medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-294medsovet-7784Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEСовременные тенденции в профилактике и лечении генитоуринарного менопаузального синдромаCurrent trends in the prevention and treatment of genitourinary menopausal syndromehttps://orcid.org/0000-0002-4581-6295АполихинаИ. А.ApolikhinaI. A.

Аполихина Инна Анатольевна – доктор медицинских наук, профессор, заведующий отделением эстетической гинекологии и реабилитации, НМИЦ АГП им. ак. В.И. Кулакова; профессор кафедры акушерства, гинекологии, перинатологии и репродуктологии Института профессионального образования, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

117997, Москва, ул. Академика Опарина, д. 4; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Inna A. Apolikhina - Dr. Sci. (Med.), Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov First Moscow State Medical University (Sechenov University).

4, Academician Oparin St., Moscow, 117997; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

apolikhina@inbox.ruhttps://orcid.org/0009-0006-7500-7516ТарнаеваЛ. А.TarnaevaL. A.

Тарнаева Лиана Александровна - врач-ординатор.

117997, Москва, ул. Академика Опарина, д. 4

Liana A. Tarnaeva - Resident Physician, Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology.

4, Academician Oparin St., Moscow, 117997

li.tarnaeva@ya.ruНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияKulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation202320102023015111116Copyright © Аполихина И.А., Тарнаева Л.А., 20232023Аполихина И.А., Тарнаева Л.А.Apolikhina I.A., Tarnaeva L.A.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/7784

Генитоуринарный менопаузальный синдром остается широко распространенной проблемой, значительно влияющей  на качество жизни в постменопаузе. Причиной данного состояния является гипоэстрогения, связанная с менопаузой,  и последующее изменение микрофлоры влагалища за счет элиминации лактобацилл. Нарушение микрофлоры вульвы и влагалища представляет риски для проникновения патогенных микроорганизмов, а дефицит половых гормонов ассоциируется с атрофией эпителия мочеполового тракта. Был проведен анализ опубликованных клинических исследований с применением комбинации L. acidophilus и ультранизкой дозой 0,03 мг эстриола (препарат Гинофлор® Э) у женщин в постменопаузе с вульвовагинальной атрофией, а также у женщин, перенесших рак молочной железы и принимающих ингибиторы ароматазы. Лечение комбинацией L. acidophilus и 0,03 мг эстриола (Гинофлор® Э) может быть оценено как безопасное без какого-либо соответствующего риска влияния на эндометрий или других системных эффектов. Локальная эстрогенная терапия у женщин в постменопаузе восстанавливает состояние эпителия влагалища, а достаточное количество лактобацилл необходимо для профилактики мочеполовых инфекций. Локальное применение эстриола предпочтительнее, так как вызывает местный пролиферативный ответ, не оказывает стимулирующего влияния на эндометрий. Локальный эстриол в ультранизких дозах (0,03 мг) демонстрирует эффективность, эквивалентную эффективности препарата в дозе 0,5 мг. Также данный метод терапии может быть рассмотрен для гормоночувствительных женщин с раком молочной железы, принимающих ингибиторы ароматазы, однако на сегодняшний день недостаточно клинически подтвержденных исследований, доказывающих абсолютную безопасность этого метода лечения. Эффект от данной терапии достигается благодаря синергическому действию эстриола и лактобацилл.

Genitourinary menopausal syndrome is still a widespread problem that significantly affects the quality of life in postmenopause. The cause of this state is hypoestrogenism that is associated with menopause and the following change in the vaginal microflora due to the elimination of lactobacilli. The disturbance of the vulval and vaginal microflora provides risks for the invasion of pathogenic microorganisms, and the deficiency of sex hormones is associated with atrophy of the epithelium of the urogenital tract. An analysis of published clinical studies using a combination of L. acidophilus and 0.03 mg estriol (Gynoflor® E) in postmenopausal women with vulvovaginal atrophy, breast cancer survivors, in postmenopausal women with breast cancer on aromatase inhibitors was performed. Treatment with a combination of L. acidophilus and 0.03 mg of estriol (Gynoflor® E) can be evaluated as safe without risk of endometrial effects or other systemic effects. Local estrogen therapy in postmenopausal women can restore the vaginal epithelium, and a useful lactobacillus flora is needed to prevent urogenital infections. Local application of estriol is preferable, as it causes a local proliferative response and has no stimulating effect on the endometrium. This method of therapy may also be considered for hormone-sensitive women with breast cancer on aromatase inhibitors. However, today, there are not enough clinically validated studies proving the absolute safety of this treatment method among breast cancer women. The effect of this therapy is achieved due to the synergistic action of estriol and lactobacilli.

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