranennost' vul'vovaginal'noj atrofii i ee vliyanie na kachestvo zhizni zhenshchin. Voprosy terminologii i bezopasnosti lokal'noj gormonal'noj terapii]. Akusherstvo i ginekologiya. 2014;(11):29–33. (In Russ.).

20. Kostava M.N., Prilepskaya V.N., Bykovskaya O.V. Dystrophic and atrophic processes of the lower genital tract: a modern view of the problem. [Distroficheskie i atroficheskie processy nizhnego otdela polovyh putej: sovremennyj vzglyad na problemu]. Ginekologiya. 2006;ekstravypusk:3–5. (In Russ.).

21. Ledina A.V. Atrophic vaginitis in postmenopausal women (to help a practitioner). [Atroficheskie vaginity u zhenshchin v postmenopauze (v pomoshch' prakticheskomu vrachu)]. Ginekologiya. 2006;ekstravypusk:11–3. (In Russ.).

22. Pushkar D.Yu., Gumin L.M. Pelvic disorders in women. [Tazovye rasstrojstva u zhenshchin]. Moskva: MEDpress-inform, 2006. 265 s. (In Russ.).

23. Ovsyannikova T.V., Kulikov I.A. Therapy for urogenital disorders in postmenopausal women. [Terapiya urogenital'nyh rasstrojstv v postmenopauze]. Medicinskij sovet. 2018;(13):155–8. (In Russ.).

24. Kulakov V.I., Kostava M.N. Treatment of dystrophic diseases of the vulva. [Lechenie distroficheskih zabolevanij vul'vy]. RMZh. 1999;1(1): 64–66. (In Russ.).

25. Menopausal syndrome. Clinic, diagnosis, prevention and hormone replacement therapy. Eds. V.I. Kulakov, E.M. Vikhlyaeva. [Menopauzal'nyj sindrom. Klinika, diagnostika, profilaktika i zamestitel'naya gormonal'naya terapiya. Pod red. V.I. Kulakova, E.M. Vihlyaevoj]. Moskva: Nauchnyj centr akusherstva, ginekologii i perinatologii RAMN, 1996. 66 s. (In Russ.).

26. Prilepskaya V.N. Vagina and cervix in postmenopausal women. The possibilities of therapy. [Vlagalishche i shejka matki v postmenopauze. Vozmozhnosti terapii. Prakticheskaya ginekologiya]. Moskva, 1999;1(1):4–7. (In Russ.).

27. Nazarova N.M., Megevitinova E.A. Urogenital disorders in postmenopausal women: experience with the use of Ovestin. [Urogenital'nye narusheniya v postmenopauze: opyt primeneniya preparata «Ovestin»]. Ginekologiya. 2006;ekstravypusk:9–10. (In Russ.).

28. Perepanova T.S., Hazan P.L. The role of estriol in the therapy of urogenital disorders in postmenopausal women. [Rol' estriola v terapii urogenital'nyh rasstrojstv u zhenshchin v postmenopauze]. Urologiya. 2007;(3):102–5. (In Russ.).

29. Serov V.N. Therapy of urogenital disorders due to estrogen deficiency. [Terapiya urogenital'nyh rasstrojstv, obuslovlennyh deficitom estrogenov]. Akusherstvo, ginekologiya i reprodukciya. 2010;4(1):21–36. (In Russ.).

30. Berging E.W. Oestriol receptor interactions: their biological importance and therapeutic implications. Acta Endocrinol. 1980;233:9–16.

31. Raz R., Stamm W.E. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infection. N Engl J Med. 1993;329(11):753–6. DOI: 10.1056/NEJM199309093291102.

32. Ovestin (tablets). Instructions for medical use. P №013327/03. State register of medicines. [Ovestin (tabletki). Instrukciya po medicinskomu primeneniyu. P №013327/03. Gosudarstvennyj reestr lekarstvennyh sredstv]. (In Russ.). Available at: https://zdravmedinform.ru/grls/reg-p-n013327-03.html.

33. Ovestin (vaginal cream). Instructions for medical use. P №013327/02. State register of medicines. [Ovestin (krem vaginal'nyj). Instrukciya po medicinskomu primeneniyu. P №013327/02. Gosudarstvennyj reestr lekarstvennyh sredstv]. (In Russ.). Available at: https://zdravmedinform.ru/grls/reg-p-n013327-02.html.

34. Ovestin (vaginal suppositories). Instructions for medical use. P №013327/01. State register of medicines. [Ovestin (suppozitorii vaginal'nye). Instrukciya po medicinskomu primeneniyu. P №013327/01. Gosudarstvennyj reestr lekarstvennyh sredstv]. (In Russ.). Available at: https://zdravmedinform.ru/grls/reg-p-n013327-01.html.

35. Weber M.A., Lim V., Oryszczyn J. et al. The effect of vaginal oestriol cream on subjective and objective symptoms of stress urinary incontinence and vaginal atrophy: an international multi-centre pilot study. Gynecol Obstet Invest. 2017;82(1):15–21. DOI: 10.1159/000445074.

36. Balan V.E., Kovaleva L.A., Zlotnikova Yu.P., Tikhomirova E.V. Possibilities of hormonal therapy of urogenital syndrome in climacteric period. [Vozmozhnosti gormonal'noj terapii urogenital'nogo sindroma v klimakterii]. Trudnyj pacient. 2015;13(8–9):20–5. (In Russ.).

37. Kalugina L.V., Tatarchuk T.F., Zanko O.V. Genitourinary menopausal syndrome – problem for women of elegant age and not only. [Genitourinarnyj menopauzal'nyj sindrom – problema zhenshchin elegantnogo vozrasta i ne tol'ko]. Reproduktivna endokrinologiya. 2016;(2):68–74. (In Russ.).

38. Razzakberganova G.O., Matyakubova Z.Sh., Sapaev M.G. Ovestin in the treatment of urogenital disorders in women with premature ovarian failure. [Ovestin v kompleksnoj terapii urogenital'nyh rasstrojstv u zhenshchin s prezhdevremennoj nedostatochnost'yu yaichnikov]. International scientific review. 2016;(1):121–3. (In Russ.).

39. Palmeira-de-Oliveira R., Machado M.R., Martinez-de-Oliveira J., Palmeira-de-Oliveira A. Testing vaginal irritation with the hen’s egg test-chorioallantoic membrane assay. ALTEX. 2018;35(4):495–503. DOI: 10.14573/altex.171009. PMID: 29534246.


Review

For citations:


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):227-238. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.3.227-238

Views: 920


ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)