Postmenopausal atrophic colpitis. Atrophic colpitis symptoms and treatment in women. What is it in simple words

14.08.2020

More than half of postmenopausal women suffer from atrophic colpitis (vaginitis). The appearance of secretions and discomfort in the vulva is regarded by many of them as an inevitable manifestation of age-related changes. However, if measures are not taken in time, vaginitis can provoke a number of serious gynecological diseases.

General information about atrophic vaginitis

Atrophic colpitis (vaginitis) occurs in postmenopausal women. It is for this age category of women that structural changes in the vaginal mucosa are characteristic, which are associated with the natural extinction of hormonal function.

Therefore, such inflammation is also called senile, senile or postmenopausal colpitis.

In some cases, due to early menopause, as well as removal of the ovaries or uterus, atrophic vaginitis develops at a younger age. This is due to the cessation of the cyclic synthesis of ovarian hormones, primarily estrogen.

Causes and ways to deal with age-related colpitis in women - video

Reasons for the development of senile colpitis during menopause: who is at risk

The main reason for the development of atrophic or age-related colpitis is estrogen deficiency. The cyclic formation of ovarian hormones in the reproductive age not only ensures the possibility of pregnancy and childbearing, but also affects the processes of maintaining the tissues of the genitourinary system in a certain tone.

Estrogen receptors are found in many organs:

Glandular cells of the vaginal mucosa.
Smooth muscle elements of the vaginal wall.
In the muscles that form the pelvic floor, which support the internal genital organs and prevent them from prolapsing.

When the production of sex hormones decreases, changes in these structures begin. The mucous membrane of the vagina becomes thinner, glandular cells cease to produce a secret and a state of dryness occurs. Such changes contribute to the fact that even minimal stretching and physical impact leads to tissue trauma. Microorganisms penetrate through these small defects, causing swelling and inflammation.

This susceptibility to the disease is also due to changes in the vaginal flora in postmenopause. Lactobacilli, which are responsible for acidity, which gradually increases, disappear, thereby creating good conditions for the reproduction of coccal flora. The formation of lactobacilli is also associated with a certain level of estrogen.

Inflammation of the mucosa in old age is chronic, persistent. The infection can easily spread to the upper section, to the pelvic area, with the development of inflammation of the internal genital organs.

The risk group for the development of senile colpitis includes women:

In postmenopause.
Suffering from chronic infectious diseases (pyelonephritis, salpingo-oophoritis and others).
With low immunity (including carriers of the AIDS virus).
Having endocrine diseases (diabetes mellitus and hypothyroidism).
After removal of the ovaries or uterus.
After a course of radiation therapy in the pelvic area.

Additional negative factors affecting the occurrence of age-related colpitis are:

insufficient hygiene of the genitals;
the use of intimate hygiene products with chemically aggressive components (perfumes);
wearing synthetic underwear.

Symptoms of atrophic vaginitis in postmenopausal women

In some cases, the disease is asymptomatic. Women may sometimes worry about an increase in vaginal discharge, but with only this symptom, they often neglect a visit to the doctor.

Genetic hearing impairment can be cured with antioxidants:

If you do not take action, then over time appears:

Itching in the vagina and in the vulva. It is especially pronounced in women with diabetes. Increases after sexual intercourse, washing and prolonged wearing of tight synthetic underwear.
Burning sensation in the vagina and perineum.
Discomfort when urinating, up to burning. Salts of uric acid irritate the thinned mucous membrane of the vagina.
White discharge with an unpleasant odor.

If these signs appear, you should immediately seek qualified help.

What diagnostic methods can the doctor use: examination, smear cytogram for flora, colposcopy and others

For the diagnosis of atrophic colpitis are used:

Atrophic colpitis is differentiated with candidomycosis, as well as with sexually transmitted infectious diseases:

syphilis;
gonorrhea;
trichomoniasis;
chlamydia.

For this, enzyme-linked immunosorbent assay for the determination of antibodies to pathogens and PCR methods are used.

The most effective is florocenosis - the determination of DNA and RNA fragments to 16 types of pathogens using polymerase chain reaction (PCR).

How to treat postmenopausal colpitis: hormone replacement therapy in the form of suppositories, creams, the use of systemic agents

Therapy of atrophic colpitis is carried out at home, but under the supervision of the attending physician. To reduce the risk of ascending infection and the addition of dysuric disorders, it is necessary to strictly adhere to all recommendations.

Since the main reason for the violation of the normal function of the vaginal mucosa in the postmenopausal period is the lack of estrogens, it is first necessary to make up for their deficiency. The main goal of treatment is to restore the tissues of the vagina and reduce the risk of recurrence of inflammation.

Estrogens are used topically in the form of suppositories and ointments, as well as systemically (that is, inside or in the form of a patch).

For local use appoint:

Ovestin (cream, suppositories) - replenishes estrogen deficiency in women;
Estriol (candles, ointment) - normalizes the hormonal background, eliminates the inflammatory process of the mucous membrane and reduces the manifestations of menopause;
Atsilakt (candles) - restores the microflora of the vagina.

Such treatment lasts two weeks with a mandatory re-examination and examination. When a bacterial infection is attached, antibiotic therapy is necessary, taking into account the sensitivity of the flora. In this case, you can use Fluomizin (vaginal tablets) - a broad-spectrum antiseptic and antibacterial agent that will help eliminate discomfort in a short time.

Systemic estrogen therapy is carried out for a long time, for several years. Use products containing natural ingredients (phytoestrogens):

Estradiol;
Climodien;

Drugs and dosages are prescribed by the attending physician.

Systemic estrogen replacement therapy is carried out taking into account contraindications, which are:

Diseases of the liver.
Angina pectoris and history.
Malignant tumors of the endometrium and breast.
Venous thrombosis and tendency to thrombosis.

In these cases, local treatment is prescribed with herbal decoctions that have antiseptic, anti-inflammatory and wound healing properties.

Drug treatment: Fluomizin, Ovestin, Atsilakt - photo gallery

Angeliq - estrogen-progestin low-dose anti-climacteric drug Ovestin replenishes estrogen deficiency in postmenopausal women and relieves postmenopausal symptoms Estriol is a hormonal agent that normalizes the hormonal background, relieves inflammation of the mucous membrane of the genital organs, and also eliminates the symptoms of menopause
Fluomizin - a broad-spectrum antiseptic that will help eliminate discomfort in a short time
Acylact is used to restore the microflora of the vagina

Folk remedies: chamomile, St. John's wort, aloe, sea buckthorn oil

The use of herbs is an auxiliary component of therapy, however, in the presence of serious cardiovascular or oncological diseases, it becomes the only way to deal with this problem.

For treatment, sitz baths, douching with a decoction of herbs and tampons are used.

For douching use:

A decoction of a mixture of herbs: oak bark, chamomile flowers, St. John's wort and nettle leaves.
Saturated decoction of calendula flowers.
Diluted alcohol tincture of peony flowers (three tablespoons per 500 ml of boiled water).

