Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar

ŞİMAL YAVUZ, NURGÜL; Özerdoğan, Nebahat

doi:10.24898/tandro.2022.35651

Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar

Nurgül ŞİMAL, (Lokman Hekim Üniversitesi, Sağlık Bilimleri Fakültesi, Ebelik Bölümü, Ankara, Türkiye)

Nebahat ÖZERDOĞAN (Eskişehir Osmangazi Üniversitesi, Sağlık Bilimleri Fakültesi, Ebelik Bölümü, Eskişehir, Türkiye)

Androloji Bülteni

27 3

Yıl: 2022 Cilt: 24 Sayı: 3 Sayfa Aralığı: 214 - 220 Metin Dili: Türkçe DOI: 10.24898/tandro.2022.35651 İndeks Tarihi: 27-09-2022

Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar

Öz:

Vulvovajinal atrofi (VVA), menopoz dönemindeki kadınlarda ortaya çıkan östrojen yoksunluğunun neden olduğu vulva ve vajinadaki mukus ve dokuların incelmesinin bir sonucudur. Kadın vücudundaki östrojen uyarımı, ürogenital sistemin normal anatomisinin ve fizyolojisinin korunmasından sorumludur. Toplam vücut östrojeninin üretimi ve miktarı azaldıkça, salgılar azalmakta ve genitoüriner dokular atrofik hale gelmektedir. Bu durum beraberinde birçok belirtiye neden olmaktadır. VVA’nın başlıca belirtileri vajinal kuruluk, tahriş, kaşıntı ve yanma hissidir. Bu belirtilerle birlikte vajinadaki kayganlığın azalması, kadınlarda disparoni ve koital kanamaya neden olmaktadır. Tüm bu değişikliklerle ilişkili olarak cinsel işlev bozukluğu ve cinsel aktivitenin azalması gibi sorunlar ortaya çıkabilmektedir. Bu nedenlerle VVA, kadının yaşamını önemli oranda etkileyen ve yaşam kalitesini düşüren ciddi bir problemdir. VVA’nın yönetimine yönelik son yıllarda farklı uygulamaların gündeme geldiği ve deneysel çalışmaların özellikle uluslararası alanda aktif olarak sürdürüldüğü görülmektedir. Bu derleme makalesinde amaç, postmenopozal dönemde sıklıkla görülen vulvovajinal atrofinin yönetiminde kullanılan güncel uygulamaların incelenmesidir

Anahtar Kelime:

Current practices in the management of vulvovagınal atrophy in postmenoposal perıod

Öz:

