Treatment of postmenopausal atrophic vaginitis: suppositories, alternative means

The main method of prevention and treatment of atrophic processes associated with estrogen deficiency is hormone replacement therapy with systemic and local medications. Nevertheless, quite often the patients have contraindications to the use of synthetic sex hormones and phytoestrogens, some are categorically opposed to hormonal drugs even without contraindications. In addition, non-hormonal treatment of atrophic colpitis suggests the possibility of side effects, and serious enough, not only nausea and urticaria, but also increased vaginal irritation, discomfort in the mammary glands, bleeding. Women who undergo a course of estrogen replacement therapy are recommended regular diagnostic mammography and gynecological examinations.

Medicinal treatment of atrophic vaginitis

Non-hormonal drugs that have the ability to restore the mucosal epithelium of the vagina, reduce inflammatory manifestations and provide antimicrobial action are created by pharmacists based on prescriptions of alternative medicine.

For example, vaginal  suppositories Vagical, the active ingredient of which is a medicinal plant of calendula or marigold.

Antibacterial action of calendula provides the content of natural acids - salicylic, pentadicyl, apple, especially active against staphylococci and streptococci, phytoncides, which have antifungal activity. The plant has a pronounced anti-inflammatory effect, promotes cellular renewal, effectively combats dryness with glucuronic acid (a relative of the famous "humidifier" - hyaluronic). Prevents the formation of cells of connective tissue, strengthens the blood vessels, preventing the occurrence of a pathological capillary network. Due to the use of suppositories, microcirculation of blood, nutrition and breathing of the tissues of the vaginal wall improves. Carotenoids promote the healing of microdamages. Vegetable mucus, which is part of the calendula, also contributes to moisturizing and allows the use of the suppository as lubricants.

Improvement of the patient is felt quite quickly. Suppositories dissolve well in the vagina, medicinal substances are absorbed into its walls, and quickly enough the patients note a subjective improvement in their well-being. It is administered intravaginally on a single suppository twice a day, the recommended treatment course is ten days, during which the external genitalia ceases to itch, the vaginal dryness passes, visual examination shows a decrease in the pathological proliferation of the capillary mesh, the surface of the epithelium looks more even, pale pink, without petechia and sores. If necessary, the doctor can extend the course of treatment. Supportive therapy involves the introduction of one or two suppositories per week.

Also effective are  suppositories of Cicatridine, which also contain an oil extract of calendula, and in addition, three more medicinal plants: Asian cinnamon, Aloe vera and tea tree. Suppositories also contain hyaluronic acid, which returns the tone to the vaginal walls and makes them more elastic. In addition, it promotes the assimilation of nutrients, the normalization of metabolic processes, which accelerates the cellular renewal and recovery of the epithelial surface of the vagina.

The standard dosage is one suppository intravaginally at night during the first ten days of treatment, then one day later. The doctor can change this scheme. Suppositories can be applied without interruption for a long time (up to three months). To prevent exacerbation and maintain the state of the vagina, it is recommended to inject one suppository once a week.

Preparations with plant hormones containing extracts of tsimitsifugi, red clover, wild yam, soy are not considered hormonal therapy, although they contain compounds (isoflavones), similar in structure and action to human estrogens. The effectiveness of soy isoflavones (they are studied most carefully) - daidzin and genistein is quite comparable with the effectiveness of synthetic estrogens, however, the probability of developing hyperplastic processes during their intake does not increase. Nevertheless, women who have estrogen-dependent tumors, drugs with phytoestrogens are contraindicated.

Phytoestrogens of red clover, tsimitsifugi and other plants can also make a worthy alternative to synthetic hormones and normalize not only the state of the vaginal wall, but also to get rid of other manifestations of menopause

The drug for oral administration  Feminal, is released in capsules and drops, according to customers, gives a steady effect, prevents the growth of the endometrium, myomatous nodes, polyps. Drops are dissolved in a quarter or half a glass of water. Take once or twice a day. Capsules - once a day after meals. The duration of treatment is determined by the doctor and ranges from two months to six months.

Klimadinon  - drops on the basis of drawing from the rhizome of tsimitsifugi. It has a regenerating and easy sedative effect. Take 30 undiluted drops in the morning and evening, you can drip them into a slice of a refined sugar. Tsimitsifuga can cause reactions from the liver (icterus, changes in the activity of transaminases) and gastrointestinal tract (dyspeptic phenomena), allergic urticaria and facial swelling.

