medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-16-1medsovet-7101Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEМенопауза и генитоуринарное здоровье: оптимальная поддержка и коррекция нарушенийMenopause and genitourinary health: optimal support and correction of disordershttps://orcid.org/0000-0002-7430-1207ЯкушевскаяО. В.YakushevskayaO. V.

Оксана Владимировна Якушевская,  к. м. н., врач – акушер- гинеколог, онколог, научный сотрудник

отделение гинекологической эндокринологии

117997

ул. Академика Опарина, д. 4

Москва

Oksana V. Yakushevskaya, Cand. Sci. (Med.), Obstetrician-Gynecologist, Oncologist, Researcher

Department of Gynecological Endocrinology

117997

4, Academician Oparin St.

Moscow

aluckyone777@gmail.comНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В. И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation202209102022016136141Copyright © Якушевская О.В., 20222022Якушевская О.В.Yakushevskaya O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7101

   Вульва, влагалище, нижние отделы мочевыводящего пути и тазовое дно имеют одинаковое эмбриональное происхождение. Таким образом, все перечисленные структуры одинаково чувствительны к дефициту эстрогенов и менопаузальной гормональной терапии за счет экспрессии соответствующих рецепторов. Генитоуринарный менопаузальный синдром (ГУМС) – понятие, впервые введенное в 2013 г. для более полного определения последствий дефицита эстрогенов в урогенитальных тканях и отражающее весь спектр вагинальных и мочевых симптомов, которые испытывают женщины в период менопаузы. Термин широко отображает состояние, которое, в отличие от более старого термина «вульвовагинальная атрофия», не ограничивается одним симптомом диспареунии и включает женщин, которые не ведут половую жизнь. Последствия ГУМС существенно изменяют качество жизни большинства менопаузальных женщин. Часть пациенток с симптомами вульвовагинальной атрофии полностью прекращает половую жизнь (58 %) и избегает интимной близости (55 %). Различные формы нарушений мочеиспускания также изменяют повседневную деятельность, сон, сексуальную активность и могут привести к социальной изоляции и потере чувства собственного достоинства. Женщины с рецидивирующей вульвовагинальной инфекцией вынуждены часто обращаться за медицинской помощью. Терапия эстрогенами в период климактерия патогенетически обоснована. Интравагинальное введение эстрогенов эффективнее, чем их системное применение, купирует симптомы ГУМС – как объективно, так и субъективно. До 40 % женщин, получающих системную менопаузальную гормональную терапию, не испытывают ожидаемого влияния эстрогенов на урогенитальный тракт. При превалировании симптомов ГУМС целесообразно рассмотреть монотерапию локальными эстрогенами или совместить ее с системной вместо увеличения дозы последней. В статье представлен клинический случай персонифицированного подхода к решению проблемы вульвовагинальной атрофии в сочетании со смешанной формой недержания мочи у пациентки в постменопаузе.

   The vulva, vagina, lower urinary tract, and pelvic floor have the same embryonic origin. Thus, all of the abovementioned organs are equally sensitive to estrogen deficiency and menopausal hormone therapy due to expression of the respective receptors. Genitourinary syndrome of menopause (GSM) is a concept first introduced in 2013 to provide a more complete definition of the consequences of estrogen deficiency in urogenital tissues and reflect the full range of vaginal and urinary symptoms that women experience during menopause. The term broadly reflects the condition, which, unlike the older term “vulvovaginal atrophy”, is not limited to a single symptom of dyspareunia and includes women who are not sexually active. The consequences of GSM significantly alter the quality of life of most menopausal women. Some patients with symptoms of vulvovaginal atrophy completely stop their sexual activity (58 %) and avoid sexual intimacy (55%). Various forms of urinary disorders also alter activities of daily living, sleep, sexual activity, and can lead to social isolation and loss of self-respect. Women with recurrent vulvovaginal infection often have to seek medical care. Estrogen therapy during menopause is pathogenetically justified. Estrogens administered intravaginally are more effective in relieving the symptoms of GSM, both objectively and subjectively, than their systemic use. Up to 40% of women receiving systemic menopausal hormone therapy do not have the expected effect of estrogens on the urogenital tract. If the symptoms of GSM prevail, it is advisable to consider monotherapy with local estrogens or combine it with systemic therapy instead of increasing a dose of the latter. The article presents a clinical case of a personalized approach to solving the issue of vulvovaginal atrophy combined with a mixed urinary incontinence (MUI) in a postmenopausal female patient.

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The authors declare that there are no conflicts of interest present.