Atrophic vaginitis - is a physiologically due to changes in the state of vaginal symptoms in postmenopausal period.There atrophic vaginitis in two forms: atrophic vaginitis postmenopausal , which manifests itself several years after natural menopause in older patients;atrophic vaginitis in the reproductive age, caused an artificial menopause.
only cause of atrophic vaginitis - absolute gipoestrogeniya natural or synthetic origin.
Stratified squamous epithelium of vaginal estrogen is controlled.It depends on them, and of the normal vaginal flora.When a woman enters menopause, the ovaries gradually reduce the production of estrogen and completely stopped it a few years after the onset of menopause reception.Vaginal epithelium while thinning (atrophy), it is "dry", loses its elasticity and ability to resist inflammation.During vaginal contents quantitative changes occur in the direction of increasing opportunistic pathogens, and in a lowered immunity are easy to provoke inf
Postmenopausal atrophic vaginitis different persistent current.Although inflammatory genesis of disease, as opposed to other origin vaginitis, atrophic vaginitis rarely accompanied by increased volume of vaginal belyami.Patients feel the vagina dryness, itching, burning and discomfort.Bleeding observed in atrophic vaginitis often.Usually it is associated with damage to the vascular surface and is not significant.
diagnosis of atrophic vaginitis is not difficult and does not require a large number of surveys.Preliminary diagnosis made during the initial gynecological examination, as a rule, confirmed by laboratory test the contents of the vagina and colposcopy.
to cure atrophic vaginitis, it is necessary to eliminate the direct cause.Even the most thorough anti-inflammatory treatment will not be effective in the absence of an estrogenic effect on the vaginal epithelium, so when atrophic vaginitis only effective treatment is topical or systemic (ingestion) the use of hormonal drugs.
If a background of atrophic vaginitis develop infectious inflammation after laboratory identification of the pathogen is carried inflammatory adequate (mostly local) treatment.
Timely adequate estrogen therapy helps rehabilitate the vaginal epithelium and eliminate negative symptoms.
Not all patients properly formulate his diagnosis, and say not "postmenopausal" and "postmenopausal atrophic vaginitis."Although the meaning of the two expressions identical diagnosed postmenopausal atrophic vaginitis is considered incorrect.
reasons atrophic vaginitis
all the processes occurring in the vaginal epithelium, depends on hormonal ovarian function.Monthly cycled ovarian estrogens are synthesized by which the vaginal epithelium performs one of the most important functions: protect against genital tract infections.
Healthy woman vaginal microenvironment maintains consistency, it is represented by lactobacilli (98%) and a small amount of microorganisms belonging to the opportunistic microbes.His last name was due to become the property of pathogenic (cause disease) under certain conditions.
vaginal epithelium is composed of several layers of cells having a flat shape (hence the name "multi-layer flat").Many layers of coating cells allow the vagina is constantly updated with desquamation (rejection) of the surface layer.The update process of the mucous layer of the ovaries are controlled by estrogen.Exfoliated cells of the mucous layer of the surface contain a lot of glycogen, which "feed" lactobacilli.
main waste product of lactobacilli - lactic acid.With it is controlled by the desired level of acidity (pH) of the vagina.The acidic environment prevents undesirable microorganisms multiply, protecting mucous infection.
When it's menopause, hormonal ovarian function begins to gradually fade away, and then (postmenopause) stops at all.In the absence of estrogen thinning (atrophy), vaginal mucosa, reduces the amount of glycogen, reduces the number of lactobacilli.Quantitative changes in the composition of the vaginal microenvironment leads to an increase in pH.As a result of the colonization starts (settling) vaginal opportunistic pathogens, they cause local inflammation and clinic form of vaginitis.This creates an unusual situation when the body itself generates disease.
there are other forms of atrophic vaginitis, it is not associated with aging, and provoked an artificial menopause.The lack of estrogen after removal of both ovaries is the vagina changes similar to those of older women.
Infrequently, patients experiencing episodes of hypoestrogenism experiencing symptoms similar to symptoms of atrophic vaginitis.This can be observed:
- who gave birth to breastfeeding among women whose ovarian function after childbirth is restored;
- from experiencing a strong psycho-emotional disorder of women;
- with serious hormonal dysfunction causing significant decrease in the amount of estrogen;
- with endocrine disorders.
However, these abnormalities are reversible and temporary.Typically, such vaginitis not associated with atrophy and eliminated as soon restored normal ovarian function.
symptoms of atrophic vaginitis
Postmenopausal atrophic vaginitis different persistent recurrent course.However, its clinical features, not all have the same severity.Despite the age-legitimate status changes vaginal mucosa, atrophic vaginitis symptoms do not occur in all women.The probability of their occurrence increases significantly with age: the more years pass from the time of menopause, the greater the risk of atrophic inflammation.