The solution for douching should be at room temperature. The procedure is carried out once a day at night for two weeks.

For sitz baths use:

Saturated decoction of Rhodiola rosea.
Decoction of juniper fruit.

The procedure is carried out once a day at night for 35-40 minutes. The solution should be warm, but not hot. The course of treatment is 7-10 days.

Photo gallery of folk remedies

Treatment prognosis and consequences

If all recommendations are followed, the prognosis of treatment is favorable. The mucous membrane of the vagina is restored, atrophic changes are reduced. In some cases, they do not disappear completely, however, replenishing the hormone deficiency is sufficient to activate the protective functions and eliminate the conditions for the long-term existence of the infection.

However, relapses of atrophic colpitis are likely, since the natural level of hormones in older women is reduced. Therefore, a prophylactic course of local hormone therapy and herbal treatment should be carried out on the recommendation of the attending physician.

What happens if not treated

If treatment is not started on time, then the following consequences and complications are possible:

Dysuric disorders - urinary incontinence, frequent urges. This is because the bladder tissue (sphincter) also has estrogen receptors. An insufficient amount of this hormone leads to a weakening of the muscle elements and the development of urination disorders.
Purulent discharge from the genital tract, indicating the addition of a coccal infection.
Pain in the lower abdomen. This symptom is indicative of an ascending infection. In this case, signs of intoxication may join - fever, chills, general weakness.

Prevention of postmenopausal colpitis

All women at risk of developing atrophic colpitis are recommended to adhere to dietary and lifestyle restrictions:

refuse spicy and salty foods;
eliminate bad habits (alcohol, smoking);
monitor your weight;
limit sexual contact;
wear loose underwear made from natural materials;
adhere to thorough hygiene of the genital organs without the use of chemical additives;
follow the recommendations of the attending physician in the presence of concomitant pathology (diabetes mellitus and other diseases).

Age-related colpitis significantly reduces the quality of a full-fledged life of an elderly woman. However, unpleasant and dangerous consequences can be avoided if treated in a timely manner.

The aging of the female body begins with the extinction of ovarian function. This leads to a natural decrease in estrogens - sex hormones that govern many processes in a woman's body. Atrophic colpitis (vaginitis) in menopausal women is a consequence of these regular processes. But this state is not pleasant. Are there ways to influence it?

Estrogen deficiency diseases include neuroendocrine disorders, osteoporosis, urogenital problems, and pathology of the cardiovascular system. Everything is explained by the presence of estrogen receptors in many tissues: bone, epithelial, fat. Estrogen deficiency can occur naturally - with aging. There is also an artificial menopause, when the work of the ovaries is stopped by medication or surgery. In this case, the symptoms of menopause manifest themselves in the same way as with its natural onset.

Hormonal affairs: what happens to the body after 50

Estrogens in the blood are represented by several fractions with varying degrees of activity. Their disappearance with age occurs in a certain order. Body aging is a natural programmed process. Approximately five years before the onset of menopause, mechanisms are activated that lead to a decrease in estradiol. With the onset of menopause, its concentration is almost zero. In postmenopausal women, another fraction, estrone, remains circulating in the blood, but its effect on receptors is minimal, which means that the necessary effects are unattainable.

The hypothalamus tries to stimulate the ovaries by artificially increasing follicle-stimulating and luteinizing hormones, which during menopause exceed the norm of reproductive age. But the function of the ovaries fades, they do not respond to stimulation of the hypothalamus. The formation of the main estrogen hormone occurs due to the adrenal cortex or by converting androgens into it in the tissues of the ovaries. Also, its amount can be affected by obesity, liver dysfunction and ovarian tumors.

Estrogen deficiency affects the entire body. In this case, the following pathologies are observed:

neurotic disorders;
urogenital problems;
high risk of developing atherosclerosis;
dystrophic processes in the skin;
osteoporosis;
psychological changes.

But all these symptoms do not appear at the same time. There is a clear sequence. The sexual organs are the first to feel the lack of estrogen. Therefore, atrophic vaginitis develops in women after about 50 years. After that, skin problems appear, urinary incontinence torments. Closer to 60 years, the problem of osteoporosis arises, and after - atherosclerosis.

Atrophic colpitis in menopausal women: why a problem arises

The period of menopause is characterized by the occurrence of a complex of urogenital disorders, which include the following conditions:

atrophy of the vaginal mucosa;
urinary incontinence;
prolapse of the pelvic organs.

The causes of these conditions are atrophic changes in tissues that are sensitive to estrogens:

epithelium of the vagina;
lower third of the urinary tract;
pelvic floor muscles;
connection apparatus.

Rarely do changes occur in isolation, usually a combination of several problems. Moreover, the frequency of their occurrence is associated with age. If at 50 urogenital disorders occur in 10% of cases, then after 55 years - in 50%. For women 75 years old, this figure reaches 80%.

According to ICD-10, the code for atrophic colpitis is N59.2, but if the menopause is caused by surgery, then it is assigned the code N59.3.

How the norm turns into pathology

In women of reproductive age, the pH of the vagina is maintained at a level of 3.5-5.5 due to the metabolism of lactobacilli. They convert glucose into lactic acid. The nutrient medium for their life activity is formed from the desquamated epithelium, in which a large amount of glycogen has been accumulated. In addition to lactic acid, lactobacilli produce many other useful substances, including even hydrogen peroxide. The normal microflora of the mucosa is maintained by the following mechanisms.

Glycogen. Its amount in desquamated cells determines how many microorganisms are able to survive.
Acidity. Normal pH affects not only the beneficial flora, but also does not allow the opportunistic pathogen to multiply.
Estrogens. Their concentration is the determining factor. Under the influence of hormones, the epithelium is intensively stored with glucose, and glycogen is formed.
Sex life. Full sex increases the extravasation of fluid into the vagina if the woman is aroused, and contributes to the desquamation of the epithelium. Sufficient humidity allows lactobacilli to feel good.

But it is worth developing an estrogen deficiency, the amount of glycogen in the epithelial cells will significantly decrease. This means that lactobacilli will not receive a nutrient medium for themselves. Their number gradually decreases until it disappears completely. The disappearance of lactobacilli leads to a decrease in the production of lactic acid, a change in pH to the alkaline side. This creates favorable conditions for conditionally pathogenic and pathogenic flora. The protective properties of the vagina are significantly reduced.

Then there are such symptoms of atrophic colpitis as dryness, thinning of the epithelium.

The main manifestations of the condition: complaints and diagnosis

The first signs of a decrease in proliferative processes in the vagina are the appearance of a feeling of discomfort, which turns into itching and burning. Women also complain of the following symptoms:

dyspareunia - painful intercourse due to dryness in the vagina;
discharge - may be associated with inflammation;
bleeding - contact, often after intercourse, associated with thinning of the mucosa;
prolapse of the vaginal walls- a consequence of estrogen deficiency.

