(202) Use of Platelet-Rich Plasma for the Treatment of Dyspareunia in Women at the Stage of Menopausal Transition

Introduction In Ukraine, before the war, the average age of menopausal women was 48-49 years, and 3 years after the military invasion, it is 47-48 years. This age period is associated with a range of qualitative changes in the female body that occur continuously against the background of endocrine imbalances caused by the decline of ovarian function. Timely prevention and treatment of genitourinary disorders and sexual dysfunction in women during menopause using modern methods is a pressing issue today. Plasma therapy is a type of cell therapy that primarily affects the restoration and regeneration of tissues under the influence of growth factors contained in platelets. In 1982, for the first time, David R.Knighton described the local use of activated growth factors received from human platelets. Objective To evaluate the effectiveness of the use of Platelet-rich Plasma (PRP) for the treatment of dyspareunia in women at the stage of menopausal transition. Methods A psychological, sexological and gynaecological examination of 41 women aged from 45 to 47 (46.7±1.4) at the final stage of the menopausal transition and with dyspareunia was carried out. Sexological examination included: interview method questionnaire; genital vascular responses value (duplex Doppler scanning of clitoris vessels in ultrasound diagnostic system Vinno G86 before and after video-erotic stimulation). PRP is an autologous product obtained through the centrifugation of the patient’s blood, containing a higher concentration of platelets. Patients were given injections of autologous PRP (6 ml of plasma containing platelet concentration around 1.6 times the baseline, where more than 80% are viable) in the region of the paraurethral zone, introitus vagina and vagina twice with an interval of 21-22 days. Results Dyspareunia developed against the background of lubrication disturbance and was accompanied by a reduction in libido (87.8%), formation of secondary anorgasmia (46.3%), and disharmony in partner relations (36.6%). Doppler scanning of clitoris vessels registered: maximum speed of blood flow (Vsmax) – 1.7–2.4 cm/sec at rest and 3.7–4.5 cm/sec in 30 minutes after video-erotic stimulation; resistance index (IR) – 0.82-0.86 at rest and 0.93-0.95 after the stimulation. Treatment of female sexual dysfunctions was based on the principles of an interdisciplinary approach: both individual and couple psychotherapy, and a course of PRP therapy (2 procedures). On the 7th day after the PRP therapy, we established an improvement in lubrication. After the treatment, the Vsmax of the clitoris vessels was 3.9-5.7 cm/sec at rest and 6.2-8.8 cm/sec after stimulation, with an IR of 0.71-0.73 and 0.68-0.71, respectively. As a result of the treatment, we observed a gradual reduction in dyspareunia symptoms in 78.1% of cases and a decrease in dyspareunia intensity in 21.9% of cases. Conclusions The menopausal transition in the women studied was characterised by moderate atrophy, reduced genital blood flow, and decreased lubrication. This was associated with the development of dyspareunia and coital insufficiency. Use of PRP promotes improvement of blood flow in the urogenitals, restoration of lubrication and removal of dyspareunia symptoms in women already at the stage of menopausal transition. Disclosure No