Combination Local Therapy of Genitourinary Menopausal Syndrome Symptoms

Introduction: Genitourinary syndrome of menopause (GSM) is a pressing gynecological problem since the condition leads to the deterioration in the quality of life of postmenopausal women. Objective: compare the efficacy of relief of GSM with intravaginal use of estriol monoproduct and a combination product containing estriol, micronized progesterone and Lactobacillus casei rhamnosus Doderleini. Materials and Methods: the study enrolled 69 postmenopausal women aged 53.6±2.1 diagnosed with postmenopausal atrophic vaginitis. After screening, the patients were randomized into 2 groups: Group 1 (n=34) used 0.5 mg/day of estriol monoproduct intravaginal for 14 days, followed by a gradual dose reduction based on symptom relief until a maintenance dose was reached (i.e. 1 suppository 2 times a week), Group 2 (n=35) used intravaginal combination product in the form of capsules containing 0.2 mg of estriol, 2.0 mg of micronized progesterone and lyophilized culture of L. casei rhamnosus Doderleini – 341mg (2*107 CFU) (Trioginal, Besins Healthcare SA, Belgium). The product was prescribed to be taken at a dose of 2 capsules intravaginal 1 time/day for 20 days, then 1 capsule/day. Total duration of therapy in both groups was 12 weeks. After the end of therapy, patients were monitored for 12 weeks. To determine the efficacy of the treatment, subjective and objective clinical symptoms of GSM were evaluated using the adapted Nappi RE scale at the study visits. 5-point D. Barlow scale, vaginal pH, Bachmann’s Vaginal Health Index was additionally used. The main software for statistical analysis was the IBM SPSS 22 statistical package. Results: After 12 weeks of treatment, complaints of dyspareunia resolved completely in 18 (52.9%) patients in Group 1 and 25 (71.5%) in Group 2, p<0.05; 12 weeks after the end of therapy: in 24 (70.6%) patients in Group 1 and in 34 (97.1%) patients in Group 2, p<0.05. Improvement in elasticity after 12 weeks of therapy was observed in 19 (55.9%) and 27 (77.1%) patients of Group 1 and Group 2, respectively (p<0.05); normal epithelial thickness was observed in 26 (76.5%) and 30 (85.7%) patients, respectively (p<0.05). 12 weeks after the end of treatment in Group 1 and Group 2, improvement in elasticity was observed in 22 (64.7%) and 30 (85.7%) patients; normal epithelial thickness was observed in 22 (64.7%) and 27 (77.1%) patients, respectively (p<0.05). For the rest of analysed parameters (D. Barlow scale, pH, Bachmann’s Vaginal Health Index) statistical analysis did not reveal any statistically significant differences between the groups in the dynamics of treatment and follow-up. Conclusion: Thus, local combination hormone therapy with probiotic support can be an effective treatment option for genitourinary syndrome of menopause since it helps to enhance proliferative processes, improve blood circulation, restore biocenosis and relieve symptoms of coital pain. Compared with local estriol monotherapy, having a comparable effect on the condition of vaginal epithelium, it is significantly more effective for eliminating the symptoms of sexual dysfunction.