Estroel  is a complex preparation containing extracts of rhizome of tsimitsifugi, soybean grains, wild yams, nettles, vitamins of B group, ascorbic acid, vitamin K, promoting blood clotting and metabolic processes in bone tissue, boron and calcium source (calcium fructoborate). The dose and duration of admission is determined by the doctor, the standard dosage assumes taking one tablet once or twice a day after a meal, the recommended course of treatment is 30 days.

Complex drug  Menovitol is  registered as a biologically active additive. It contains many herbal components: St. John's wort flavonoids, wild yam saponins, soy genistein, female ginseng root extract - Chinese whistle, rich in phytoestrogens, polyunsaturated fatty acids, tocopherol, sea oak (fucus bubbly) and fruits of the Abraham tree. In addition, it contains phenylalanine, zinc gluconate, pyridoxine, and calcium fructoborate. The components of the drug have a multifaceted effect, eliminating the symptoms associated with postmenopause, and comprehensively improving the quality of life of a woman. Contraindicated in patients with phenylketonuria. Take a month for one capsule twice a day, combined with food intake.

Herbal preparations with atrophic vaginitis can cause allergic reactions of various kinds, more often - from the skin, respiratory organs or digestion. They are contraindicated in case of intolerance of any ingredients in their composition.

However, the main method of treatment of atrophic vaginitis is replacement therapy with drugs of female sex hormones, both local and systemic. This method is widely practiced all over the world and has allowed many women to avoid urogenital pathological manifestations associated with hypoestrogeny.

However, hormone replacement therapy has many contraindications. These include the presence of estrogen-dependent diseases and a suspicion of their possible development (malignant neoplasms of the breast, endometrium, vaginal bleeding, the cause of which is not established). In addition, HRT is usually not prescribed for women with severe chronic liver disease, abnormalities in liver function tests, porphyria, history of vascular thromboembolism, presence of thromboembolic diseases of the arteries, and decompensated heart failure.

Many chronic diseases that are present in adulthood are not direct contraindications to hormone therapy, however, are a reason for careful prescription of drugs and careful analysis of the risk / benefit ratio.

Currently, with atrophic vaginitis, hormonal preparations of estriol are preferred, which have a local effect directly on the vaginal tissues and do not require additional progestogen therapy, like estradiol preparations.

Estriol is a secondary estrogen hormone that is not very active and has a short-term effect only on the mucous membrane of the vaginal wall. However, it does not cause intensive division and growth of endometrial cells and cyclic changes in the uterus, as estradiol preparations, which have a systemic effect, regardless of the mode of their administration. In the menopausal period of local action, estriol is quite enough to relieve discomfort in the vagina. It eliminates pain, itching and dryness, stops complaining of urinary incontinence and the risk of infection of the urino-genital organs decreases several times. Therefore, the suppository for atrophic vaginitis with estriol is well established and is the drug of choice in the prevention and treatment of this condition.

Candles  estriol  contain natural active hormone. They are particularly effective in the presence of urogenital problems. The result of their application is the normalization of the epithelial membrane of the vaginal wall, the acidity of the vaginal environment and the restoration of the ecosystem. In patients with estrogen deficiency, local immunity is markedly increased, and as a result, exacerbations of chronic urogenital pathologies are reduced or stopped altogether. If the recommended dose is not exceeded, it is possible to avoid such a side effect of HRT as endometrial hyperplasia and compaction in the mammary glands. Suppositories with estriol do not cause bleeding after their withdrawal. The recommended dose is one suppository per day at the beginning of treatment with a gradual decrease in the number of administrations to a maintenance dose (twice a week).

Vaginal tablets  Gynoflora  in addition to estriol contain lyophilized sticks of Doderlein (lactobacilli), which, when entering the vagina, begin to multiply actively, creating a natural acidic environment and preventing the multiplication of pathogenic bacteria. Estriol restores the normal state of cells of the vaginal mucosa, which contains glycogen - a nutrient medium, favorable for the development of lactobacilli. There is a natural sanitation of the mucous membrane of the vagina, its recovery and enhancement of protective properties. At the beginning of treatment, one tablet is administered intravaginally once a day for six to twelve days, then go on to supportive therapy - once or twice a week.

Local preparations can cause a sensitization reaction in the form of itching, burning, flushing, edema. Often on the second or third day, these effects occur without the drug being withdrawn.

In severe cases, when atrophic vaginitis is combined with other postmenopausal manifestations, in particular a high risk of fractures, systemic therapy with estradiol preparations is prescribed. It is taken either inward in a tablet form (Femoston, Angelica), or locally - in the form of patches, gels, which also affect the entire body, removing climacteric symptoms. Preparations containing estradiol are much more likely to cause side effects and require careful follow-up of the doctor's recommendations regarding dosages and frequency of administration.

