Vaginal dysbiosis with menopause
With age, when a woman's body prepares for menopause and the synthesis of sex hormones decreases, the composition of the obligate microflora of the female genital tract changes. And this leads to the development of a condition that is defined in clinical gynecology as dysbiosis of the vagina in menopause.
Causes of the dysbiosis of the vagina with menopause
Studying the etiology of age-related changes occurring in the female body, the researchers found significant changes in the vaginal microbiocenosis, which explain the pathogenesis of many problems associated with the sexual sphere of elderly women.
So, if in reproductive age in healthy women the level of acidity inside the vagina (pH) is 3.8-4.2, then during the hormonal involution this indicator increases to 5.4-6.8. That is, the causes of vaginal dysbiosis with menopause may consist in a more alkaline reaction of the mucous membranes and secretory fluids released by them. What is the reason for this?
Normally, the vaginal microbiota is almost 94% represented by various species of microanerophilic lactobacilli (Lactobacillus acidophilus, Lactobacillus cellobiosum, Lactobacillus fermentum, Lactobacillus plantarum, etc.). They produce lactic acid for a stably healthy pH, antibacterial hydrolase enzyme lysozyme, and also produce hydrogen peroxide, which protects the female reproductive tract from representatives of the so-called transitory microflora-epidermal staphylococci, streptococci, E. Coli, enterococci, bacteroides, fusobacteria present in the vagina , clostridia, gardnerell, etc.
In menstruation, the upper epithelial cells are subjected to excision and lysis, and in the process of lysis from the cytosol of the leaved cells, the polysaccharide glycogen is released. Under the influence of estrogens, it is metabolized into glucose, which lactobacilli is processed into lactic acid. It is clear that with a decrease in the level of estrogens, menstrual periods are absent during the menopause, and this factor disrupts the habitual life cycle of lactobacilli, causing dysbiosis of the vagina in menopause.
It should also be borne in mind that at the same time the vaginal mucosa under climax is undergoing atrophy, and cytological changes associated with estrogen deficiency lead to a significant reduction in the number of surface cells, a decrease in immunoglobulins (IgA) and globular glycoprotein lactoferrin, which provide humoral immunity.
Thus, the key causes of vaginal dysbiosis in menopause are related to the fact that under the conditions of cessation of hormonal stimulation of the vaginal tissues the glycogen content in cells of its mucosa decreases, the number of lactobacilli colony decreases and the mechanisms of local immune protection of the genital tract significantly weaken. First and foremost, the most important component of nonspecific protection of women from pathogens is the acid pH of the vagina.
Symptoms of the dysbiosis of the vagina with menopause
The first signs of a violation of the balance of the microflora of the vagina in women during the menopause are not particularly manifested.
Typically, the symptoms of vaginal dysbiosis with menopause may include:
- discomfort in the external genitalia and vagina:
- yellowish discharge from the vagina (in the absence of secondary infection by pathogenic bacteria, secretions are odorless);
- vaginal prurit (pruritus), caused, primarily, by atrophy and dryness of the vaginal mucosa;
- burning with urination and a feeling of incomplete emptying of the bladder (in gynecology this is called genitourinary syndrome of menopause);
- dyspareunia (pain during intercourse).
Clinical manifestations can also have the form of thinning and changing the color of the walls of the vagina, the formation of petechiae due to intradermal or submucous hemorrhages. And these are signs of vaginal atrophy that accompanies the vaginal dysbiosis with menopause.
The appearance of any additional symptoms (for example, an increase in the volume of vaginal secretions and a change in their consistency and odor) is evidence that certain complications of dysbiosis develop, because a decrease in acidity (ie, an increase in pH) in the vagina creates the conditions for the activation of its transient microflora.
Among the most common complications, gynecologists call nonspecific bacterial vaginitis, endocastvitis, candidiasis and chlamydial vulvovaginitis, etc.
Also noted are the consequences of dysbiosis of the vagina in menopause, such as adnexitis, salpingitis, endometritis, inflammation of the urethra or bladder.
Diagnostics of the dysbiosis of the vagina with menopause
For a gynecologist, the diagnosis of the dysbiosis of the vagina in menopause begins with the clarification of the patient's complaints and the collection of an anamnesis, followed by a routine gynecological examination of the genitals and vagina.
The tests consist of a smear on the microflora of the vagina with the determination of the pH level of the vaginal mucous secretion. Read more - Microbiological and bacterioscopic examination of vaginal discharge
A blood test (PCR test) for sexually transmitted diseases is also done.
Based on the results of a biochemical smear test, which allows to determine the presence of signs of infection, a differential diagnosis of vaginal dysbiosis with a climax is performed, which gives grounds for correctly diagnosing.
Treatment of the dysbiosis of the vagina with menopause
Since the etiology of changes in the vaginal microflora during the menopause is associated with natural, physiologically conditioned processes occurring in the female body, treatment of vaginal dysbiosis with menopause is carried out with the help of probiotics containing lyophilized culture of live lactobacilli.
To restore the microflora of the vagina, the following medicines can be prescribed:
- vaginal capsules Vagilak (Laktozhinal, Ekofemin) - enter into the vagina (at night) one capsule per day for 10 days. The drug is contraindicated in the presence of inflammation of the vaginal mucosa, including candidiasis.
- vaginal suppository Lactobacterin (Acilact, Ginolact, Lactovag) and suppositories Bifidumbacterin - are administered intravaginally one suppository once a day.
- vaginal tablets Ginoflor is injected deep into the vagina before bedtime, one tablet a day for 12 days; supportive application - one tablet twice a week. The drug contains estriol, so it can not be used in the presence of endometriosis, tumors of the mammary glands or uterus.
Homeopathy offers for the treatment of vaginal dysbiosis with climax the preparation Actaea Racemosa on the basis of drawing from the roots of the plant tsimicifuga (klopogon). However, this remedy, like most phytopreparations containing extracts of soybeans, Canadian sanguinary, the roots of the disco, the leaves of the common finger, are intended to reduce such symptoms of menopause as hot flushes. The instructions do not say anything about the effect of these funds on the state of the vaginal microflora. So treatment with herbs and medicinal plants in this case is not considered.
And alternative treatment of vaginal dysbiosis associated with menopause, recommends the introduction of introvaginally tampons with aloe vera, olive or linseed oil (obviously, to reduce the dryness of the mucosa).
Prevention
Since the prevention of a decrease in the level of estrogen associated with menopause is impossible (recommended hormone replacement therapy is ineffective and most often unsafe), then there are no ways to prevent the "accompanying" numerous physiological changes, including the microbiocenosis of the vagina.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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