Vulvovaginal atrophy in postmenopausal women: diagnosis and modern-day treatments

The article is devoted to the study of modern methods of diagnosis and treatment of benign diseases of the vulva and vagina in postmenopausal women. The analysis of the etiology, clinical picture, methods of diagnosis and treatment of vulvovaginal atrophy, as the most common  benign disease of the vulva and vagina in postmenopausal women, has been carried out. It has been established that the main factor leading to vulvovaginal atrophy in postmenopausal women is climacteric hormonal  imbalance with a gradually increasing estrogen deficiency. Postmenopausal women note such signs of vulvovaginal atrophy as vaginal dryness, burning and itching, dyspareunia, hypersensitivity to infectious diseases of the pelvic organs, which significantly aggravates the state of health, a negative effect on the general and sexual quality of life. Diagnosis of vulvovaginal atrophy is based on examination  data, laboratory and instrumental studies. The main therapeutic goal in the treatment of vulvovaginal atrophy is to relieve symptoms and restore the vaginal environment to a healthy premenopausal state. The «gold standard» for the treatment of vulvovaginal atrophy is local and systemic estrogen therapy. HRT drugs contribute to an increase in proliferative processes, an improvement in blood supply, a rapid normalization of the vaginal microflora and can be prescribed for therapeutic and prophylactic purposes. For the treatment of vulvovaginal atrophy in women for whom estrogen preparations are contraindicated, selective estrogen receptor modulators are used. The drugs in this group, ospemifen and lasofoxifene, help to alleviate the symptoms of vaginal atrophy and dyspareunia, improve vaginal epithelium and vaginal pH. Also, with mild symptoms, an improvement in the condition occurs with the use of non-hormonal vaginal lubricants. In addition,  there are experimental  options for vulvovaginal rejuvenation in women with symptoms that do not fit or tolerate local or systemic estrogen therapy: platelet-rich plasma injections, hyaluronic acid or fat implants, fractional carbon dioxide laser, diode laser and monopolar radiofrequency devices, vaginoplasty.

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