Treatment of postmenopausal atrophic vaginitis: suppositories, folk remedies

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

Drug treatment of atrophic vaginitis

Non-hormonal drugs that have the ability to restore the vaginal mucosa, reduce inflammatory manifestations and have an antimicrobial effect are created by pharmacists based on traditional medicine recipes.

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

The antibacterial effect of calendula is provided by the content of natural acids - salicylic, pentadicylic, malic, especially active against staphylococci and streptococci, phytoncides with antifungal activity. The plant has a pronounced anti-inflammatory effect, promotes cellular renewal, effectively combats dryness with the help of glucuronic acid (a relative of the famous "moisturizer" - hyaluronic). Prevents the formation of connective tissue cells, strengthens blood vessels, preventing the occurrence of pathological capillary network. Thanks to the use of suppositories, blood microcirculation, nutrition and respiration of the tissues of the vaginal wall improve. Carotenoids promote the healing of microdamage. Plant mucus, which is part of the calendula, also promotes moisturizing and allows the use of suppositories as lubricants.

The patient feels improvement quite quickly. The suppositories dissolve well in the vagina, the medicinal substances are absorbed into its walls, and the patients notice a subjective improvement in their well-being quite quickly. It is used intravaginally, one suppository twice a day, the recommended treatment course is ten days, during which the external genitalia stop itching, vaginal dryness passes, a visual examination shows a decrease in the pathological proliferation of the capillary network, the surface of the epithelium looks smoother, pale pink, without petechiae and ulcers. If necessary, the doctor can extend the course of treatment. Maintenance therapy involves the introduction of one or two suppositories per week.

Also effective are Cicatridin suppositories, which also contain calendula oil extract, as well as three more medicinal plants: Asian centella, aloe vera and tea tree. The suppositories also contain hyaluronic acid, which restores the tone of the vaginal walls and makes them more elastic. In addition, it promotes the absorption of nutrients, normalization of metabolic processes, which accelerates cellular renewal and restoration of the epithelial surface of the vagina.

The standard dosage is one suppository intravaginally at night for the first ten days of treatment, then every other day. The doctor may change this scheme. Suppositories can be used without interruption for quite a long time (up to three months). To prevent exacerbation and maintain the vaginal condition normally, it is recommended to insert one suppository once a week.

Preparations with plant hormones containing extracts of black cohosh, red clover, wild yam, soybeans are not considered hormonal therapy, although they contain compounds (isoflavones) similar in structure and action to human estrogens. The effectiveness of soy isoflavones (they have been studied most thoroughly) - daidzin and genistein is quite comparable to the effectiveness of synthetic estrogens, however, the likelihood of developing hyperplastic processes when taking them does not increase. Nevertheless, women who have estrogen-dependent tumors are contraindicated to take preparations with phytoestrogens.

Phytoestrogens from red clover, black cohosh and other plants can also be a worthy alternative to synthetic hormones and normalize not only the condition of the vaginal wall, but also relieve other manifestations of menopause.

The drug for oral administration Feminal, available in capsules and drops, according to customer reviews, gives a lasting 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 based on the extract of the rhizome of black cohosh. It has a regenerating and mild sedative effect. Take 30 undiluted drops in the morning and evening, you can drip them onto a piece of refined sugar. Black cohosh can cause reactions from the liver (jaundice, changes in transaminase activity) and the gastrointestinal tract (dyspeptic phenomena), allergic urticaria and facial edema.

Estrovel is a complex preparation containing extracts of the rhizome of black cohosh, soybeans, wild yam, nettle, B vitamins, ascorbic acid, vitamin K, which promotes blood clotting and metabolic processes in bone tissue, a source of boron and calcium (calcium fructoborate). The dose and duration of administration are determined by the doctor, the standard dosage involves taking one tablet once or twice a day after meals, the recommended course of treatment is 30 days.

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

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

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

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

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

Currently, for atrophic vaginitis, preference is given to hormonal preparations of estriol, which have a local effect directly on the vaginal tissue and do not require additional therapy with progestogens, like estradiol preparations.