Vulvovaginal atrophy (VVA) is the result of thinning of mucus and tissues in the vulva and vagina caused by estrogen deprivation that occurs in menopausal women. Estrogen stimulation in the female body is responsible for maintaining the normal anatomy and physiology of the urogenital system. As the production and amount of total body estrogen decreases, secretions decrease and the genitourinary tissues become atrophic. This situation causes many symptoms. The main symptoms of VVA are vaginal dryness, irritation, itching and burning sensation. Decreased lubricity in the vagina along with these symptoms causes dyspareunia and coidal bleeding in women. Associated with all these changes, problems such as sexual dysfunction and decreased sexual activity may occur. For these reasons, VVA is a serious problem that significantly affects women’s lives and reduces their quality of life. It is seen that different applications for the management of VVA have come to the fore in recent years and experimental studies are actively carried out, especially in the international arena. The aim of this review article is to examine current practices used in the management of vulvovaginal atrophy, which is frequently seen in the postmenopausal period.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Bleibel B, Nguyen H. Vaginal Atrophy. 2021 Jul 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID:32644723. Erişim adresi: https://pubmed.ncbi.nlm.nih. gov/32644723/ [Erişim tarihi: 28.06.2021]
2. Koothirezhi R, Ranganathan S. Postmenopausal Syndrome. 2021 Aug 20. In: StatPearls [İnternet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID:32809675. Erişim adresi: https:// pubmed.ncbi.nlm.nih.gov/32809675/ [Erişim tarihi: 28.06.2021]
3. Palma F, Volpe A, Villa P, Cagnacci A; Writing group of AGATA study. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas. 2016;83:40–4. [CrossRef ]
4. Palacios S, Mejía A, Neyro J. Treatment of the genitourinary syndrome of menopause. Climacteric. 2015;18:23–9. [CrossRef ]
5. Palacios S, Nappi RE, Bruyniks N, Particco M, Panay N; EVES Study Investigators. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018;21:286–91. [CrossRef ]
6. Pérez-López FR, Phillips N, Vieira-Baptista P, Cohen-Sacher B, Fialho SC, Stockdale CK. Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease. Gynecol Endocrinol. 2021;37(8):746–52. [CrossRef ]
7. Weidlinger S, Schmutz C, Janka H, Gruetter C, Stute P. Sustainability of vaginal estrogens for genitourinary syndrome of menopause-a systematic review. Climacteric. 2021;24:551–9. [CrossRef ]
8. Nappi RE, Palacios S, Panay N, Particco M, Krychman ML. Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey. Climacteric. 2016;19(2):188–97. [CrossRef ]
9. Zhang L, Ruan X, Cui Y, Gu M, Mueck AO. Menopausal symptoms among Chinese peri- and postmenopausal women: a large prospective single-center cohort study. Gynecol Endocrinol. 2021;37(2):185–9. [CrossRef ]
10. Zhang GQ, Chen JL, Luo Y, Mathur MB, Anagnostis P, Nurmatov U, et al. Menopausal hormone therapy and women’s health: An umbrella review. PLoS Med. 2021;18(8):e1003731. [CrossRef ]
11. Hill K. The demography of menopause. Maturitas. 1996;23(2):113– 27. [CrossRef ]
12. Pınar ŞE, Yıldırım G, Duran Ö, Cesur B. A problem peculiar to women: Mental health in menopause. J Hum Sci. 2015;12:787– 98. [CrossRef ]
13. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T. C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye; 2019. Erişim adresi: http://www.hips.hacettepe.edu. tr/tr/2018_tnsa_analiz_ve_rapor-56 [Erişim tarihi: 28.06.2021].
14. Kaya Şenol D, Polat F, Doğan M. Gynecological Cancer Awareness: Reproductive Age and Postmenopausal Women. Turk J Fam Med Prim Care. 2021;15(1):56–62. [CrossRef ]
15. Minkin MJ, Maamari R, Reiter S. Postmenopausal vaginal atrophy: evaluation of treatment with local estrogen therapy. Int J Womens Health. 2014;6:281–8. [CrossRef ]
16. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health Insights, Views & Attitudes survey. Menopause. 2013;20:1043–8. [CrossRef]
17. Faubion SS, Sood R, Kapoor E. Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. Mayo Clin Proc. 2017;92(12):1842–9. [CrossRef ]
18. Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz HJ, Jaeger A. Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach. Dtsch Arztebl Int. 2020;116(8):126–33. [CrossRef ]