Atrophic colpitis rarely occurs as an independent disease, in 78% of cases it is combined with urination disorders:

cystalgia - pain in the bladder;
nocturia - frequent nightly trips to the toilet;
pollakiuria - frequent daytime urination;
urinary incontinence- stress and non-stress form;
imperative urges- requiring immediate emptying.

Complications in the absence of treatment can manifest themselves in the form of microtrauma of the mucous membrane, the attachment of the inflammatory process and its spread to other parts of the genitourinary tract, cystitis, urethritis may develop.

Establishing diagnosis

Diagnosis requires a seated examination. The doctor notes that the mucous membrane of the vulva and vagina is thinned, it bleeds easily when touched. For analysis, a smear is taken from the vagina. The cytogram reflects the following indicators.

KPI. The karyopyknotic index is the ratio of the number of surface cells with pyknotic nuclei to the total number of all cells. With the development of atrophic changes, the KPI decreases to less than 15-20.
maturation index. It is determined by the ratio of parabasal, intermediate and superficial cells per 100 counted. Changes are determined by formula shift. If more parabasal cells appear, then this is a sign of atrophy.

Identification of cells with signs of atypia indicates a possible precancerous process. This condition requires further diagnosis.

Vaginal discharge is also taken for examination of the flora. A large number of leukocytes in a smear simultaneously with the microbial flora speak in favor of inflammation.

To confirm this, a colposcopy is performed. This is a special method of examining the vagina and cervix using a magnifying device - a colposcope. During the study, the doctor conducts small additional tests.

Schiller's test allows you to determine the condition of the epithelium of the vagina and cervix. The technique is based on the fact that in the normal epithelium there is a large amount of glycogen, which can react with iodine. If there is no glycogen, the reaction will not occur. The sampling procedure consists of five steps.

The neck is exposed in the mirrors.
The neck is cleaned with a cotton ball from mucus and secretions.
Enter 10-15 ml of Lugol's solution.
After a minute, the solution is blotted with a swab.
Conduct an inspection.

With atrophic colpitis, the walls of the vagina, the neck are stained very weakly and unevenly. But sometimes a negative result can be a sign of leukoplakia. The test strips also check the pH of the vagina. With atrophic changes, it can reach six to seven.

How to fix the situation

Treatment of age-related atrophic colpitis should be carried out after examination by a gynecologist. The basis is hormone replacement therapy. Only this method will help with atrophic colpitis in women, because it is the only one aimed at the cause of the pathology.

In the absence of other signs of an approaching menopause, topical preparations can be used. With atrophic colpitis, Ovestin candles are taken. It is also available in gel and tablet form.

The composition of the drug includes estriol - a hormone that disappears from the body when the function of the ovaries is weakened. Estriol normalizes the microflora of the vagina, restores pH. The hormone has a positive effect on urinary problems, eliminates dyspareunia, and makes sexual life possible.

Contraindications for the use of hormonal suppositories:

pregnancy;
estrogen-dependent tumor;
bleeding of unknown origin;
allergy;
liver dysfunction.

Use "Ovestin" start with a large dose - 0.5 g daily two to three times a day. This treatment lasts for two weeks. Then they switch to maintenance doses of 0.5 g twice a week. Candles are produced in the indicated dosage.

Non-hormonal treatment for atrophic colpitis is ineffective. Despite the reviews on the network, folk remedies, homeopathy, douching with herbs, the use of sea buckthorn oil can only reduce the severity of inflammation, slightly softening the dry mucous membrane.

Alternative treatment of atrophic colpitis leads to a long-term absence of pathogenetic and etiological treatment. Therefore, signs of urinary incontinence, nocturia, pollakiuria, as well as omission of the walls of the vagina will be the consequences of neglecting high-quality therapy.

It is necessary to treat atrophic colpitis only after visiting a gynecologist, although preparations for local hormonal treatment can be purchased without a prescription. Atrophic vaginitis is dangerous because it can be a background for the development of oncological pathologies. A prolapse of the pelvic organs can lead to their prolapse and the need for surgical care in the future.

General information about atrophic vaginitis

Therefore, such inflammation is also called senile, senile or postmenopausal colpitis.

In some cases, due to early menopause, as well as removal of the ovaries or uterus, atrophic vaginitis develops at a younger age. This is due to the cessation of the cyclic synthesis of ovarian hormones, primarily estrogen.

Causes and ways to deal with age-related colpitis in women - video

Reasons for the development of senile colpitis during menopause: who is at risk

Estrogen receptors are found in many organs:

Glandular cells of the vaginal mucosa.
Smooth muscle elements of the vaginal wall.
In the muscles that form the pelvic floor, which support the internal genital organs and prevent them from prolapsing.

Thinning of the epithelium of the vagina with atrophic vaginitis

Inflammation of the mucosa in old age is chronic, persistent. The infection can easily spread to the upper section, to the pelvic area, with the development of inflammation of the internal genital organs.

The risk group for the development of senile colpitis includes women:

In postmenopause.
Suffering from chronic infectious diseases (pyelonephritis, salpingo-oophoritis and others).
With low immunity (including carriers of the AIDS virus).
Having endocrine diseases (diabetes mellitus and hypothyroidism).
After removal of the ovaries or uterus.
After a course of radiation therapy in the pelvic area.

Additional negative factors affecting the occurrence of age-related colpitis are:

insufficient hygiene of the genitals;
the use of intimate hygiene products with chemically aggressive components (perfumes);
wearing synthetic underwear.

Symptoms of atrophic vaginitis in postmenopausal women

In some cases, the disease is asymptomatic. Women may sometimes worry about an increase in vaginal discharge, but with only this symptom, they often neglect a visit to the doctor.

If you do not take action, then over time appears:

Itching in the vagina and in the vulva. It is especially pronounced in women with diabetes. Increases after sexual intercourse, washing and prolonged wearing of tight synthetic underwear.
Burning sensation in the vagina and perineum.
Discomfort when urinating, up to burning. Salts of uric acid irritate the thinned mucous membrane of the vagina.
White discharge with an unpleasant odor.

If these signs appear, you should immediately seek qualified help.

What diagnostic methods can the doctor use: examination, smear cytogram for flora, colposcopy and others

For the diagnosis of atrophic colpitis are used:

Atrophic colpitis is differentiated with candidomycosis, as well as with sexually transmitted infectious diseases:

syphilis;
gonorrhea;
trichomoniasis;
chlamydia.

For this, enzyme-linked immunosorbent assay for the determination of antibodies to pathogens and PCR methods are used.

The most effective is florocenosis - the determination of DNA and RNA fragments to 16 types of pathogens using polymerase chain reaction (PCR).

How to treat postmenopausal colpitis: hormone replacement therapy in the form of suppositories, creams, the use of systemic agents

Estrogens are used topically in the form of suppositories and ointments, as well as systemically (that is, inside or in the form of a patch).

For local use appoint:

Ovestin (cream, suppositories) - replenishes estrogen deficiency in women;
Estriol (candles, ointment) - normalizes the hormonal background, eliminates the inflammatory process of the mucous membrane and reduces the manifestations of menopause;
Atsilakt (candles) - restores the microflora of the vagina.