Estriol is a secondary estrogen hormone, not very active and having a short-term effect only on the mucous membrane of the vaginal wall. At the same time, it does not cause intensive division and growth of endometrial cells and cyclic changes in the uterus, like estradiol preparations, which have a systemic effect regardless of the method of their administration. During menopause, the local action of estriol is quite sufficient to relieve discomfort in the vagina. It eliminates pain, itching and dryness, complaints of urinary incontinence stop and the risk of infection of the genitourinary organs is reduced several times. Therefore, suppositories for atrophic vaginitis with estriol have proven themselves well and are the drug of choice in the prevention and treatment of this condition.

Estriol suppositories contain this natural hormone. They are especially effective in the presence of urogenital problems. The result of their use is the normalization of the epithelial lining of the vaginal wall, the acidity of the vaginal environment and the restoration of the ecosystem. In patients with estrogen deficiency, local immunity increases significantly, as a result of which exacerbations of chronic urogenital pathologies are reduced or stop altogether. If you do not exceed the recommended dose, you can 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 cancellation. 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).

In addition to estriol, Gynoflor vaginal tablets contain lyophilized Doderlein bacilli (lactobacilli), which, when they enter the vagina, begin to actively multiply, creating a natural acidic environment and preventing the proliferation of pathogenic bacteria. Estriol restores the normal state of the cells of the vaginal mucosa, which contain glycogen - a nutrient medium favorable for the development of lactobacilli. Natural sanitation of the vaginal mucosa occurs, its health is restored and its protective properties are increased. At the beginning of treatment, one tablet is administered intravaginally once a day for six to twelve days, then they switch to maintenance therapy - once or twice a week.

Local preparations can cause a sensitization reaction in the form of itching, burning, hyperemia, and swelling. Often, on the second or third day, these effects disappear without discontinuing the drug.

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 both orally in tablet form (Femoston, Angelique), and locally - in the form of patches, gels, which also affect the entire body, relieving climacteric symptoms. Preparations containing estradiol are much more likely to cause side effects and require careful adherence to the doctor's recommendations regarding dosages and frequency of administration.

Patients undergoing hormone replacement therapy must undergo regular examinations by a gynecologist and mammologist.

In no case should you use even local estrogen-containing drugs on your own, or supplement drug treatment with folk remedies without consulting a doctor.

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

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

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

However, in the off-season, it is possible to prevent the development of exacerbations with the help of vitamin and mineral complexes. The best are: Alphabet +, Doppelherz-active Menopause, Complivit 45+, Menopace, Qi-Klim and others, addressed specifically to this age group of women. It is recommended to choose a suitable complex together with a doctor, who will tell you how long to take vitamins. You do not need to do this constantly, since hypervitaminosis does not affect the body's condition any better than vitamin deficiency.

Physiotherapy treatment effectively complements the drug component of treatment, allows to reduce the dose of drugs, avoid their side effects and achieve stable remission. Physiotherapy procedures are prescribed by a 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 there was one). Electrical procedures, magnetic and laser therapy, ultraviolet waves, sun and air baths are used.

Folk remedies

In case of 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 using folk methods of treatment. Moreover, these methods are also studied by pharmacists as an alternative to hormones. Naturally, before treating with folk remedies, it is recommended to undergo an examination and consult a doctor about the advisability of their use.

For example, one of the effective methods is considered to be urine therapy. In this case, we are talking about douching with your own urine. When carrying out such procedures, it is necessary to adhere to several rules.

Firstly, only the so-called middle urine is suitable for douching. You will need about 10 ml of physiological fluid. About the first third of the morning portion is flushed down the toilet, then the middle third is collected in a sterile jar, the rest is sent 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-milliliter syringe, remove the needle and douche.

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

The recommended course of treatment is in the morning for two weeks. If you suspect a urinary tract infection - unusual urine color, sediment, blood streaks, the procedure is contraindicated.

With atrophic vaginitis, the main symptom is vaginal dryness. Tampons with sea buckthorn oil or simply lubricating the vagina with this product can help.

Suppositories with sea buckthorn oil are sold in pharmacies – you can use them.

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

You can put tampons soaked in a mixture of honey and vegetable oil, preferably olive oil, but you can also use sunflower oil, in equal parts, at night. Put tampons in every evening until the symptoms disappear.

Herbal treatment of atrophic vaginitis has also been used for a long time and brings women significant relief. It is not for nothing that the pharmaceutical industry produces suppositories, drops, tablets and elixirs based on medicinal herbs.

