Non-hormonal therapy of atrophic vaginitis at different postmenopausal stages
DOI: 10.32364/2618-8430-2025-8-4-10
Yu.E. Dobrokhotova, A.Kh. Karanasheva
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Aim: to evaluate efficacy of a non-hormonal agent containing phytoestrogens, lactobacilli, and hyaluronic acid in correcting vaginitis manifestations depending on a postmenopausal stage according to the STRAW+10 (Stages of Reproductive Aging Workshop) criteria.
Materials and Methods: 58 women diagnosed with atrophic vaginitis according to the STRAW+10 criteria at various postmenopausal stages were examined. Three groups were formed: +1a, +1b — 16 patients (average age: 48.3±3.1 years); +1c — 14 patients (average age: 53.2±2.3 years); and +2 — 28 patients (average age: 59±3.3 years). A non-hormonal pre-dosed intimate cream containing phytocomplex, lactobacilli and hyaluronic acid, was injected to treat atrophic vaginitis into the vulvar vestibule daily at the bedtime within 30 days.
Results: after the treatment course, complaints persisted in significantly fewer women (p<0.05): 2 (12,5%), 2 (14.38%), and 4 (14.3%) cases were reported in the groups +1a, +1b, +1c and +2 respectively. After the treatment, a decrease in pH values and an increase in Vaginal Health Index (VHI) were statistically significant (p<0.05) in the group +1a, +1b, and pH value became normal along with an increase in VHI in the groups +1c and +2 (p>0.05). As a result of the therapy, Lactobacillus spp. replaced both facultative aerobes (Streptococcus spp. and Staphylococcus spp., etc.) and obligate anaerobes (Gardnerella vaginalis, Peptostreptococcus spp., Atopobium vaginae, etc.) whose number decreased at all postmenopausal stages. Severity of symptoms of vaginal atrophy according to the visual analog scale adapted by E.I. Ermakova, decreased in all patients (p<0.05). In sexually active women, subjective well-being improved in all the groups (p>0.05).
Conclusion: the use of non-hormonal topical agent containing phytoestrogens, lactobacilli and hyaluronic acid, has significantly reduced clinical manifestations of atrophic vaginitis and improved the quality of life in patients. At the same time, the efficacy did not depend on a menopausal stage.
Keywords: atrophic vaginitis, non-hormonal therapy, postmenopausal stages according to the STRAW+10 criteria, phytoestrogens, hyaluronic acid.
For citation: Dobrokhotova Yu.E., Karanasheva A.Kh. Non-hormonal therapy of atrophic vaginitis at different postmenopausal stages. Russian Journal of Woman and Child Health. 2025;8(4):346–351 (in Russ.). DOI: 10.32364/2618-8430-2025-8-4-10
ABOUT THE AUTHORS:
Yulia E. Dobrokhotova — Dr. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology of the Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-7830-2290
Albina Kh. Karanasheva — C. Sc. (Med.), Teaching Assistant of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117997, Russian Federation; ORCID iD 0000-0003-3410-2059
Contact information: Albina Kh. Karanasheva, e-mail: kar.albina@gmail.com
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.10.2025.
Revised 27.10.2025.
Accepted 21.11.2025.
2. Зиганшина Л.З., Муслимова С.Ю., Сахаутдинова И.В. Особенности вагинальной микробиоты у женщин на различных стадиях постменопаузы. Гинекология. 2023;25(4):447–451. DOI: 10.26442/20795696.2023.4.20238Ziganshina L.Z, Muslimova S.Yu., Sakhautdinova I.V. Features of vaginal microbiota in women at different stages of postmenopause. Gynecology. 2023;25(4):447–451 (in Russ.). DOI: 10.26442/20795696.2023.4.202381
3. Kim H.K., Kang S.Y., Chung Y.J. et al. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015;21:65–71. DOI: 10.6118/jmm.2015.21.2.65
4. Muhleisen A.L., HerbstKralovetz M.M. Menopause and the Vaginal Microbiome. Maturitas. 2016;91:4250. DOI: 10.1016/j.maturitas.2016.05.015
5. Godha K., Tucker K.М., Biehl С. et al. Human vaginal pH and microbiota: an update. Gynecol Endocrinol. 2018;34(6):4515. DOI: 10.1080/09513590.2017.1407753
6. Kim S., Seo H., Rahim M.A. et al. Changes in the Microbiome of Vaginal Fluid after Menopause in Korean Women. J Microbiol Biotechnol. 2021;31(11):1490500. DOI: 10.4014/jmb.2106.06022