Patients undergoing hormone replacement therapy should undergo regular examinations at a gynecologist and mammologist.

Independently, even local estrogen-containing drugs should never be used, and also - supplement the drug treatment with alternative medications without consulting a doctor.

Antibiotics are prescribed for complications - a pronounced inflammatory process, attachment of a secondary infection. Usually, they are not included in the scheme of treatment of atrophic vaginitis.

Vitamins and minerals must necessarily be present in the diet of a woman who has crossed the age of "berry again". They help slow down the aging process, stabilize the well-being and maintain the working condition of tissues and organs. Vitamins are especially important during the course of hormone replacement therapy.

Of course, in the first place, provide the body with the necessary substances should be nutrition. The diet should be rich in vitamins A, E, C, D, K, F, all representatives of group B. They strengthen immunity, start and regulate metabolic processes, the synthesis of all necessary substances.

However, in the off-season to prevent the development of exacerbations possible with the help of vitamin-mineral complexes. The best are: Alphabet +, Doppelgerz-asset Menopause, Complivit 45+, Menopace, Tsi-Klim and others, addressed specifically to this age group of women. To pick up a suitable complex is recommended together with a doctor who will tell you how long to take vitamins. Constantly it is not necessary to do this, since hypervitaminosis does not affect the state of the organism better than the vitamin deficiency.

Physiotherapy treatment effectively complements the drug component of treatment, allows you to reduce the dose of drugs, avoid their side effects and achieve a stable remission. Physiotherapy procedures are appointed by the doctor, based on the general condition of the patient, contraindications for existing chronic pathologies.

The procedures are carried out after the acute infectious process has been eliminated (if it was). Electroprocedures, magnetic and laser therapy, ultraviolet waves, solar and air baths are applied.

Alternative means

With atrophic vaginitis, women who have contraindications to hormone replacement therapy or who do not accept this method of treatment can try to eliminate the problem of vaginal discomfort with alternative therapies. Moreover, these methods are also studied by pharmacists as an alternative to hormones. Naturally, before being treated by alternative means, it is recommended to be examined and consulted with a doctor about the advisability of their use.

For example, one of the most effective methods is urinotherapy. In this case we are talking about douching with our own urine. When conducting such procedures, several rules should be followed.

Firstly, only the so-called medium urine is suitable for syringing. You need about 10ml of physiological fluid. Approximately the first third of the morning portion you lower into the toilet, then collect in the sterile jar an average third, the rest you send after the first.

Secondly, the procedure is carried out immediately in the morning with fresh urine. You draw it from the jar into a clean ten-gallon syringe, remove the needle and syringe.

Thirdly, I repeat, all the devices for this must be sterile.

The recommended course of treatment is in the mornings for two weeks. If you have a suspicion of having a urinary tract infection - an unusual color of urine, sediment, bloody veins, the procedure is contraindicated.

With atrophic vaginitis, the main symptom is the dryness of the vagina. Tampons with sea buckthorn oil can help or just lubricate the vagina with this remedy.

In the pharmacies are sold suppositories with sea buckthorn oil - you can use them.

Sea buckthorn oil is rich in carotenoids, has anti-inflammatory and softening effect, heals wounds and erosions well.

You can put tampons at night, impregnated with a mixture of honey with vegetable oil, preferably with olive, but you can also with sunflower, in equal parts. Tampons are put every evening until the symptoms disappear.

Treatment with herbs atrophic vaginitis has also been used for a long time and it gives women a tangible relief. No wonder the pharmaceutical industry produces candles, drops, tablets and elixirs based on herbs.

Herbal preparations with atrophic vaginitis can be prepared at home.

Infusions and decoctions of medicinal plants are applied externally in the form of trays and syringes.

For example, with whitish cheesy discharge, talking about the colonization of the vagina with fungi (candidiasis), you can syringe infusions of calendula. Infusion for syringing is prepared in a water bath at the rate of - a tablespoon with the top of dried flowers pour a glass of boiling water and are pressed for about a third of an hour under the lid. Then, for an hour, insist, without opening the lid, filter and perform the procedure. The effect is noticeable after two or three procedures. Long-term douching (more than a week) is undesirable.

For preventive purposes, a sessile bath with infusion of calendula is made. For the baths, the flowers are brewed with boiling water in proportions of two tablespoons per liter, doused in a water bath for 20 minutes, allowed to cool to a temperature of 36-37 ℃, filtered, poured into a comfortable clean container and take a bath

Irritation and dryness will help to eliminate the sessile baths with the flowers of chamomile medicinal, brewed in the same proportions, you can also syringe infusion of chamomile, only in a bath it can withstand no more than ten minutes.

