Urogenital atrophy in postmenopausal women

In postmenopausal women, estrogen levels drop and affect health, which can cause urogenital atrophy. Menopause is usually spontaneous, but can also be caused by surgical removal of the ovaries for medical reasons, or by radiation therapy.

Perimenopause - Menopause is a normal physiological phenomenon of women that occurs when estrogen levels decrease. Menopause includes the period before, during, and after menopause.
The average age of menopause is 48 - 52 years old. If menopause occurs before the age of 40, it is called early menopause, and if after the age of 55, it is called late menopause.
Menopause is diagnosed mainly on clinical grounds, when a woman who has had regular periods every month suddenly stops, has not had a period for 12 consecutive cycles. When a young woman (under 40 years of age, without amenorrhea for 12 consecutive months) or a woman who has had a hysterectomy, has some of the symptoms of menopause and wants to be diagnosed as menopause, tests should be done. Quantitative ovarian and pituitary endocrine assay.

Genitourinary atrophy is caused by a decrease in estrogen in postmenopausal women, causing atrophy of the triangle of the vagina, urethra, and bladder. The epithelium in these areas becomes thin and loses its natural wrinkles, and its elasticity and color are reduced due to reduced blood supply.
Symptoms of vaginal and lower urinary tract atrophy are often progressive, persist for many years, and require treatment. Rates of vaginal dryness increase after menopause, causing symptoms of itching, burning, and pain during intercourse. While up to 40% of women will experience these symptoms, only a minority (about 25% in Western countries) seek medical help. The reason is not only lack of knowledge but also common side effects of hormone replacement therapy (HRT) and the misconception that topical treatment of vaginal atrophy is similar to HRT. Other reasons may be due to reluctance to discuss such matters.
Estrogen receptors are present in the vaginal, urethral, ​​and bladder triangles and with postmenopausal estradiol depletion there is bound to be a degree of atrophic change in these sites. In particular, vaginal epithelial cells become thin, lose their wrinkles, elasticity and become noticeably paler due to a decrease in blood supply; when there are symptoms may appear with acute inflammation and vulnerability. The reduction of glycogen in the surface cells raises the pH because less lactic acid, a factor that fights the growth of pathogens, is produced. Cervical discharge and vaginal discharge are also reduced resulting in decreased lubrication.
Atrophic urethritis and this triangular region can also cause dysuria, urinary frequency, bladder pain, and recurrent urinary tract infections. Atrophy of the skin of the vulva and labia can also cause itching.

Symptomatic urogenital atrophy is easily diagnosed but is often missed. A simple questionnaire for all postmenopausal women, regardless of the initial reason for consultation, elicits classic symptoms. The principle of treatment of vaginal atrophy is to restore the urogenital physiological environment and improve symptoms. Treatment should be started early and before irreversible changes occur.
3.1 Non-hormonal lubricants and moisturizers Available lubricants and moisturizers are over-the-counter and often expensive; some require a doctor's prescription (Replens, SYLK, Hyalofemme and Regelle). This is usually a combination of a protectant and thickener in the form of a water-soluble base and is mainly used to relieve vaginal dryness during intercourse, not for long-term use or to restore urogenital physiology. . Moisturizers can help retain water in the surface cells of the vagina, so the effects last longer.
The integrity and effectiveness of condoms can be affected by lubricants. Therefore, care should be taken when using condoms to prevent sexually transmitted diseases.
3.2 Estrogen Estrogen can be given either systemically or topically, but 10-25% of women using systemic hormones alone will still experience symptoms of urogenital atrophy. This plus the safety concerns of oral/transdermal HRT are the reasons why systemic treatment is generally not recommended for women with only vaginal symptoms, however, In women with severe symptoms, a combination of systemic and vaginal estrogen should be used from the beginning. Topical treatment options include low-dose natural estrogens such as Estradiol tablets or rings or Estriol topical or vaginal creams.
Horse-derived Linked Estrogen Cream is no longer used as it is readily absorbed into the circulation, causing endometrial irritation and bleeding.
Systemic absorption occurs with all topical estrogen preparations but to a lesser extent with estradiol tablets or vaginal rings and hormone levels remain within the normal postmenopausal range. Absorption is greatest during the first few days, when the vaginal epithelial cells are still atrophy. Once it has recovered, absorption is reduced and lower doses of estrogen are continued indefinitely to prevent recurrence of atrophy.
Estriol is significantly absorbed in both topical and vaginal formulations, but because Estriol is a weak Estrogen and is not converted to Estrone or Estradiol, there is little systemic effect. There is no evidence of endometrial stimulation when estradiol or estriol is used in appropriate doses and therefore progestogen supplementation is not necessary for endometrial protection. However, if there is abnormal bleeding after menopause, this should be considered.
All estrogen preparations are effective on urogenital atrophy, reducing symptoms of vaginal dryness, pain during intercourse and urinary tract infections. Tablets and rings produce less discharge than vaginal and cream formulations. Depending on the patient's wishes, decide which formulation to choose. The use of topical estrogens beyond 12 months has not been studied, but there are no contraindications to long-term use of low-dose estrogen.
In urogenital atrophy, changes in the cervix can affect the cervical smear. The squamo - columnar junction can retract into the cervical canal which also interferes with colposcopy. The use of a topical estrogen for several weeks can resolve these problems.

Vaginal atrophy is also common after treatment for gynecological and breast cancer, but there are insufficient data on the use of topical estrogens in women with hormone-responsive cancer to make medical-based recommendations. study evidence. Use of topical estrogen therapy in women taking tamoxifen or an aromatase inhibitor should be considered.
Urogenital atrophy in postmenopausal women significantly affects the health and life of women. Symptoms of urogenital atrophy are common but underdiagnosed and untreated. Treatment of urogenital atrophy in postmenopausal women needs to be continued to remain effective. All topical estrogen preparations are effective and a decision should be made on which formulation to choose based on patient preference. There is no need to add a progestogen when using low-dose topical estrogen appropriately. If Estrogen is not effective, moisturizers and lubricants can be used temporarily to relieve symptoms of vaginal dryness.
When you see unusual changes, you should immediately go to a medical facility for early examination and treatment before those changes cannot be reversed.
Vinmec International General Hospital offers customers a package of pre-menopause health care examinations and consultations to help customers examine and consult with a gynecologist, perform tests to assess their condition. Hormonal.
Women between the ages of 45-55, possibly younger (when suffering from premature ovarian failure), have menstrual irregularities, sexual disorders, suspected endocrine disorders, or have a need for medical treatment. hormone replacement therapy, or want to prepare yourself for perimenopause and menopause.