Treatment of genitourinary menopausal syndrome in patients with gynecologic cancer
Dobrokhotova Yu.E., Ilyina I.Yu., Venediktova M.G., Utina M.S., Morozova K.V., Suvorova V.A.

Russian National Research Medical University named after N.I. Pirogov, Moscow

Genitourinary menopausal syndrome (GUMS) is a common problem observed in more than 50% of postmenopausal women.
Aim: to determine the effectiveness and safety of the use of CO₂ laser as an independent method and in combination with phytoestrogens in the treatment of vulvovaginal atrophy as one of the GUMS manifestations in patients after uterine cancer treatment.
Patients and Methods: the study included the patients (n = 40) with symptoms of vulvovaginal atrophy and the patients treated for uterine cancer in 2010-2011. The mean age was 62.2 ± 4.7 years. The first group (n = 20) was treated with three sessions of CO₂ laser treatment with FemTouch procedure on AcuPulse (Lumenis) device with the intervals of 21-28 days. In the second group (n = 20), in addition to the main therapy, phytoestrogens were prescribed after the end of the course of laser treatment. To assess the results, the authors used the specialized international questionnaire VSQ (The Vulvovaginal Symptom Questionnaire), determining the vaginal health index (VHI), real time sonoelastography, and evaluation of vaginal walls blood flow before and after treatment. 
Results: after treatment there was a significant improvement in both groups: the average score according to the VSQ questionnaire with the use of the CO₂ laser as a single method was 14.5 ± 2.7 before treatment and 6.6 ± 2.5 (p <0.001) - after treatment, and in combined use with phytoestrogens it was 12.2 ± 3.9 before treatment and 5.3 ± 2.3 (p <0.001) after treatment, respectively. The index of vaginal health in the first group was 11.2 ± 4.4 before treatment and 17.3 ± 3.5 (p <0.001) after therapy, in the second group 9.3 ± 3.6 and 19.8 ± 2.9 (p <0.001), respectively. When carrying out sonoelastography, a month after the start of treatment, a positive effect was noted, after the completion of the treatment course, the stiffness (elasticity) of the vaginal tissues increased in 85% of patients. The appointment of phytoestrogens had an additional positive effect, obtained after 3 sessions of CO₂ laser therapy.

Conclusion: the use of CO₂ laser in combination with phytoestrogens is an effective and safe method of the vulvovaginal atrophy treatment in onco-gynecologic patients.
Key words: genitourinary menopausal syndrome, vulvovaginal atrophy, CO₂ laser, phytoestrogens.
For citation: Dobrokhotova Yu.E., Ilyina I.Yu., Venediktova M.G. et al. Treatment of genitourinary menopausal syndrome in patients with gynecologic cancer // RMJ. 2017. № 26. P. 1921–1925.