Vaginal dysbiosis in 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 in clinical gynecology is defined as vaginal dysbiosis during menopause.

Causes of menopausal vaginal dysbiosis.

By studying the etiology of age-related changes occurring in the female body, researchers have identified significant shifts in the vaginal microbiocenosis, which explain the pathogenesis of many problems associated with the sexual sphere of older women.

Thus, if in reproductive age in healthy women the level of acidity inside the vagina (pH) is 3.8-4.2, then during the period of hormonal involution this indicator increases to 5.4-6.8. That is, the causes of vaginal dysbiosis during menopause may be a more alkaline reaction of the mucous membranes and the secretory fluids they secrete. What is this connected with?

Normally, vaginal microbiota is almost 94% represented by various types of microanaerophilic lactobacilli (Lactobacillus acidophilus, Lactobacillus cellobiosum, Lactobacillus fermentum, Lactobacillus plantarum, etc.). They produce lactic acid for a stable healthy pH level, the antibacterial hydrolase enzyme lysozyme, and also produce hydrogen peroxide, which protects the female genital tract from representatives of the so-called transient microflora - epidermal staphylococci, streptococci, E. coli, enterococci, bacteroids, fusobacteria, clostridia, gardnerella, etc. present in the vagina.

During menstruation, the upper epithelial cells undergo excretion and lysis, and during the lysis process, the polysaccharide glycogen is released from the cytosol of the exfoliated cells. Under the influence of estrogens, it is metabolized into glucose, which lactobacilli process into lactic acid. It is clear that with a decrease in estrogen levels, menstruation is absent during menopause, and this factor disrupts the usual life cycle of lactobacilli, causing vaginal dysbiosis during menopause.

It should also be borne in mind that at the same time, the vaginal mucosa undergoes atrophy during menopause, and cytological changes associated with estrogen deficiency lead to a significant decrease in the number of superficial cells, a decrease in immunoglobulins (Ig A) and the globular glycoprotein lactoferrin, which provide humoral immunity.

Thus, the key causes of vaginal dysbiosis during menopause are related to the fact that when hormonal stimulation of vaginal tissue ceases, the glycogen content in the cells of its mucous membrane decreases, the number of lactobacilli colonies decreases, and the mechanisms of local immune protection of the genital tract significantly weaken. First of all, the most important component of women's non-specific protection from pathogens is the acidic pH of the vagina.

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Symptoms of menopausal vaginal dysbiosis.

The first signs of an imbalance of vaginal microflora in women during menopause do not manifest themselves in any particular way.

Typically, symptoms of vaginal dysbiosis during menopause may include:

• discomfort in the area of the external genitalia and vagina:
• yellowish vaginal discharge (in the absence of a secondary infection with pathogenic bacteria, the discharge has no odor);
• vaginal pruritis (itching), caused primarily by atrophy and dryness of the vaginal mucosa;
• burning during 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 may also take the form of thinning and discoloration of the vaginal walls, the formation of petechiae on them due to intradermal or submucous hemorrhages. And these are signs of vaginal atrophy, accompanying vaginal dysbiosis during menopause.

The appearance of any additional symptoms (for example, an increase in the volume of vaginal discharge and a change in its consistency and odor) is evidence that certain complications of dysbiosis are developing, since a decrease in acidity (i.e. an increase in pH) in the vagina creates conditions for the activation of its transient microflora.

Among the most common complications, gynecologists name non-specific bacterial vaginitis, endocervitis, candidal and chlamydial vulvovaginitis, etc.

Also noted are such consequences of vaginal dysbiosis during menopause as adnexitis, salpingitis, endometritis, inflammation of the urethra or bladder.

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Diagnostics of menopausal vaginal dysbiosis.

For a gynecologist, the diagnosis of vaginal dysbiosis during menopause begins with finding out the patient’s complaints and collecting anamnesis, after which a routine gynecological examination of the genitals and vagina is carried out.

The tests consist of a smear of vaginal microflora with determination of the pH level of vaginal mucous secretion. Read more - Microbiological and bacterioscopic examination of vaginal discharge

A blood test (PCR test) is also done for sexually transmitted diseases.

Based on the results of a biochemical study of a smear, which allows one to determine the presence of signs of infection, a differential diagnosis of vaginal dysbiosis during menopause is carried out, which provides grounds for making a correct diagnosis.

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Treatment of menopausal vaginal dysbiosis.

Since the etiology of changes in vaginal microflora during menopause is associated with natural, physiologically determined processes occurring in the female body, treatment of vaginal dysbiosis during menopause is carried out using probiotic preparations containing a lyophilized culture of live lactobacilli.

The following medications may be prescribed to restore vaginal microflora:

• Vaginal capsules Vagilak (Laktozhinal, Ecofemin) - insert into the vagina (at night) one capsule per day for 10 days. The drug is contraindicated in case of existing inflammation of the vaginal mucosa, including candidiasis.
• Lactobacterin vaginal suppositories (Atsilakt, Ginolakt, Lactovag) and Bifidumbacterin suppositories are administered intravaginally, one suppository once a day.
• Gynoflor vaginal tablets are inserted deep into the vagina before bedtime, one tablet per day for 12 days; maintenance use - one tablet twice a week. The drug contains estriol, so it cannot be used in the presence of endometriosis, breast tumors or uterine tumors.

Homeopathy offers the drug Actaea Racemosa for the treatment of vaginal dysbiosis during menopause, based on an extract from the roots of the plant black cohosh (black cohosh). However, this drug, like most herbal preparations containing extracts of soybeans, sanguinaria canadensis, roots of discorea, leaves of common chaste, are intended to reduce such symptoms of menopause as hot flashes. The instructions say nothing about the effect of these drugs on the state of the vaginal microflora. So treatment with herbs and medicinal plants is not considered in this case.

And folk treatment for vaginal dysbiosis associated with menopause recommends inserting tampons with aloe vera, olive or linseed oil intravaginally (obviously, to reduce dryness of the mucous membrane).

Prevention

Since prevention of the decrease in estrogen levels associated with menopause is impossible (the recommended hormone replacement therapy is ineffective and most often unsafe), there are no ways to prevent the numerous physiological changes that “accompany” this, including in the state of the vaginal microbiocenosis.

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Forecast

And the prognosis can only concern the outcome of timely treatment of those complications that vaginal dysbiosis can cause during menopause.

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