19. Pérez-López FR, Vieira-Baptista P, Phillips N, Cohen-Sacher B, Fialho SC, Stockdale CK. Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy. Gynecol Endocrinol. 2021;37(8):740–5. [CrossRef ]
20. Simon JA, Nappi RE, Kingsberg SA, Maamari R, Brown V. Clarifying Vaginal Atrophy’s Impact on Sex and Relationships (CLOSER) survey: emotional and physical impact of vaginal discomfort on North American postmenopausal women and their partners. Menopause. 2014;21(2):137–42. [CrossRef ]
21. Nappi RE, Palacios S, Bruyniks N, Particco M, Panay N; EVES Study Investigators. The burden of vulvovaginal atrophy on women’s daily living: implications on quality of life from a face-toface real-life survey. Menopause. 2019;26(5):485–91. [CrossRef ]
22. North American Menopause Society (NAMS). Management of symptomatic vulvovaginal atrophy:2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–904. [CrossRef ]
23. Mitchell CM, Reed SD, Diem S, Larson JC, Newton KM, Ensrud KE, et al. Efficacy of vaginal estradiol or vaginal moisturizer vs placebo for treating postmenopausal vulvovaginal symptoms: a randomized clinical trial. JAMA Intern Med. 2018;178(5):681– 90. [CrossRef ]
24. Bachmann G, Santen MRJ. Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy): Clinical Manifestations and Diagnosis. 2022.
25. Biehl C, Plotsker O, Mirkin S. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause. Menopause. 2019;26(4):431–53. [CrossRef ]
26. Kagan R, Kellogg-Spadt S, Parish SJ. Practical treatment considerations in the management of genitourinary syndrome of menopause. Drugs Aging. 2019;36(10):897–908. [CrossRef ]
27. de Riese CS, Yandell RB. Light/Laser Applications in Gynecology. In: Nouri K, editor. Lasers in Dermatology and Medicine, 2nd ed. Springer; 2018. p.115–34.
28. Rosner-Tenerowicz A, Zimmer-Stelmach A, Zimmer M. The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy. Ginekol Pol. 2021. [CrossRef ]
29. Eder SE. Long-Term safety and efficacy of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy fractional CO2 laser in vaginal atrophy. Laser Ther. 2019;28(2):103–9. [CrossRef ]
30. Alexiades MR. Fractional CO2 laser treatment of the vulva and vagina and the effect of postmenopausal duration on efficacy. Laser Surg Med. 2021;53(2):185–98. [CrossRef ]
31. Arroyo MA, Denys GA. Parallel evaluation of the MALDI sepsityper and verigene BC-GN assays for rapid identification of gram-negative bacilli from positive blood cultures. J Clin Microbiol. 2017;55(9):2708–18. [CrossRef ]
32. Kiesel M, Wöckel A, Zeller C, Meden H. Treatment of Vulvovaginal Atrophy with Fractional CO2 Laser: Evaluating Real-World Data. Photobiomodul Photomed Laser Surg. 2021;39(11):716–24. [CrossRef ]
33. Nappi RE, Kotek M, Brešt’anský A, Giordan N, Tramentozzi E. Effectiveness of hyaluronate-based pessaries in the treatment of vulvovaginal atrophy in postmenopausal women. Climacteric. 2020;23(5):519–24. [CrossRef ]
34. Origoni M, Cimmino C, Carminati G, Iachini E, Stefani C, Girardelli S, et al. Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study. Eur Rev Med Pharmacol Sci. 2016;20(20):4190–5. https://www.europeanreview.org/ article/11586
35. Buzzaccarini G, Marin L, Noventa M, Vitagliano A, Riva A, Dessole F, et al. Hyaluronic acid in vulvar and vaginal administration: evidence from a literature systematic review. Climacteric. 2021;24(6):560–71. [CrossRef ]
36. Dos Santos CC, Uggioni ML, Colonetti T, Colonetti L, Grande AJ, Da Rosa MI. Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. J Sex Med. 2020;18(1):156–66. [CrossRef ]
37. Hersant B, SidAhmed-Mezi M, Belkacemi Y, Darmon F, Bastuji- Garin S, Werkoff G, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10):1124–30. [CrossRef ]
38. Rad P, Tadayon M, Abbaspour M, Latifi SM, Rashidi I, Delaviz H. The effect of vitamin D on vaginal atrophy in postmenopausal women. Iranian J Nursing Midwifery Res. 2015;20:211–5. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4387645/
39. Riazi H, Ghazanfarpour M, Taebi M, Abdolahian S. Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review. J Menopausal Med. 2019;25(3):109–16. [CrossRef ]
40. Kamronrithisorn T, Manonai J, Vallibhakara SAO, Sophonsritsuk A, Vallibhakara O. Effect of Vitamin D Supplement on Vulvovaginal Atrophy of the Menopause. Nutrients 2020;12:2876. [CrossRef ]
