Effect of Dasapaka Bala Taila Yonipooranam in Atrophic Vaginitis - A Case Report

Atrophic vaginitis is a common condition that occurs in post menopause due to the deficiency of estrogen. The condition Atrophic vaginitis is defined as atrophy of the vaginal epithelium due to decreased estrogen levels. This common menopausal condition which is often underreported and under diagnosed is caused by estrogen related changes to the vaginal epithelium and can adversely affect quality of life. Atrophic vaginitis is a common condition in postmenopausal women experience due to estrogen deficiency that causes involution of the vaginal tissue, leading to vaginal dryness, burning sensation in vagina and dyspareunia, the atrophy of the vulvovaginal structures occurs due to estrogen deficiency. Among them Sushka yoniroga can be most suitably correlated with Atrophic vaginitis. The management principle of Atrophic vaginitis includes Vathika yoniroga chikitsa, along with Sthanika chikitsa. Treatment mainly aims at Vatapittasamana, Brimhana, Balya and natural supplementation of estrogen containing drugs. Sthanika chikitsa like Yonipooranam, Pichu dharanam, etc can be done in Atrophic vaginitis. Sthanika chikitsa which is of prime importance in the management of Streeroga facilitates absorption of drugs through the vagina as the walls and adjacent tissues are highly vascular, where the medicines are administered intra vaginally. In the present case, Yonipoorana as Sthanika chikitsa as tried. A 54 year old lady was presented with complaints of burning sensation in vagina and pain during sexual intercourse. The vaginal examination was painful and the walls are found inflamed, she was diagnosed with Atrophic vaginitis. She was sent to cytological screening. The reports revealed high grade parabasal cells and low grade superficial cells. The maturation index was found 60/25/5 vaginal pH was 5.3. Pap smear was done which was negative for intraepithelial lesion or malignancy. Dasapaka Bala tailam was administered intravaginally for 7 days in 3 consecutive months. During follow up she was relieved from the symptoms like burning sensation in vagina and pain during sexual intercourse. From this case report, it shows that Yonipoorana with Dasapaka Bala tailam is effective for the management of Atrophic vaginitis.

Tratamiento no hormonal del síndrome genitourinario de la menopausia / Non-hormonal treatment of genitourinary syndrome of menopause

El síndrome genitourinario de la menopausia (SGUM) describe los síntomas y signos vulvo-vaginales y del tracto urinario inferior, de carácter crónico y progresivo, secundario a un estado clínico de hipoestrogenismo que caracteriza a la postmenopausia. La presente revisión tiene como objetivo describir y analizar las diferentes alternativas terapéuticas no hormonales, con sus ventajas y desventajas, a fin de ofrecerle a los lectores una completa variedad de opciones a la hora de establecer el tratamiento en una mujer con SGUM. Se ha realizado una búsqueda en bases de datos, incluyendo investigaciones originales, consensos de expertos, revisiones sistemáticas y metaanálisis. Se ha revisado la evidencia actual para diversas modalidades terapéuticas farmacológicas y no farmacológicas (no hormonales), encontrando que los hidratantes y los lubricantes son la primera línea terapéutica para proporcionar alivio, a corto plazo, de la sequedad vaginal (leve a moderada) y la dispareunia; sin embargo, el tratamiento ha de ser individualizado. Existen numerosos tratamientos disponibles, cada uno con beneficios y limitaciones y se destacan las sustanciales lagunas, en la evidencia científica, de terapias seguras y efectivas, así como la necesidad de realizar investigaciones futuras..(Au)

The genitourinary syndrome of menopause (SGUM) describes the symptoms and signs of the vulvo-vaginal and lower urinary tract, of a chronic and progressive nature, secondary to a clinical state of hypoestrogenism that characterizes postmenopause. The present review aims to describe and analyze the different non-hormone therapeutic alternatives, with their advantages and disadvantages, in order to offer readers a full range of options when establishing treatment in a woman with SGUM. A database search, including original research, expert consensus, systematic reviews and meta-analysis. The current evidence for various pharmacological and non-pharmacological (non-hormonal) therapeutic modalities has been reviewed, finding that moisturizers and lubricants are the first line of therapy to provide short-term relief of vaginal dryness (mild to moderate) and dyspareunia; however, treatment must be individualized. It is concluded that there are numerous treatments available, each with benefits and limitations. Substantial gaps in the scientific evidence for safe and effective therapies are highlighted, as well as the need for future research..(Au)

Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials

OBJECTIVES: Atrophic vaginitis (AV), which is common in postmenopausal women, is characterized by vaginal dryness, dyspareunia, and discomfort. There are a variety of therapeutic agents for the treatment of AV, besides hormone replacement therapy. We performed this systematic review to compare the effectiveness of various therapies for symptom improvement in AV patients. METHODS: We searched the Cochrane Library, EMBASE, MEDLINE, and other literature (Google Scholar, Web of Science, and hand search) for studies published between January 2010 and March 2015. AV was evaluated by the following outcomes: vaginal pH, dyspareunia, vaginal dryness, or cytological change (endometrial thickness, percentages of superficial cells and parabasal cells). They measured treatment efficacy with various outcomes pertaining to AV symptoms. RESULTS: Meta-analysis suggested that ospemifene was effective against dyspareunia, vaginal dryness, endometrial thickness, and percentage changes in superficial and parabasal cells. Vaginal pH was most affected by soy isoflavone vaginal gel. Ospemifene was effective for AV symptoms. CONCLUSIONS: This systematic review compared the effects of several therapeutic agents on symptoms of AV through a network meta-analysis. This study provides objective evidence for clinical treatment and efficacy management in AV.

Effect of Herbal Medicine on Vaginal Epithelial Cells: A Systematic Review and Meta-analysis

OBJECTIVES: The present meta-analysis aimed to assess the effect of the herbal medicine on the vaginal epithelial cells (VECs) among the menopausal subjects. METHODS: The literature related to VECs exposed to various herbal medicines in menopausal women were searched on three databases, MEDLINE (1966–August 2017), Scopus (1990–August 2017) and Cochrane Library (Cochrane Central Register of Controlled Trials; 2014). RESULTS: Totally, the meta-analysis was conducted on 11 randomised controlled trials. Based on the findings, the standardized mean difference (SMD) of maturation value (MV) was observed to be elevated by 0.48% (95% interval confidence [CI], 0.108–0.871; P = 0.012), as well as the heterogeneity was high (I2 = 84%; P < 0.001). The MV revealed a significant increase in soy group (SMD, 0.358; 95% CI, 0.073–0.871; P = 0.014) compared to the control group. CONCLUSIONS: The herbal medicines exhibited a statistically significant effect on the VECs. A significant effect on the VECs was also found in the subgroup analysis of the patients, who received soy. However, further and extensive studies are required to achieve reliable outcomes.

Clinical Observation of Vaginal Administration of Lactobacillus Combined with Chlorquinaldol-promestriene for Senile Patients with Atrophic Vaginitis / 中国药房

OBJECTIVE:To investigate therapeutic efficacy and recurrence rate of vaginal administration of lactobacillus com-bined with chlorquinaldol-promestriene for senile patients with atrophic vaginitis. METHODS:150 senile patients with atrophic vag-initis were selected and divided into group A,B,C according to random number table,with 50 cases in each group. Group A was given Lactobacillus vaginal capsules,2 capsules,qd (at bedtime);group B given Chlorquinaldol-promestriene vaginal tablets,1 tablet,qd(at bedtime);group C given Chlorquinaldol-promestriene vaginal tablets,1 tablet,qd(at bedtime),and Lactobacillus vaginal capsules,2 capsules,qd,next morning,implanting into vagina. 3 groups received treatment for 18 d. Clinical efficacy, vaginal health score,vaginal symptom score and vaginal pH value were observed in 3 groups,and the occurrence of ADR and re-currence rate during follow-up period (12 months) were recorded. RESULTS:The total effective rate of group C was 94.00%, which was significantly higher than group A(72.00%)and B(74.00%),with statistical significance(P0.05). After treatment,vaginal health score of 3 groups were increased significantly,while vaginal symptom score and vaginal pH value were decreased significantly;and the improvement of above indexes in group C were significantly better than in group A and B,with statistical significance(P<0.05). No obvious ADR was found in 3 groups during treatment. The recurrence rate of group C during follow-up period(4.00%)was significantly lower than that of group A(18.00%)and group B(20.00%),with statistical significance(P<0.05). CONCLUSIONS:Vaginal administration of lactobacillus combined with chlorquinaldol-promestriene for se-nile patients with atrophic vaginitis can effectively relieve clinical symptoms and signs,improve vaginal cleanliness,regulate the lo-cal pH value and reduce the risk of recurrence,with good safety.