Systemic estrogen therapy is carried out for a long time, for several years. Use products containing natural ingredients (phytoestrogens):

Estradiol;
Climodien;
Angelique.

Drugs and dosages are prescribed by the attending physician.

Systemic estrogen replacement therapy is carried out taking into account contraindications, which are:

Diseases of the liver.
History of angina pectoris and myocardial infarction.
Malignant tumors of the endometrium and breast.
Venous thrombosis and tendency to thrombosis.

In these cases, local treatment is prescribed with herbal decoctions that have antiseptic, anti-inflammatory and wound healing properties.

Drug treatment: Fluomizin, Ovestin, Atsilakt - photo gallery

Folk remedies: chamomile, St. John's wort, aloe, sea buckthorn oil

The use of herbs is an auxiliary component of therapy, however, in the presence of serious cardiovascular or oncological diseases, it becomes the only way to deal with this problem.

For treatment, sitz baths, douching with a decoction of herbs and tampons are used.

For douching use:

A decoction of a mixture of herbs: oak bark, chamomile flowers, St. John's wort and nettle leaves.
Saturated decoction of calendula flowers.
Diluted alcohol tincture of peony flowers (three tablespoons per 500 ml of boiled water).

The solution for douching should be at room temperature. The procedure is carried out once a day at night for two weeks.

For sitz baths use:

Saturated decoction of Rhodiola rosea.
Decoction of juniper fruit.

The procedure is carried out once a day at night for 35-40 minutes. The solution should be warm, but not hot. The course of treatment is 7-10 days.

Photo gallery of folk remedies

Treatment prognosis and consequences

What happens if not treated

If treatment is not started on time, then the following consequences and complications are possible:

Dysuric disorders - urinary incontinence, frequent urges. This is because the bladder tissue (sphincter) also has estrogen receptors. An insufficient amount of this hormone leads to a weakening of the muscle elements and the development of urination disorders.
Purulent discharge from the genital tract, indicating the addition of a coccal infection.
Pain in the lower abdomen. This symptom is indicative of an ascending infection. In this case, signs of intoxication may join - fever, chills, general weakness.

Prevention of postmenopausal colpitis

All women at risk of developing atrophic colpitis are recommended to adhere to dietary and lifestyle restrictions:

refuse spicy and salty foods;
eliminate bad habits (alcohol, smoking);
monitor your weight;
limit sexual contact;
wear loose underwear made from natural materials;
adhere to thorough hygiene of the genital organs without the use of chemical additives;
follow the recommendations of the attending physician in the presence of concomitant pathology (diabetes mellitus and other diseases).

Age-related colpitis significantly reduces the quality of a full-fledged life of an elderly woman. However, unpleasant and dangerous consequences can be avoided if treated in a timely manner.

Obstetrician-gynecologist. I write articles for medical websites in my spare time.

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Atrophic colpitis - what is it and how to treat

The diagnosis of age-related atrophic colpitis, which gynecologists also call senile or chenille, is often made by women who have crossed the 50 or 60-year mark. That is, those who have already come menopause.

This is a period in the life of every woman, which requires special attention and respect. The natural process of the extinction of the female reproductive system, those anatomical formations that make a woman a woman.

What happens in the body during menopause

During the reproductive period, a woman's ovaries secrete sex hormones - estrogens. They are responsible for the formation of the mammary glands, external genital organs and the femininity of the figure during puberty. There are receptors for these substances in almost the entire female body. Thanks to this, a woman before the onset of menopause is protected from coronary heart disease, heart attack and stroke.

Gradually, the reserves of eggs in the ovaries are depleted (menstruation stops), and the formation of hormones stops. The lack of estrogen causes all the characteristic changes for menopause. Dystrophic processes occur not only in the uterus and vagina, but also in other mucous membranes, bladder, pelvic floor muscles, skin, bones and blood vessels. Therefore, it is not uncommon for the manifestation of various diseases during the menopause.

It is necessary to distinguish between the concepts of menopause and menopause. Menopause is the last natural menstruation in a woman's life. This concept can be applied if there is no menstruation for 12 months. Menopause occurs at the age of 45-55 years, but there are early and late variants. The period before menopause is called premenopause and is characterized by irregular menstruation and its changes (scanty or heavy). The period after menopause is called postmenopause. It continues for the rest of a woman's life. The concept of menopause characterizes all of these periods together.

Symptoms of atrophic (chenille) colpitis or vaginitis

With age, there are symptoms such as a feeling of dryness in the vagina, unbearable itching and burning pains that occur after intercourse or on their own.

The occurrence of complaints is observed 3-5 years after menopause. They are due to a decrease in the synthesis of glycogen in the mucosa, a decrease in the number of lactic acid bacteria and a change in the pH of the vaginal environment from natural acid to alkaline. Under these conditions, microbial agents will often join, which causes an inflammatory process in the vagina. With frequent inflammation, scars and adhesions form. In this case, the urethral syndrome develops.

If these phenomena are accompanied by atrophic changes in the labia minora and sclerosis of the vulva, kraurosis of the vulva occurs. This condition is manifested by the resistance of symptoms to hormone therapy.

In conditions of reduced resistance, microbes (strepto- and staphylococci, bacteria of the Escherichia coli group) colonize the mucosa and form nonspecific colpitis - microbial inflammation of the vagina. In addition to microbes, colpitis is caused by various mechanical and chemical factors.

Often, damage to the vagina is accompanied by damage to the mucous membranes of the cervix or urethra. When examined by a doctor, the vaginal mucosa is edematous, bright red. There is bleeding on light touch. There are purulent accumulations on the walls of the vagina. In severe forms, mucosal defects are formed - erosion and ulcers. They are caused by desquamation of the epithelium and exposure of deeper tissues.

The chronic stage implies some subsidence of the inflammatory process. The main complaint in this phase is suppuration from the genital tract. Redness and swelling also decrease, and tender scar tissue forms at the site of erosion. Formed granulation colpitis.

What methods allow to clarify the diagnosis?

To diagnose this pathology, in addition to examining the vagina, a number of methods are used. To accurately determine the pathogen, methods of sowing discharge from the vagina, urethra and cervical canals are used. An important step in the examination is microscopy of smears from the vagina. Colposcopy is used - examination of the mucous membrane through a lens system. By magnifying the picture several times, the doctor will be able to detect weak signs of inflammation and dysplasia, which is important in the early diagnosis of tumors. Atrophy of the integumentary epithelium of the cervix after 40 years is a normal colposcopic picture.

A cytological study is underway. It is based on the determination of the morphology of the cells of the vagina. With menopause, an atrophic type of smear is often found. It implies the presence of epithelial cells from its various layers with signs of atrophy. In the results of the cytogram, there may also be such a thing as pseudokeratosis. Inflammatory infiltration indicates the activity of the process. These types of smears do not occur in women of reproductive age, but may be detected in those under 16 and over 55 years of age.