41. Checa MA, Garrido A, Prat M, Conangla M, Rueda C, Carreras R. A comparison of raloxifene and calcium plus Vitamin D on vaginal atrophy after discontinuation of long-standing postmenopausal hormone therapy in osteoporotic women A randomized, maskedevaluator, one-year, prospective study. Maturitas. 2005;52(1):70– 7. [CrossRef ]
42. Lee A, Lee MR, Lee H-H, Kim Y-S, Kim J-M, Enkhbold T, Kim T-H. Vitamin D proliferates vaginal epithelium through RhoA expression in postmenopausal atrophic vagina tissue. Mol Cells. 2017;40(9):677–84. [CrossRef ]
43. Ghorbani Z, Mirghafourvand M. The efficacy and safety of intravaginal oxytocin on vaginal atrophy: A systematic review. Post Reprod Health. 2021;27(1):30–41. [CrossRef ]
44. Al-Saqi SH, Uvnäs-Moberg K, Jonasson AF. Intravaginally applied oxytocin improves post-menopausal vaginal atrophy. Post Reprod Health. 2015;21(3):88–97. [CrossRef ]
45. Jonasson AF, Bixo M, Poromaa IS, Åstrom M. Safety and efficacy of an oxytocin gel and an equivalent gel but without hormonal ingredients (Vagivital® Gel) in postmenopausal women with symptoms of vulvovaginal atrophy: a Randomized, Double-Blind Controlled Study. Med Devices (Auckl) 2020;13:339–47. [CrossRef]
46. Al-Saqi SH, Jonasson AF, Naessén T, Uvnäs-Moberg K. Oxytocin improves cytological and histological profiles of vaginal atrophy in postmenopausal women. Post Reprod Health. 2016;22(1):25–33. [CrossRef ]
47. Abedi P, Zohrabi I, Ansari S, Maraghi E, Maram NS, Houshmand G. The impact of oxytocin vaginal gel on sexual function in postmenopausal women: a randomized controlled trial. J Sex Marital Ther. 2020;46(4):377–84. [CrossRef ]
48. Thomas JV, Rao J, John F, Begum S, Maliakel B, Krishnakumar IM, Khanna A. Phytoestrogenic effect of fenugreek seed extract helps in ameliorating the leg pain and vasomotor symptoms in postmenopausal women: A randomized, double-blinded, placebocontrolled study. PharmaNutrition. 2020;14:100209. [CrossRef ]
49. Mazalzadeh F, Hekmat K, Namjoyan F, Sakimalehi A. Effect of fenugreek vaginal cream on dyspareunia and sexual satisfaction in menopausal women: a randomized clinical trial. Iranian J Obstet Gynecol Infertil. 2018;21(3):22–30. [CrossRef ]
50. Hakimi S, Alizadeh M, Delazar A, Abbasalizadeh F, Bamdad Mogaddam R, Siiahi M, et al. Probable effects of fenugreek seed on hot flash in menopausal women. J Med Plants. 2006;5(19):9–14. http://jmp.ir/article-1-658-en.html
51. Mazalzadeh F, Hekmat K, Namjouyan F, Saki A. Effect of Trigonella foenum (fenugreek) vaginal cream on vaginal atrophy in postmenopausal women. J Family Med Prim Care. 2020;9(6):2714–9. [CrossRef ]
52. Safary M, Hakimi S, Mobaraki-Asl N, Amiri P, Tvassoli H, Delazar A. Comparison of the Effects of Fenugreek Vaginal Cream and Ultra Low-Dose Estrogen on Atrophic Vaginitis. Curr Drug Deliv. 2020;17(9):815–22. [CrossRef ]
53. Hutchinson-Colas J, Segal S. Genitourinary syndrome of menopause and the use of laser therapy. Maturitas. 2015;82(4):342– 5. [CrossRef ]
54. Pearson A, Booker A, Tio M, Marx G. Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study. Breast Cancer Res Treat. 2019;178(1):135–40. [CrossRef ]
55. DiBonaventura M, Luo X, Moffatt M, Bushmakin AG, Kumar M, Bobula J. The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe. J Womens Health (Larchmt). 2015;24(9):713–22. [CrossRef ]
56. Siliquini GP, Tuninetti V, Bounous VE, Bert F, Biglia N. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017;20(4):379–84. [CrossRef ]
57. Karakoç H, Kul Uçtu A, Özerdoğan N. Genitourinary syndrome of menopause: effects on related factors, quality of life, and self-care power. Przeglad Menopauzalny= Menopause Review. 2019;18(1):15–22. [CrossRef ]
58. TÜİK (Türkiye İstatistik Kurumu). 2019. İstatistik Yıllığı. Ankara: T.C. Başbakanlık TÜİK. https://data.tuik.gov.tr/Bulten/ Index?p=Hayat-Tablolari-2017-2019-33711# [Erişim tarihi: 01.03.2022]
59. Portman DJ, Gass ML. 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. Maturitas. 2014;79(3):349–54. [CrossRef ]
60. Pace DT, Chism LA, Graham S, Amadio J. How nurse practitioners approach treatment of genitourinary syndrome of menopause. J Nurse Pract. 2020;16(2):136–42. [CrossRef ]
61. Chism L, Pace DT, Reed LK, Moore A, Khanna P. Genitourinary Syndrome of Menopause and the Role of Nurse Practitioners. J Nurse Pract. 2022;1–4. [CrossRef ]