In some sources it is recommended to alternate external procedures with calendula, plantain, chamomile and sage.

Inside of itching, dryness and burning in the vagina it is recommended to drink a decoction of a mixture of St. John's wort and a thousand-thousandth. Take a tablespoon of each herb, pour boiling water in a volume of 200ml, boil for five minutes on a weak flame, set aside for a quarter of an hour, strain and take a tablespoon before each meal.

Natural phytoestrogens are found in such plants growing in our latitudes, like sage and red clover. Decoctions and infusions of these plants are recommended to drink with menopausal and postmenopausal symptoms, in order to normalize the hormonal background and get rid of not only from the tides, but also to eliminate the symptoms of atrophic vaginitis.

The infusion or decoction of sage is taken by a two-week course, then the same break is made and the course of treatment is repeated if necessary.

Brew infusion as a regular tea with boiling water from the calculation of a teaspoon with a slide of grass for 200ml of water. During the day you need to drink two such servings.

The broth is prepared in the proportions: on a teaspoon of chopped herb - ½ liter of boiling water. They boil for just one minute. Drink instead of tea three times a day.

Sage is contraindicated in estrogen dependent diseases, thyroid dysfunction and severe renal failure.

Red clover in addition to phytoestrogens contains a large number of minerals, calcium in it is more than in milk. In its composition, magnesium, selenium, phosphorus, iron and many other biologically active components. It is believed that it prevents the development of neoplasms of the mammary glands.

Infusion from this herb is brewed in a thermos for the night in the proportions: 200ml of boiling water - two tablespoons of dry shredded clover. In the morning, the infusion is filtered and the whole portion is drunk the day before the meal by a quarter of the glass until the symptoms disappear.

Red clover can be drunk, brewing instead of tea or adding to tea brew. Instead of tea, a mixture of red clover, dry strawberries, raspberries and lime-colored flowers is brewed. This herb is used for syringing, making it a tincture on vodka. It also has contraindications - neoplasms of the genitourinary system, suffered myocardial infarction, thrombocytopenia, varicose veins, frequent diarrhea.

In addition, phytoestrogens do not use in combination with drugs containing female sex hormones.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]

Homeopathy

To treat atrophic vaginitis with homeopathic remedies, first of all, it is necessary to consult a homoeopathic doctor. The arsenal of drugs used to eliminate such pathology is very large, therefore, an expert in this field can only choose an effective drug that takes into account the features of manifestations, localizations, concomitant diseases and traits of the patient's character.

Patients complaining of loss of sexual desire because of soreness of coitus, burning inside the vagina, can be appointed Barbaris vulgaris (Berberis vulgaris).

With severe itching of the vulvar ring and vaginal mucosa, edema of the external genitalia, burning in the folds of the labia, contact discharge of blood from the vagina, aversion to sex in postmenopause helps Beech tar (Kreosotum).

The medicine prepared from the spores of the clown planus (Lycopodium) is prescribed for women suffering from painful intercourse due to the dryness of the vagina, with corrosive irritating discharge, bleeding, varicose veins of the external genitalia.

Sodium chloride (Natrium muriaticum) is also recommended for patients with vaginal dryness, discharge and complications such as uterine prolapse.

Buckwheat (Fagopyrum), Black mercury oxide (Mercurius solubilis), Spotted spotted (Conium) are prescribed to older women complaining of symptoms of atrophic vaginitis with an attached infection and urological complications.

With inflammation of the vagina, pains and severe complications in the form of prostration (falling out) of the genitals, homeopathic grains from the contents of a bag of black cuttlefish (Sepia) can be prescribed.

Like alternative healers, homeopaths noticed the effectiveness of drugs made from Voronets racemic or Cimicifuga and Calendula officinalis in inflammatory processes in older women.

The hormonal regulating effect is provided by the complex homeopathic preparation Climakt-Heel, which contains the following ingredients that ensure the action of the drug: the already mentioned Sepia (substance from the bag of black cuttlefish), snake venom (Lachesis) also often prescribed in pathological climacteric symptoms, especially in combination with the appearance of seals in the mammary glands.

The plant components of the preparation are represented by the Canadian Sanguinaria (Sanguinaria Canadensis), complementing the action of Lahiesis, Ignazia bitter (Strychnos ignatii), prescribed for various sexual disorders, Cedron (Simarouba cedron), which has a detoxification and anti-inflammatory effect.

Mineral components Sulfur and Stannum metallicum also stop such manifestations as discharge, bleeding, pain, itching, vaginal and uterine prolapse.

