Over the past few years, data have been accumulated on the pathophysiology of vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) in peri- and postmenopausal women and on treatment options for these conditions. Recently, recommendations from several societies have been updated in favor of low-dose vaginal estrogen therapy for VVA/GSM. Objective. To study the efficacy of therapy for GSM symptoms and increase of recurrence-free period of lower urinary tract infections (LUTIs) – recurrent cystitis, using topical hormone replacement therapy with ultra-low-dose estriol 0.03 mg in combination with lyophilized cultures of Lactobacillus acidophilus KS400 bacteria (Gynoflor E) in peri- and postmenopausal women. Patients and methods. The study included postmenopausal patients (n = 124) with laboratory-confirmed GSM – atrophic vulvovaginitis with recurrent cystitis. All patients were treated with standard antibacterial therapy (AT) for LUTIs according to the findings of urine culture test, in accordance with the Russian clinical guidelines for urology. Of 124 patients, 47 (group 1) received additional therapy with Gynoflor E containing ultra-low-dose estriol (0.03 mg) and lyophilized culture of L. acidophilus KS400 bacteria in one vaginal tablet. Gynoflor E® was prescribed intravaginally in two stages: 1 tablet daily for 12 days, then 1 tablet twice a week for 4 weeks (28 days). Group 2 (n = 47) received AT and additional therapy with an intravaginal medication containing estriol 0.5 mg (Ovipol Clio) in two stages: 1 suppository daily for 15 days, then 1 suppository twice a week for 2 weeks. Group 3 consisted of 30 patients receiving only standard AT for LUTIs, without topical hormone therapy for VVA/GSM. The follow-up period was 12 months from the initiation of therapy. Urine culture tests and assessment of vaginal biocenosis were performed at all stages of treatment. All patient groups were comparable in terms of baseline characteristics. Results. The group of patients treated with Gynoflor E® showed a significant improvement in GSM symptoms throughout the study period (in group 1, only 41% of patients had symptoms at the end of therapy vs. 100% before its initiation; in group 2 – 60% vs. 100%, respectively; in group 3 – 96% vs. 100%, respectively; p < 0.05); vaginal biocenosis parameters (in group 1, 72% of patients achieved normocenosis at the end of therapy vs. 53% before its initiation; in group 2 – 58% vs. 57%, respectively; in group 3 – 51% vs. 61%, respectively; p < 0.05). During the period of treatment and follow-up (one year), UTI recurrences in group 1 were 2.5 times less frequent compared with group 2 and 3 times less frequent compared with group 3. Conclusion. The combination of vaginal ultra-low-dose estriol (E3) 0.03 mg and lyophilized cultures of viable L. acidophilus KS400 with a dual mechanism of action can be used in the complex therapy for recurrent cystitis in peri- and postmenopausal women with GSM, contributing to the improvement of LUTI treatment results and GSM symptoms and reduced recurrence rates. Key words: genitourinary syndrome of menopause, vulvovaginal atrophy in peri- and postmenopause, recurrent lower urinary tract infections, chronic recurrent cystitis, topical hormone replacement therapy, menopause
A. R. Gevorkyan (Wed,) studied this question.