Manejo de la atrofia vulvovaginal posmenopáusica / Management of postmenopausal vulvovaginal atrophy

Objetivo: Identificar las propuestas terapéuticas disponibles para el manejo de la vulvovaginitis atrófica o atrofia vulvovaginal posmenopáusica (AVVP) o síndrome genitourinario de la menopausia. Metodología: Revisión temática sin intervención en la cual se incluyeron artículos cuyo principal criterio fue tratamiento y manejo de la AVVP, obtenidos luego de búsqueda en las bases de datos: Pubmed, Science Direct, Embase, Medline y Scielo. 2119 títulos se consideraron adecuados, 136 ajustados al objetivo y en 87 fue identificada información relevante. Resultados: Diferentes estrategias terapéuticas han mostrado eficacia para el tratamiento de AVVP. Cambios en el estilo de vida, como evitar el hábito de fumar, prevenir la obesidad, realizar ejercicio físico y adelantar actividad sexual, pueden ser beneficiosos. Los hidratantes y lubricantes vaginales son la primera línea terapéutica para mejorar la AVVP, los primeros se administran permanentemente y los últimos en el coito. Existe controversia acerca de la importancia de la vitamina D, isoflavonas y diferentes hierbas. La terapia estrogénica local es la terapéutica más efectiva y debe preferirse siempre en AVVP severa, puede ser estriol, estradiol, estrógenos conjugados o estrona. El ospemifeno, un modulador selectivo del receptor estrogénico, está aprobado para la AVVP. Se encuentran en investigación los TSECs, existe poca información sobre la eficacia de DHEA y son buenos los resultados con los STEAR. Estudios iniciales han señalado los beneficios del láser fraccionado de CO2. Conclusiones: Diferentes medidas son adecuadas para tratar la AVVP, para que las mujeres conserven saludable la vagina y disfruten la actividad sexual.

Objective: To identify the available therapeutic proposals for the management of the atrophic vulvovaginitis or vulvovaginal atrophy in postmenopause (VVAP) or genitourinary syndrome of menopause. Methods: Thematic review without intervention in which there was included articles whose main criterion was treatment and management of the VVAP, obtained after search in the databases: Pubmed, Science Direct, Embase, Medline and Scielo. 2119 titles were considered appropriate, 136 were adjusted to the aim and in 87 relevants information was identified. Results: Different therapeutic strategies have shown effectiveness for the treatment of the VVAP. Changes in the lifestyle, as to avoid the smoking habit, to prevent the obesity, to do exercise and to practice sexual activity, could be beneficial. The vaginal moisturizers and lubricants are the first-line therapies for the improvement of the VVAP, the first ones are administered permanently and the last ones are used during the coitus. There is controversy about the importance of the D vitamin, soya isoflavones and different herbs. The local estrogen therapy is the most effective therapeutic and it always must be preferred in severe VVAP. It could be estriol, estradiol, conjugated estrogens or estrone. The ospemifene, a selective estrogen-receptor modulator, is approved for the VVAP. The TSECs are in research, few information exists about the effectiveness of DHEA and the results with the STEAR are good. Initial studies have indicated the benefits of the fractional CO2 laser. Conclusions: Different measures are appropriate to treat the VVAP, in order that the women preserve a healthy vagina and enjoy the sexual activity.

Expression of Ezrin in Vagina Cells of Postmenopausal Rats after Dietary Administration of Omega-3 Fatty Acid Formula

OBJECTIVES: To see the effect of dietary administration of omega 3-fatty acid formula on the vaginal cells of postmenopausal rats. METHODS: Three-week-old female Wistar/ST rats were raised after one week of adjustment period. The rats were then divided into three groups, for three different kinds of diet; general diet, 1% omega-3 fatty acid diet, and 2% omega-3 fatty acid diet. After eight weeks of having assigned diet, after the oophorectomy, with the same diet previously they had Immunohistochemistry, Immunofluorescence, and Western Blot about ezrin, merlin were done. RESULTS: In immunohistochemistry, estrogen injection group revealed thicker and well differentiated features. In Immunofluorescence, Omega-3 fatty acid composition in diet did not effect expression of ezrin and merlin in rat vagina in estrogen injection group, their vaginal epithelium showed full layers (from basal to apical layer). In Western Blot analysis, Omega-3 fatty acid composition in diet did not affect expression of ezrin and merlin in rat vagina estrogen presented significant impact on expression of ezrin and merlin. CONCLUSION: Although omega-3 fatty acid composition changed in diet, vaginal epithelial morphology unchanged. Estrogen did effect on vagina cell, but omega-3 fatty acid did not effect on ezrin and merlin in vagina.