7. Shardell M., Gravitt P.E., Burke A.E. et al. Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages. J Gerontol A Biol Sci Med Sci. 2021;76(9):154250. DOI: 10.1093/gerona/glab120
8. De Oliveira N.S., De Lima A.B.F., De Brito J.C.R. et al. Postmenopausal Vaginal Microbiome and Microbiota. Front Reprod Health. 2022;3:780931. DOI: 10.3389/frph.2021.780931
9. Wang Y., Zhang Y., Zhang Q. et al. Characterization of pelvic and cervical microbiotas from patients with pelvic inflammatory disease. J Med Microbiol. 2018;67(10):151926. DOI: 10.1099/jmm.0.000821
10. Park M.G., Cho S., Oh M.M. Menopausal Changes in the Microbiome — A Review Focused on the Genitourinary Microbiome. Diagnostics (Basel). 2023;13(6):1193. DOI: 10.3390/diagnostics13061193
11. Mitchell C.M., Ma N., Mitchell A.J. et al. Association between postmenopausal vulvovaginal discomfort, vaginal microbiota, and mucosal inflammation. Am J Obstet Gynecol. 2021;225(2):159.e115. DOI: 10.1016/j.ajog.2021.02.034
12. Татарова Н.А., Линде В.А., Гусев С.Н. Негормональная терапия генитоуринарного менопаузального синдрома. Вопросы гинекологии, акушерства и перинатологии. 2021;20(2):141–146. DOI: 10.20953/1726-1678-2021-2-141-146Tatarova N.A., Linde V.A., Gusev S.N. Non-hormonal treatment for genitourinary syndrome of menopause. Gynecology, Obstetrics and Perinatology. 2021;20(2):141–146 (in Russ.). DOI: 10.20953/1726-1678-2021-2-141-146
13. Доброхотова Ю.Э., Боровкова Е.И., Залесская С.А. Атрофический вагинит у пациенток репродуктивного возраста. Вопросы гинекологии, акушерства и перинатологии. 2021;20(3):42–47. DOI: 10.20953/1726-1678-2021-3Dobrokhotova Yu.E., Borovkova E.I., Zalesskaya S.A. Atrophic vaginitis in patients of reproductive age. Gynecology, Obstetrics and Perinatology. 2021;20(3):42–47 (in Russ.). DOI: 10.20953/1726-1678-2021-3
14. Auriemma R.S., Scairati R., Del Vecchio G. et al. The Vaginal Microbiome: A Long Urogenital Colonization Throughout Woman Life. Front Cell Infect Microbiol. 2021;11:686167. DOI: 10.3389/fcimb.2021.686167
15. Нариманова М.Р., Сапрыкина Л.В. Эффективность негормональной терапии атрофического вагинита у женщин в постменопаузе. РМЖ. Мать и дитя. 2019;2(3):257–261.Narimanova M.R., Saprykina L.V. The efficacy of non-hormone therapy for atrophic vaginitis in postmenopausal women. Russian Journal of Woman and Child Health. 2019;2(3):257–261 (in Russ.).
16. 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):431–453. DOI: 10.1097/GME.0000000000001221
17. Доброхотова Ю.Э., Хлынова С.А. Использование лубрикантов при вульвовагинальной атрофии. РМЖ. Мать и дитя. 2018;1(2):163–167. DOI: 10.32364/2618 8430-2018-1-2-163-167Dobrokhotova Yu.E., Khlynova S.A. Lubricants application in vulvovaginal atrophy. Russian Journal of Woman and Child Health. 2018;1(2):163–167 (in Russ.). DOI: 10.32364/2618 8430-2018-1-2-163-167
18. Тихомирова Е.В., Балан В.Е., Балан П.В. Негормональная терапия генитоуринарного менопаузального синдрома: как помочь пациентке. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2022;6(93):33–36.Tikhomirova E.V., Balan V.E., Balan P.V. Non-hormonal therapy of genitourinary menopausal syndrome: how to help the patient. StatusPraesens. Gynecology, obstetrics, infertile marriage. 2022;6(93):33–36 (in Russ.).
19. Mitchell C.M., Reed S.D., Diem S. 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):681–690. DOI: 10.1001/jamainternmed.2018.0116
20. Ермакова Е.И., Сметник А.А. Опыт клинического применения негормонального вагинального крема для лечения генитоуринарного менопаузального синдрома/вульвовагинальной атрофии у пациенток с эстрогензависимыми онкологическими заболеваниями в анамнезе. Акушерство и гинекология. 2023;8:175–184. DOI: 10.18565/ aig.2023.192Ermakova E.I., Smetnik A.A. Experience of clinical application of nonhormonal vaginal cream for the treatment of genitourinary menopausal syndrome/vulvovaginal atrophy in patients with estrogen-dependent oncologic diseases in anamnesis. Obstetrics and Gynecology. 2023;8:175–184 (in Russ.). DOI: 10.18565/aig.2023.192
21. Harlow S.D., Gass M., Hall J.E. et al.; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–1168. DOI: 10.1210/jc.2011-3362
This work is licensed under a Creative Commons «Attribution» 4.0 License.