How and how to treat inflammation of the vagina from infections

Treatment of atrophic colpitis should be comprehensive, carried out under the supervision of a gynecologist. Therapy is aimed at combating infectious agents and concomitant diseases, increasing the body's resistance.

To reduce the microbial flora, douching with antiseptic solutions is locally prescribed ( Dioxidin, Miramistin, Betadine, Chlorphyllipt) 1-2 times a day. Long-term (more than 4 days) douching interferes with the restoration of the natural flora and acidic environment of the vagina, therefore it is not recommended.

Antibacterial agents can be administered topically and orally. Combined drugs are applied locally. They are in the form of a gel, suppositories, vaginal tablets. Widely used drugs: Terzhinan, Ginalgin, Neopenotran, Polygynax. These are the most effective vaginal suppositories. If intestinal flora is detected, use Metronidazole, Ornidazole, Betadine. Inside, antibiotics are prescribed with a pronounced process and strictly according to the sensitivity of the identified bacteria to antibiotics detected in the culture.

Eubiotics are used: Lactobacterin, Biovestin, Vagilak, Bifidumbacterin. They restore the natural flora and pH of the vagina. They are prescribed after a course of antibiotics.

As a non-hormonal prevention of relapse, periodic use of suppositories with anti-inflammatory and regenerative effects is prescribed - Depantol and Methyluracil. Interestingly, methyluracil suppositories are used not only in gynecological practice, but also for the treatment of hemorrhoids, rectal fissures. In this case, they are used rectally.

To heal cracks on the dried mucous membranes of the labia and vagina, an ointment is used Pantoderm. It contains the substance dexpanthenol, known to many mothers of infants with skin problems. It is included in the popular Bepanthen cream.

These activities will relieve symptoms at any age. However, during menopause, the main mechanism for the development of diseases is estrogen deficiency. It is this component that is the target for the main treatment - hormone replacement therapy (HRT).

Hormone Replacement Therapy

Many patients at the doctor's appointment ask the following question: “For a long time I have been tormented by dryness in the vagina, due to which sexual intercourse has become impossible. Is it possible to restore the mucosa and resume sexual activity, what does this mean? Or is it too late and you need to reconcile?

The answer is simple: it is possible and necessary to fight this disease. Pharmaceutical companies offer a large selection of drugs for the treatment of estrogen deficiency. They contribute to the restoration of the normal epithelium and microflora of the vagina, increase the resistance of tissues to infection. But you need to accept the fact that the cure for 1 day will not happen. It will take at least 2-3 months before you feel the first improvements in your condition.

You should know that hormone replacement therapy is prescribed strictly on the recommendation of a doctor and only after a comprehensive examination. It is necessary to conduct an oncocytological examination of the cervix, ultrasound of the small pelvis, mammography. This is aimed at identifying neoplasms in these organs. The appointment of hormonal drugs in case of detection of a tumor can lead to its increased growth. In addition to tumors, pathologies of the blood coagulation system are excluded, otherwise the appointment of replacement therapy is fraught with the development of thrombosis.

Hormone replacement therapy is divided into local and general. The general one implies the appointment of hormonal drugs for oral administration according to certain schemes. They immediately enter the bloodstream, providing a systemic effect throughout the body. However, these funds are prescribed strictly according to the indications, and the need for their appointment is decided by the gynecologist in each case.

Local hormonal therapy is the only true and most preferred in the treatment of atrophic colpitis. Natural estrogen preparations are used. They are in the form of a cream or candles. This is Ovestin, Estriol, Elvagin, Estrocad. Estrogen treatment has been carried out for many years, since withdrawal within 2-3 weeks will lead to the return of all symptoms present before treatment.

Since the drugs are quite expensive, and the treatment has an indefinitely long period, the therapy is carried out according to the appropriate schemes. There is a phase of intensive estrogen treatment and a phase of maintenance doses.

Treatment of atrophic colpitis using the example of Ovestin

Systemic treatment (ingestion of tablets). Intensive phase: 4 mg/day for 2 weeks, 2 mg/day for 1 week, 1 mg/day for 1 week. In the maintenance phase, the use of Ovestin is reduced to 0.5 mg / day every other day indefinitely.
local treatment. In addition to tablets, Ovestin is in the form of a cream or suppositories. Intensive phase: 1 dose of cream/suppository per day for 3 weeks, then 1 dose of cream/suppository every 3 days for 3 weeks. Maintenance phase: 1 dose of cream/suppository at night once a week indefinitely.

It is important to note that application of Ovestin locally is most effective. The drug is not absorbed into the blood, but acts on nearby tissues (vaginal mucosa, urethra, bladder). It is devoid of many of the side effects that occur when taking hormonal pills orally. Treatment is more effective the earlier it is started, and can continue indefinitely without harm to health. The drug is injected into the vagina at night. In addition, Ovestin cream is used during intercourse. It is important to use a special cream dispenser to avoid overdose.

Folk remedies for home use

They will not help restore the normal microflora of the vagina, only slightly alleviate the symptoms. The problem will remain if medical treatment is not carried out. Folk is suitable only as an addition or temporary measure before visiting a gynecologist and receiving a treatment regimen from him.

Sitz baths with chamomile

Baths with the addition of chamomile are a traditional remedy for the treatment of local irritation of the genital organs. They are practiced even when relieving inflammation in infants. Chamomile rarely causes allergic reactions. But it can lead to dryness of the mucous membrane, that is, worsen the course of atrophic colpitis if you take chamomile baths too often and for a long time.

Chamomile baths are available at home and are easy to make. 3-4 procedures are enough to make burning and swelling less noticeable. Medicinal chamomile flowers have a positive effect on the delicate microflora of the labia, gently eliminate discomfort due to antiseptic properties.

10 grams (2 tablespoons) of dried flowers of this plant must be poured with 1 liter of boiled water and steamed for at least 10 minutes, then cooled to 35-38 degrees. Take sitz baths for 20-30 minutes. This decoction is also effective in the form of douching.

Candles and tampons with sea buckthorn

To cook it yourself, you need to transfer 200 grams (1 cup) of washed sea buckthorn berries into a thick gruel. Pour the resulting mixture with refined sunflower oil and leave for a week. In work, use glassware with a tight lid.

A gauze pad is soaked with the finished oil and placed in the vagina overnight. The course of treatment is 14 days.

An alternative is to use sea buckthorn suppositories vaginally. They are sold in pharmacies.

Mud swabs and applications

This procedure must be agreed with the gynecologist, since it has a number of contraindications. Mud tampons or a tube should be slightly warmed up to 38-42 degrees beforehand and slowly inserted into the vagina for 30-40 minutes. Tampons are advised to combine with a mud application on the lower back. After the time has elapsed, you need to remove the mud swabs, and rinse the vagina well with mineral water.

As a remedy, the mud of Lake Tambukan, located in the Stavropol Territory, is usually used. But other options are also possible. Mud therapy in gynecology is an unconventional way to treat and prevent women's diseases.

