Treatment of vaginal atrophy with estriol and lactobacilli combination: a clinical review

Abstract

In recent years, a vast quantity of clinical data has been accumulated on the pathophysiology of symptomatic vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) in peri-and postmenopausal women and on the treatment options for these conditions. Guidelines from several societies have recently been updated in favor of VVA/GSM vaginal therapy with the lowest possible doses of estrogens. The combination of a vaginal ultra-low dose of 0.03 mg of estriol (E3) and lyophilized, viable Lactobacillus acidophilus KS400 (0.03 mg-E3/L) is a unique product with a dual mechanism of action supporting not only the proliferation and maturation of the vaginal epithelium, but also restoration of the lactobacillary microflora. It has been demonstrated efficiently to establish and maintain a healthy vaginal ecosystem. Use of this combination considerably improves the clinical signs and symptoms as well as the quality of life of menopausal women suffering from vaginal atrophy. This combination therapy is well tolerated with a low overall incidence of side-effects and negligible estriol absorption. Based on recent scientific evidence and current treatment guidelines, the 0.03 mg-E3/L combination could be considered one of the options for the treatment of symptomatic vaginal atrophy in aging menopausal women. ARTICLE HISTORY

Nonablative, Noncoagulative Multipolar Radiofrequency and Pulsed Electromagnetic Field Treatment Improves Vaginal Laxity and Sexual Function

“…21 It is well established in postmenopausal women with vulvo-vaginal atrophy and premenopausal women with estrogen loss (e.g., during lactation, cancer treatment, and in smokers) that changes are exhibited in vaginal flora due to increased vaginal pH; a loss in the abundance of protective lactobacilli develops that can increase the potential for bacterial diversity and symptomatic infection. 24,25 A vaginal epithelium with a rise in beneficial lactobacillus flora, associated with lower pH, is important for maintaining a healthy vaginal state. 21 While the majority of women enrolled into this study were not of menopausal age, pH results post-treatment proved to be favorable and are worthy of further evaluation.…”

Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause

“…A low-dose estriol vaginal gel formulation (0.005% estriol vaginal gel) has been shown to significantly increase vaginal maturation index and improve vaginal pH compared with a baseline evaluation in postmenopausal women [70]. A combination of low-dose estriol and lyophilized viable Lactobacillus acidophilus tablet appears effective for relieving GSM symptoms, reducing urogenital atrophy, and restoring vaginal flora [71]. Estriol is not approved by the FDA for any indication.…”

Treatment of genitourinary syndrome of menopause: the potential effects of intravaginal ultralow-concentration oestriol and intravaginal dehydroepiandrosterone on quality of life and sexual function

“…However, the main concerns regarding oestrogen administration are side-effects, although few have been observed for intravaginal oestriol, and those that have are mainly local: irritation, burning sensation, itching, and leucorrhoea [71]. Furthermore, some studies have shown, on the basis of blood concentrations, that the profile for oestriol is safe because of its very low systemic bioavailability [66, 69], and no correlations have been found between intravaginal oestriol administration and increased endometrial thickness [59, 72].…”