APA	ŞİMAL YAVUZ N, Özerdoğan N (2022). Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. , 214 - 220. 10.24898/tandro.2022.35651
Chicago	ŞİMAL YAVUZ NURGÜL,Özerdoğan Nebahat Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. (2022): 214 - 220. 10.24898/tandro.2022.35651
MLA	ŞİMAL YAVUZ NURGÜL,Özerdoğan Nebahat Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. , 2022, ss.214 - 220. 10.24898/tandro.2022.35651
AMA	ŞİMAL YAVUZ N,Özerdoğan N Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. . 2022; 214 - 220. 10.24898/tandro.2022.35651
Vancouver	ŞİMAL YAVUZ N,Özerdoğan N Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. . 2022; 214 - 220. 10.24898/tandro.2022.35651
IEEE	ŞİMAL YAVUZ N,Özerdoğan N "Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar." , ss.214 - 220, 2022. 10.24898/tandro.2022.35651
ISNAD	ŞİMAL YAVUZ, NURGÜL - Özerdoğan, Nebahat. "Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar". (2022), 214-220. https://doi.org/10.24898/tandro.2022.35651

APA	ŞİMAL YAVUZ N, Özerdoğan N (2022). Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. Androloji Bülteni, 24(3), 214 - 220. 10.24898/tandro.2022.35651
Chicago	ŞİMAL YAVUZ NURGÜL,Özerdoğan Nebahat Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. Androloji Bülteni 24, no.3 (2022): 214 - 220. 10.24898/tandro.2022.35651
MLA	ŞİMAL YAVUZ NURGÜL,Özerdoğan Nebahat Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. Androloji Bülteni, vol.24, no.3, 2022, ss.214 - 220. 10.24898/tandro.2022.35651
AMA	ŞİMAL YAVUZ N,Özerdoğan N Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. Androloji Bülteni. 2022; 24(3): 214 - 220. 10.24898/tandro.2022.35651
Vancouver	ŞİMAL YAVUZ N,Özerdoğan N Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar. Androloji Bülteni. 2022; 24(3): 214 - 220. 10.24898/tandro.2022.35651
IEEE	ŞİMAL YAVUZ N,Özerdoğan N "Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar." Androloji Bülteni, 24, ss.214 - 220, 2022. 10.24898/tandro.2022.35651
ISNAD	ŞİMAL YAVUZ, NURGÜL - Özerdoğan, Nebahat. "Postmenopozal dönemde görülen vulvovajinal atrofi yönetiminde güncel uygulamalar". Androloji Bülteni 24/3 (2022), 214-220. https://doi.org/10.24898/tandro.2022.35651