Baths with coltsfoot

Pour 100 grams of dried grass with 1 liter of boiling water, leave for about an hour and take sitz baths. Daily use only freshly brewed infusion. Treat for at least a month.

Herbal douching

Peeled chamomile - 25 g, dried forest mallow flowers - 10 g, dried oak bark - 10 g, sage leaves - 15 g. Mix all the ingredients, pour 1 liter of boiling water and let it brew. Strain the finished infusion and use it in the form of baths and for douching.

Summing up, I would like to note that menopause is an inevitability, a certain period in a woman's life. And it depends only on you what it will be. With the help of a competent doctor and special means, you can avoid many troubles and continue to enjoy life as before.

And for a snack, we offer you a video from the respected Elena Malysheva on the topic of atrophic vaginitis.

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Olga: “How lucky you are! I had a pessary put in at 23 weeks and my water broke at 25 weeks. They did a caesarean section. A son was born weighing.

Christina: "What a nightmare! It turns out, I almost killed a child with this infection! And why didn't my doctor prescribe bakposev.

Oksana: “My uterus ached for at least 5 days after cleaning (I had a miscarriage for a long time, 10 weeks ...). A nightmare. Constantly drank "Ibuprofen".

Nina Olegovna: “The gynecologist questioned sarcoma ... That is, it is not yet clear whether I have sarcoma (cancer) or a rapidly growing fibroid.

Ekaterina: “I haven’t been able to get pregnant for six months now after curettage of the uterus (LDV) ... Doctors say that the germ layer may have been damaged during cleaning.

Elena: “I bled 2 weeks after cleaning. The doctor said that the uterus did not completely empty immediately. And because of this, it arose.

Darina: “Because of this polyp, it turns out that I could not get pregnant for a year. And it was only 20 minutes. In 20 minutes I had a curettage.

Vera: “I was put on a drip, after which I was completely blacked out. I woke up after it was all over. The nurses laid her on the couch and took her to the ward.

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Atrophic colpitis: treatment, symptoms, suppositories, drugs

Up to 40% of women after menopause experience symptoms of atrophic colpitis (itching and burning, vaginal dryness and pain during intimacy). It is characteristic that the longer the period of menopause, the higher the risk of this disease. Thus, the percentage of patients with this disease increases to 75 approximately 10 years after the date of the last menstruation.

Since atrophic changes in the vaginal epithelium, as a rule, are associated with the physiological completion of hormone production by the ovaries, atrophic colpitis is considered as a pathology only in the event of pronounced clinical signs (the appearance of significant discomfort).

Definition of the term and types of disease

Atrophic colpitis refers to changes in the vaginal epithelium associated with structural and functional changes, as a result of which the vaginal epithelium becomes thinner, which leads to the appearance of characteristic symptoms (dryness, dyspareunia, itching and recurrent inflammation). This condition is associated with a significant decrease in estrogen levels, which can be due to both physiological causes (physiological menopause) and artificial cessation of the production of female sex hormones (artificial menopause or atrophic colpitis of reproductive age).

The disease got its name "colpitis" or "vaginitis" from the Greek word colpos or from the Latin vagina, which translates as the vagina. The suffix "it" means inflammation.

Other synonyms of the disease are atrophic vaginitis, senile or senile colpitis.

An excursion into the physiology and pathogenesis of the disease

The vagina is lined with stratified squamous epithelium, which performs a large number of functions necessary to protect the genital organs from infectious pathogens. The vaginal epithelium is constantly renewed due to its multi-layered structure, the upper cells die and desquamate, taking pathogenic microorganisms and their toxins with them, and new ones “come” in their place.

In addition, the vaginal epithelium maintains a constancy of the environment. Normally, in women of childbearing age, the environment in the vagina is always acidic (pH 3.8 - 4.5), and the microflora is 98% represented by lactic acid bacteria (lactobacilli). Lactobacilli prevent the penetration of pathogenic pathogens and the activation of conditionally pathogenic microbes due to the maintenance of a constant acidity of the vagina. Lactic acid bacteria feed on glycogen, which is found in large quantities in desquamated epithelial cells.

With the onset of menopause, the cyclic renewal of the vaginal epithelium stops, which is associated with a decrease in estrogen synthesis and the completion of menstrual function. Epithelial cells are sloughed off in small quantities, which leads to a deficiency of glycogen, and, accordingly, to a decrease in the number of lactobacilli. In connection with these processes, the pH of the vagina shifts to the alkaline side, which leads to its contamination with opportunistic microorganisms and the penetration of pathogenic pathogens. All of the above causes a local inflammatory reaction of the mucosa, that is, colpitis.

Thinning of the epithelium and a decrease in secretion by the vaginal glands lead to fragility and slight vulnerability of the vaginal mucosa, which further contributes to the activation of opportunistic flora, and also leads to a narrowing of the vaginal lumen.

The development of the disease is based on hypoestrogenism, which can be either physiological (after the last menstruation) or artificial (surgery and other manipulations on the ovaries). In women of childbearing age, hypoestrogenism can develop under the following circumstances:

Postpartum, especially in lactating women

In the postpartum period, the restoration of hormonal balance occurs gradually, especially in breastfeeding mothers (prolactin is produced), which leads to long-term hypoestrogenism and often to the development of atrophic colpitis.

A long-term hormonal imbalance causes persistent hypoestrogenism and the development of the disease.

Strong psycho-emotional experiences (violate the level of the ratio of hormones).
Endocrine pathology

Women suffering from thyroid diseases, diabetes mellitus, adrenal pathology are prone to the occurrence of atrophic colpitis.

Other reasons

Ovariectomy (removal of the ovaries). The ovaries synthesize estrogens, and in their absence, the production of female sex hormones stops automatically.
Radiation therapy of the pelvic organs. Irradiation of the pelvic region also affects the female gonads, which contributes to the disruption of the production of hormones, including estrogen.
HIV carriers or AIDS patients.
Weakened immunity (negatively affects the hormone-forming function of the ovaries).

Predisposing factors

Of the predisposing factors for the development of the disease, it should be noted:

frequent, promiscuous and unprotected sexual intercourse;
the use of aromatic products for intimate hygiene, fragrances, antibacterial soaps, lubricants;
wearing tight synthetic underwear (prevents air access and promotes the development of anaerobic flora);
errors in the diet (lack of fermented milk products, eating unwashed vegetables and fruits, drinking low-quality water);
chronic inflammatory processes of the genitals;
common chronic diseases.

Clinical picture

The first signs of atrophic vaginitis occur approximately 5 years after the onset of the last menstruation. As a rule, the disease proceeds sluggishly, the symptoms are mild. An increase in clinical manifestations is associated with the addition of a secondary infection and the activation of opportunistic bacteria, which is facilitated by microtrauma of the mucosa due to its slight vulnerability (for example, after a gynecological examination, coition or washing / douching). The main features include:

Vaginal discomfort

Manifested as a feeling of dryness, tightness of the vagina, in some cases, pain. When pathogenic microflora is attached, significant itching and burning appear.