Herbal remedies for atrophic vaginitis can also be prepared at home.

Infusions and decoctions of medicinal plants are used externally in the form of baths and douches.

For example, in case of whitish cheesy discharge, indicating colonization of the vagina by fungi (candidiasis), you can douche with calendula infusion. The infusion for douching is prepared in a water bath at the rate of a heaped tablespoon of dried flowers, poured with a glass of boiling water and simmered 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, sitz baths with calendula infusion are made. For the baths, the flowers are brewed with boiling water in proportions of two tablespoons per liter, simmered in a water bath for 20 minutes, allowed to cool to a temperature of 36-37 ℃, filtered, poured into a convenient clean container and take a bath

Sitz baths with chamomile flowers brewed in the same proportions will help eliminate irritation and dryness; you can also douche with chamomile infusion, but keep it in the bath for no more than ten minutes.

Some sources recommend alternating external procedures with calendula, plantain, chamomile and sage.

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

Natural phytoestrogens are found in plants growing in our latitudes, such as sage and red clover. Decoctions and infusions from these plants are recommended for drinking during climacteric and postmenopausal symptoms to normalize hormonal levels and get rid of not only hot flashes, but also eliminate the symptoms of atrophic vaginitis.

An infusion or decoction of sage is taken for a two-week course, then a break of the same duration is taken and the course of treatment is repeated if necessary.

The infusion is brewed like regular tea with boiling water at the rate of a heaped teaspoon of herb per 200 ml of water. You need to drink two such portions during the day.

The decoction is prepared in the following proportions: one teaspoon of crushed grass per ½ liter of boiling water. Boil for only one minute. Drink instead of tea three times a day.

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

In addition to phytoestrogens, red clover contains a large number of minerals, it has more calcium than milk. It contains magnesium, selenium, phosphorus, iron and many other biologically active components. It is believed that it prevents the development of breast tumors.

An infusion of this herb is brewed in a thermos overnight in the following proportions: 200 ml of boiling water - two tablespoons of dry crushed clover. In the morning, the infusion is filtered and the entire portion is drunk during the day before meals, a quarter of a glass until the symptoms disappear.

Red clover can be drunk by brewing it instead of tea or adding it to tea leaves. Instead of tea, a mixture of red clover, dried strawberries, raspberries and linden blossom is brewed. This herb is used for douching, and a tincture is made from it on vodka. It also has contraindications - neoplasms of the genitourinary system, myocardial infarction, thrombocytopenia, varicose veins, frequent diarrhea.

In addition, phytoestrogens are not used in combination with medications containing female sex hormones.

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Homeopathy

To treat atrophic vaginitis with homeopathic remedies, first of all, you need to see a homeopathic doctor. The arsenal of drugs used to eliminate such a pathology is very large, so only a specialist in this field can select an effective drug, who will take into account the characteristics of the manifestations, localization, concomitant diseases and character traits of the patient.

Patients complaining of loss of sexual desire due to painful coitus and burning inside the vagina may be prescribed Berberis vulgaris.

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

A medicine prepared from the spores of Lycopodium is prescribed to women suffering from painful intercourse due to vaginal dryness, with caustic irritating discharge, bleeding, and 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), Hemlock (Conium) are prescribed to older women complaining of symptoms of atrophic vaginitis with associated infection and urological complications.

In case of vaginal inflammation, pain and severe complications in the form of prolapse of the genitals, homeopathic granules from the contents of the black cuttlefish bursa (Sepia) can be prescribed.

Like traditional healers, homeopaths have noted the effectiveness of preparations made from Black Cohosh or Cimicifuga and Calendula officinalis in inflammatory processes in older women.

Hormonal regulating action is provided by the complex homeopathic preparation Klimakt-heel, which contains the following ingredients that ensure the action of the preparation: the already mentioned Sepia (a substance from the black cuttlefish bursa), snake venom (Lachesis) is also often prescribed for pathological climacteric symptoms, especially in combination with the appearance of seals in the mammary glands.

The herbal components of the preparation are represented by Sanguinaria Canadensis, which complements the action of Lachesis, Strychnos ignatii, which is prescribed for various sexual disorders, and Cedron (Simarouba cedron), which has a detoxifying and anti-inflammatory effect.