Subjective clinical signs of atrophic vaginitis are:
- Feeling of dryness, sometimes pronounced itching, burning sensation in the vagina.
- Discomfort in the area of the external genitalia of varying severity.Sometimes patients note a significant pain in the vagina, especially during intimacy.The degree of pain depends on how thinned mucous layer and "discovered" the nerve endings.
- Abnormal vaginal discharge (leucorrhoea).Reducing the number of lactic acid bacteria and pH shift creates favorable conditions for excessive reproduction of conditionally pathogenic.It is also a source of cables in atrophic vaginitis is joined outside infection.
external characteristics and the amount of bleeding depends on the type of infection.Most vaginal discharge thin, almost watery, mucous or mucopurulent.
thin mucous layer can not protect it are blood vessels, so they are relatively easy to injured and start bleeding.Bleeding in atrophic vaginitis from damaged blood vessels appears as a minor sukrovichnyh cables or dark spotting and copious bleeding vaginal discharge point to the pathology of the cervix or uterine body.
preliminary diagnosis of atrophic vaginitis postmenopausal possible at the stage of primary gynecological examination.Vaginal mucosa looks pale and thinning, with translucent blood vessels on its individual areas are small (point) hemorrhage.In contact with some parts of gynecological instruments atrophic epithelium can bleed a little, and the inspection is often accompanied by pain.
the presence of an infectious inflammation of the mucous locally hyperemic, and the vagina is a significant amount of liquid cables watery, mucus or mucopurulent character.
To clarify the causes of vaginitis need to laboratory study of the contents of the vagina (bakposev and smear "flora").Typically, vaginal fluids are present in leukocytes (inflammatory markers), red blood cells and a significant number of pathogenic microorganisms.
Colposcopy in atrophic vaginitis carried out to study changes in the vaginal epithelium.The method identifies the phenomenon of well atrophy and evaluates the degree of inflammatory changes.
Additional research methods help to correctly differentiate atrophic vaginitis from a variety of infectious and inflammatory processes.
should be noted that old age does not exclude the emergence of an infectious inflammation of the vagina that is not associated with atrophic degeneration of the mucosa.Similar symptoms may appear in the background of bacterial infections, fungal (Candida) lesions, and have a specific origin.Therefore, treat any inflammation that appears necessary with the assistance of a doctor who will conduct the necessary diagnostic procedures and prescribe appropriate treatment.
treatment of atrophic vaginitis
Unfortunately, patients with atrophic vaginitis are not always initially go to the doctor and try to treat yourself.Using anti-spark in atrophic vaginitis, they can eliminate the unpleasant subjective symptoms but not the disease itself.Therefore, atrophic vaginitis relapses and the symptoms become worse.
The only way to eliminate postmenopausal atrophic vaginitis is the restoration of the proper structure and function of the vaginal epithelium.For this it is necessary to artificially reproduce physiological estrogenic effects on the vaginal mucosa.
Treatment of atrophic vaginitis always involves the use of hormonal methods.Based on the clinical situation, they are used as topical therapy or in tablet form, but their comparative effectiveness equal.
local (topical) treatment is performed using a vaginal suppositories or cream containing estrogens.Hormonal candles in atrophic vaginitis: Ovestin, Elvagil, Estrokard and the like.In their structure is dominated by estrogen estriol.
Systemic hormonal (Ovestin, Ginodian - depot klimonorma and the like) are taken in and are also made on the basis of estrogens.Systemic drug Tibolone (Livial, Ledibon) contains a progestin (synthetic progesterone that is).
for treatment of atrophic vaginitis successfully used herbal drugs (herbal) or homeopathic remedies.They contain natural plant etrog and have a therapeutic effect similar to synthetic drugs.It Klimadinon, Klimaktoplan and the like.
hormonal drugs used for the treatment of atrophic vaginitis, also serve as prevention of cardiovascular pathologies and osteoporosis.
Standard regimens in the treatment of atrophic vaginitis is not for every patient is made up of personal therapy.Treatment long, with few interruptions.Treatment efficacy was determined by visual examination and laboratory methods.Criteria for the proper treatment is Colposcopic and cytological picture of the "mature" vaginal epithelium and restoration of normal parameters pH.
Usually, the symptoms of atrophic vaginitis disappear after a month of treatment, but in order to prevent a recurrence of the disease, medications are used longer.