Dyspareunia

Pain during and after sexual intercourse is due to depletion of the stratified squamous vaginal epithelium, exposure of nerve endings and a decrease in secretion production by the vaginal glands, the so-called lubrication.

Vaginal discharge

With this disease, vaginal discharge is mild, mucous or closer to watery. In the case of infection, whites acquire qualities characteristic of a certain type of bacteria (curdled, greenish, foamy) and have an unpleasant odor. Also for atrophic vaginitis is characterized by spotting. As a rule, they are insignificant, in the form of a few drops of blood and are caused by traumatization of the mucous membrane (sexual contact, medical examination, douching). The appearance of any spotting (both minor and profuse) in postmenopause is a reason for immediate medical attention.

Frequent urination

Senile vaginitis is always accompanied by thinning of the bladder wall and weakening of the tone of the pelvic floor muscles. These processes are accompanied by an increase in urination, although the amount of urine excreted per day does not change (does not increase). In addition, weakened pelvic floor muscles contribute to the development of urinary incontinence (when coughing, laughing, sneezing).

The vaginal mucosa is pale pink, with numerous petechial hemorrhages. Upon contact with medical instruments, the mucous membrane bleeds easily. In the case of a secondary infection, swelling and redness of the vagina, grayish or purulent discharge are observed.

Diagnostics

Diagnosis of the disease should be comprehensive and include:

Inspection of the walls of the vagina and cervical mucosa in the mirrors;
Taking smears for microbiological examination

A large number of leukocytes is detected (when a secondary infection is attached), which indicates inflammation, the almost complete absence of lactic acid bacteria, a high content of opportunistic flora, it is possible to identify specific pathogens (Trichomonas, fungi, gardnerella, "key cells", etc.).

With an obvious inflammatory process in the vagina and doubtful microbiological results of smears, the patient is sent for PCR tests (gynecological smears, urine, blood) to detect latent genital infections. It is possible to identify chlamydia, uro- and mycoplasmas, cytomegalovirus, genital herpes virus and human papillomavirus and other pathogens.

It is carried out with a special test strip. Normally, the pH should correspond to the numbers 3.5 - 5.5. In the case of atrophic vaginitis, the pH rises to 5.5 - 7 or even becomes alkaline (more than 7).

Colposcopy

Inspection of the cervix and vaginal walls under magnification (colposcope). Pallor and atrophy of the mucous membranes of the vagina and cervix, the smallest injuries (cracks), a mild vascular pattern, and possibly foci of dysplasia on the walls of the vagina and cervix are revealed. Schiller's test (staining with Lugol's solution) weakly positive or uneven staining (depletion of the epithelial layer, an indirect sign of dysplasia).

Taking a smear from the cervix and from the posterior fornix of the vagina for cytological examination

The cervical mucosa consists of several types of cells:

keratinizing (those that exfoliate - this is the topmost layer);
intermediate (represented by 2 layers, are under keratinizing and replace them subsequently);
parabasal;
basal (mature, become parabasal, then intermediate, and finally keratinizing).

Since in this disease the epithelial layer is depleted (not only on the vaginal walls, but also on the cervix), parabasal and basal cells will predominate in the cytogram with atrophic colpitis.

Classification of cytological smears:

type 1 - no atypical cells, the cytological picture is normal;
type 2 - the structure of epithelial cells is somewhat changed due to the inflammatory process in the vagina and / or in the neck;
type 3 - cells with altered nuclei are present, but in a single amount (repeated cytological examination is necessary) and colposcopy;
Type 4 - individual epithelial cells are detected with obvious signs of atypia (malignancy) - colposcopy and histology are necessary;
Type 5 - a lot of atypical (cancerous) cells.

In atrophic colpitis, as a rule, an inflammation cytogram is diagnosed, which requires the appointment of anti-inflammatory treatment.

What and how to treat with atrophic colpitis can only be determined by a gynecologist. The main and effective way to treat atrophic colpitis in women of both postmenopausal and reproductive age is the appointment of hormone replacement therapy or HRT. It is the intake of hormones that helps to mislead the vaginal mucosa, forcing the epithelium to be cyclically renewed (the influence of estrogens), which improves the nutrition of the mucosa, reduces the degree of its atrophy and prevents the formation of microtraumas.

Conducting HRT is possible in two ways: the introduction of hormones systemically, in the form of tablets, injections or hormonal patches, or locally (suppositories, ointments, creams). Hormone therapy should be carried out for a long time, at least 1.5 - 3 years, although a positive effect is observed already after 3 - 6 months from the start of treatment. But in the event of the termination of the HRT course, the symptoms of senile vaginitis return again, and often complicated by the addition of a secondary infection.

Local treatment

Candles that are prescribed for atrophic colpitis:

Suppositories contain the main active ingredient - estriol (estrogen component) and additional - dimethyl sulfoxide. The drug is dispensed without a prescription. Treatment regimen: in the first month, intravaginal administration once a day, then (in a month) twice a week. The medicine reduces itching in the vagina, excessive dryness, eliminates dyspareunia. Effective for urination disorders and urinary incontinence caused by atrophic processes in the vaginal mucosa.

Available in the form of suppositories, vaginal cream and tablets. The main active ingredient is estriol, additional substances: potato starch, acetyl palmitate, lactic acid and others. The drug has the same properties as estriol. The treatment regimen is similar to estriol (first, daily intravaginal administration of suppositories for 4 weeks, then, subject to improvement, the dosage is reduced to 2 suppositories per week). Leave in pharmacies without a prescription.

Available in the form of tablets for intravaginal administration. The drug contains a lyophilisate of acidophilic lactobacilli in a dosage of 50 mg and estriol in an amount of 0.03 mg. Effectively restore the normal microflora of the vagina (the action of acidophilic lactobacilli), improve the trophism of the vaginal epithelium, stimulate the growth of the epithelium (the effect of estriol), due to the glycogen that is part of the drug, support the growth and development of the vagina's own lactic acid bacteria. Treatment regimen: insertion into the vagina of one tablet daily for 6 to 12 days, then one tablet twice a week. Released without a prescription.

Available in the form of vaginal suppositories and cream. The main active ingredient is estriol. It is introduced into the vagina daily once a day for 2 to 3 weeks, then the dose is reduced to twice a day. Release from pharmacies without a prescription.

Available in the form of a vaginal cream, suppositories and tablets. The composition of the drug includes estriol. Method of application: the introduction of a cream (tablets or suppositories) at a dosage of 0.5 - 1 mg per day for 20 days, then a break for a week, in case of weakening of symptoms, continue treatment for 7 days a month. Therapy should continue for at least 6 months.

Estrocard (cream and suppositories)
Estrovagin (cream, vaginal suppositories)
Ovipol Clio (suppositories).