The mineral components Sulfur and Metallic Tin (Stannum metallicum) also relieve such symptoms as discharge, bleeding, pain, itching, prolapse of the vagina and uterus.

Klimakt-heel tablets are placed under the tongue and completely dissolved there, without swallowing. To relieve acute conditions, the drug is taken every quarter of an hour for two hours (no more than eight tablets in a row). Then switch to the usual three-time dose - sublingually a quarter of an hour before meals or an hour after.

May cause sensitization reactions. If the intake continues for more than one month, liver function tests should be monitored.

The injection drug Ovarium compositum is intended to regulate hormonal deficiency and related disorders during the postmenopausal period. It contains many components that relieve menopausal symptoms: Black mercury oxide (Mercurius solubilis), a substance from the black cuttlefish bursa (Sepia), snake venom (Lachesis), beech tar (Kreosotum), extracts of tissue biological regulators of the placental, pituitary, ovarian and many others.

Contraindicated in patients with sensitization to the ingredients of the drug. The possibility of allergic reactions cannot be excluded, hypersalivation is sometimes observed during treatment with this drug.

A single dose is one ampoule, the solution is administered in any way - into the skin, muscles, under the skin, into a vein. The recommended frequency of injections is one or two per week. Duration - up to one and a half months. The doctor can change the injection regimen depending on the patient's condition.

Klimaxan tablets, which contain three components: black cohosh (Cimicifuga), snake (Lachesis) and bee (Apis mellifica) poisons. The drug normalizes hormonal levels and reduces the manifestations of climacteric symptoms, has a calming effect. It contains lactose, which should be taken into account in case of lactose intolerance, as well as diabetics. There is a risk of allergic reactions in case of sensitization to the active substances of the drug.

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

Treatment with homeopathic preparations 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. It is imperative to inform the doctor if you are undergoing a course of physiotherapy or manual therapy. If all the rules of admission and doctor's recommendations are followed, homeopathic treatment can be very effective.

Exercises for atrophic vaginitis

Every woman who wants to avoid vaginal wall prolapse and uterine prolapse 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, significantly slowing them down, should familiarize themselves with a set of exercises for training the pelvic muscles. Performing such simple exercises helps prevent incontinence of physiological waste (urine and feces), prolapse and prolapse of the genitals, the development of inflammatory and dystrophic changes in them. In addition, good blood circulation in this area will ensure sexual health and a full sexual life for a long time.

Exercises are not performed in the first period after operations, in the presence of neoplasms of the pelvic organs and peritoneum.

You can start doing Kegel's intimate gymnastics exercises at any time, according to the gynecologist who first introduced them into practice, and it is better not to postpone it. They are most valuable as a preventive technique. In case of mild atrophic changes, doing the exercises can also help to correct the situation. In more serious and advanced cases, the result is not guaranteed, although it is always useful to train the pelvic floor muscles.

These exercises consist of alternating tension and relaxation of the pelvic floor muscles. They can be done in any position (lying in bed, sitting in front of the monitor, standing in 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, block the stream. These are the muscles that need to be trained. Now that you have found them, you can start doing the exercises. They are done with an empty bladder. You should not repeat the trick with stopping urination.

At first, when doing exercises at home, you can insert a clean finger into the vaginal opening. If the muscles are working correctly, they will contract around the finger.

Begin the exercises by tensing the muscles for 3-5 seconds, then relaxing them for the same amount of time. Do not hold your breath, but inhale and exhale evenly. At first, repeat the exercise 4-5 times in one approach, focusing on the technique and performing such small complexes several times a day.

Later, you can extend the period of tension-compression to 10 seconds. Once the correct technique is mastered, you can do the exercises anywhere. It is recommended to do at least three approaches a day, each of which repeats the tension-relaxation of the muscles approximately 20 times.

To achieve a more stable state, Kegel exercises can be performed in combination with other movements that strengthen the pelvic floor muscles. Many exercise complexes have been developed to ensure women's health; similar techniques exist in yoga and Tibetan practices.

Experts recommend doing gymnastics that strengthen the vaginal muscles throughout life. This will be the best prevention of atrophic changes in its walls and complications associated with age-related changes.

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