Climact-Heel tablets are put under the tongue and completely dissolved there, without swallowing. For relief of acute conditions, the drug is taken every quarter of an hour for two hours (no more than eight in a row). Then they switch to a regular triple reception - sublingually for a quarter of an hour before a meal or an hour after.

May cause sensitization reactions. If the intake lasts more than one month, hepatic parameters need to be monitored.

For the regulation of hormonal deficiency and associated disorders in the postmenopausal period, the Ovarium compositum injectable preparation is intended. It includes many components that stop the menopausal symptoms: Black mercury oxide (Mercurius solubilis), substance from the bag of black cuttlefish (Sepia), snake venom (Lachesis), Beech tar (Kreosotum), extracts of tissue biological regulators of the placental, pituitary, ovarian and a lot others.

Contraindicated in patients with sensitization to the ingredients of the drug. It is impossible to exclude the possibility of allergic reactions, sometimes hypersalivation is observed during the treatment with this drug.

Single dose is one ampoule, the introduction of the solution is carried out in any way - in the skin, muscles, under the skin, in a vein. The recommended frequency of injections is one or two a week. Duration - up to one and a half months. The doctor can change the injection mode depending on the patient's condition.

Klimaksan tablets, which consist of three components: Voronets (Cimicifuga), snake (Lachesis) and bees (Apis mellifica) poisons. The drug normalizes the hormonal background and reduces the manifestations of climacteric symptoms, has a calming effect. It includes lactose, which should be taken into account when it is intolerant, as well as diabetics. There is a risk of allergic reactions when sensitized to the active substances of the drug.

Tablets are designed for sublingual administration, which is carried out twice a day after 12 hours. In more severe cases, it is permitted to increase the number of receptions to three or four. The course of treatment should not last more than two months, however, after making a three-week interval, it can be repeated.

Treatment with homeopathic medicines must be carried out under the supervision of a doctor, a specialist in this field of medicine. The consequences of self-medication can be unpredictable. Be sure to tell your doctor if you are taking a course of physiotherapy or manual therapy. If you follow all the rules of the doctor's admission and recommendations, homeopathic treatment can be very effective.

Exercises with atrophic vaginitis

Every woman who wants to avoid the vaginal wall dropping and the loss of the uterus in old age, and the risk of such pathologies is very high (1: 5), and also - to ensure blood flow to the organs, in which atrophic processes begin, slowing them down significantly, should familiarize themselves with the complex exercises for training the muscles of the small pelvis. Performing such simple exercises helps to prevent incontinence of physiological waste (urines and feces), omission and prolapse of the genital organs, development of inflammatory and dystrophic changes in them. In addition, good blood circulation in this area will allow for a long time to provide sexual health and a full sexual life.

Exercises are not performed at the first time after surgery, in the presence of neoplasms of the pelvic organs and peritoneum.

Begin the exercises of intimate gymnastics Kegel, the gynecologist, who first introduced them into the everyday life, you can at any time and better not postpone it. They are most valuable as a preventive technique. With an easy degree of atrophic changes, doing exercises can also help correct the situation. In more serious and neglected cases, the result is not guaranteed, although it is always useful to train the muscles of the pelvic floor.

These exercises consist in the alternation of stress and relaxation of the pelvic floor musculature. They can be done in any position (lying in bed, sitting in front of the monitor, standing in the transport). The main thing is to find the muscles that need to be trained. This is also not difficult. In the process of emptying the bladder, close the jet. It is these muscles that need to be trained. Now that you've found them, you can start doing the exercises. They are made with an empty bladder. Repeat the focus with stop urinating should not be.

First, doing the exercises at home, you can insert a clean finger into the vaginal opening. With the proper operation of the muscles, they will shrink around the finger.

Begin the exercises, straining the muscles for 3-5 seconds, then relaxing them for the same time. In this case, you do not need to hold your breath, but to do even inhalations and exhalations. At first, repeat the exercise in one approach 4-5 times, focusing on the technique and performing such small complexes several times a day.

Later, you can extend the voltage-compression period to 10 seconds. When the right technique is mastered, you can do the exercises, anywhere. It is recommended not less than three approaches a day, in each of them about 20 times repeating the tension-relaxation of the muscles.

To achieve a more stable condition, Kegel exercises can be performed in conjunction with other movements that strengthen the muscles of the pelvic floor. A lot of exercise complexes that provide women's health have been developed, similar techniques exist in yoga and Tibetan practices.

Specialists recommend doing gymnastics, which strengthens the muscles of the vagina throughout life. This will be the best prevention of atrophic changes in its walls and complications associated with age-related changes.

[15], [16], [17], [18]