Systemic therapy

Prescribed drugs for systemic treatment:

Available in the form of tablets for oral administration. One package contains 28 tablets. The composition of the drug includes estradiol and dienogest. The medication is taken one tablet daily, preferably at the same time. At the end of the package, they immediately begin taking a new one. Climodien is prescribed to women with severe menopausal symptoms (hot flashes, disturbed sleep, increased sweating) and signs of senile vaginitis, but not earlier than a year after menopause. Available in pharmacies by prescription.

One blister contains 28 tablets. You can start taking the drug on any day, but not earlier than one year after the last menstruation. The composition of the drug includes estradiol propionate and norethisterone acetate. The drug is prescribed as HRT for women over 55 years of age, for the prevention of osteoporosis and the treatment of senile vaginitis. Released by prescription.

Available in the form of white (11 pieces) and blue (10 pieces) tablets. The package contains 21 tablets. The white tablets contain estradiol, while the blue tablets contain estradiol and medroxyprogesterone. They are taken daily, at the same time for 3 weeks, then a 7-day break is needed, during which menstrual-like bleeding occurs. The drug is prescribed for estrogen deficiency (atrophic vaginitis), menopausal syndrome and for the prevention of postmenopausal osteoporosis. Released by prescription.

The composition of the drug includes estradiol and norethisterone (monophasic drug). The package contains 28 tablets. Pausegest is taken daily, one tablet for 4 weeks. After the completion of the packaging, they immediately begin taking a new one. Pausegest is prescribed no earlier than one year after the last menstruation. Released by prescription.

Herbal preparations (phytohormonotherapy)

Available as a syrup or elixir. The composition of the preparation includes: wild rose, cedar seeds, hawthorn, coriander seeds, chaga, chamomile and other plant components. Treatment regimen: 10-15 ml of the drug is diluted in 100 ml of water and taken three times a day 15 minutes before meals for 2-3 weeks. If necessary, the course of treatment is repeated after 7 to 14 days. Released without a prescription.

The composition of the drug includes rhizomes of cimicifuga, which has an estrogen-like and anti-menopausal effect. One blister contains 15 tablets, in a package of 4 or 6 blisters. Take the drug should be 1 tablet twice a day at the same time, the duration of treatment is determined by the doctor. Released without a prescription.

The drug contains an extract of cimicifuga root, available in tablets, in the form of face and body creams. Reception is carried out daily, 1 - 2 tablets, at least a month. The duration of the course is prescribed by the doctor.

Klimadinon Uno
Climaxan
Feminal
Remens (drops)
Menopace (multivitamins and minerals)
Menopace Plus (herbal ingredients)
Bonisan
Tribestan
Estrovel
Inoklim
Lephem.

Question answer

Is it possible to use folk remedies for senile colpitis?

Yes, you can, but only as an addition to the main treatment (hormone therapy). Folk remedies are used for a pronounced inflammatory reaction in the vagina, to relieve swelling, eliminate redness and itching, and heal microtraumas of the vaginal mucosa. Warm baths with decoctions of chamomile, calendula, sage, juniper berries, Rhodiola rosea and other medicinal plants are used. You can intravaginally administer tampons with aloe juice (accelerate the regeneration of the mucosa), take an infusion of celandine herb or a mixture of mint, sage, nettle, sweet clover, rose hips. Tea from raspberry leaf, willow leaves and chamomile is also allowed.

I am 35 years old, six months ago, both ovaries were removed (ovarian endometriosis) and hormonal birth control pills were prescribed. About 2 weeks ago, I began to feel a burning sensation and itching in the vagina, yellowish discharge with an unpleasant odor appeared. Are these signs of atrophic colpitis?

You should visit a gynecologist as soon as possible and pass smears on the microflora of the vagina. Most likely you do not have atrophic vaginitis, but nonspecific, possibly thrush. For the development of this disease, at least a year after the operation is necessary, especially since you are taking a hormonal drug. The doctor, after passing the smears and identifying the pathogen, will prescribe you the appropriate anti-inflammatory treatment. But HRT should be continued.

Is it possible to prevent the development of senile colpitis and how?

Yes, as a preventive measure of the disease, you should regularly visit a gynecologist, give up bad habits and wear tight synthetic underwear, adhere to proper nutrition, and take multivitamins. You should also exclude the use of flavored intimate hygiene products, refuse unprotected sexual intercourse, perform physical exercises and Kegel exercises (to strengthen the muscles of the pelvic floor), replace the bath with washing in the shower.

How is the effectiveness of the treatment of senile vaginitis determined?

To identify the positive or negative dynamics of the disease, regular colposcopy is performed (once every 3-6 months), measurement of the pH of the vaginal environment, and cytological examination of smears.

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The development of atrophic colpitis, treatment with folk recipes

Causes of pathology and its signs

Most often, the symptoms characteristic of atrophic colpitis appear in women several years after menopause occurs. Usually the disease develops as a result of age-related changes and a lack of estrogen:

the formation of epithelial cells in the vagina stops;
thinning of the mucous layer;
vaginal glands produce less secretion;
pathological changes in the microflora are observed, changes in the acid-base balance are noticeable;
reduced number of lactobacilli;
the vaginal walls are easily injured;
a noticeable and rather unpleasant dryness forms in the vagina;
there is an increased activity of facultative flora;
pathogenic microorganisms enter the body from the outside.

Also, the development of this type of disease contributes to a violation of the rules of hygiene, preference given to synthetic underwear, unprotected sexual contact. With the development of an atrophic form of pathology, symptoms may be implicit or absent altogether. The disease proceeds rather sluggishly, the main symptom of the problem is itching or burning.. Some concern can be caused by vaginal dryness, which makes sexual intercourse quite painful. After intercourse, spotting, slight bleeding are not excluded.

The reproduction of opportunistic organisms in the vagina as a result of an insufficient amount of lactobacilli leads to inflammation and an increase in the volume of secretions. They become watery, often with an admixture of blood after examinations, douching. There are five classic symptoms that indicate the presence of senile vaginitis:

There is pain that appears during walking, urination, at rest. Pain can be aggravated by exposure to hypothermia or infectious processes in the body.
In the affected areas, redness occurs due to vasodilation.
In the area of inflammation, swelling is noticeable.
Burning appears due to increased temperature in the lesion.
The functionality of the organ is impaired.

Principles of treatment of the disease

Usually, when diagnosing atrophic colpitis, treatment involves the appointment of hormone replacement therapy. It can be not only local, but also systemic. Local treatment is carried out by prescribing estrogen preparations - usually ointments, vaginal tablets (Estriol or Ovestin). The standard course of treatment is 14 days and is repeated if necessary..

Systemic hormone therapy includes the appointment of Climodien, Kliogest and other drugs in the form of tablets or patches. Therapy should be continuous, it lasts for five years. When a secondary infection is attached, colpitis is treated as a disease in an acute form - the use of etiotropic drugs is prescribed.

It happens that it is impossible to use a hormonal agent due to oncology, liver pathologies, bleeding, angina pectoris and other diseases. In this case, experts suggest being treated with douching and baths. Decoctions and infusions of medicinal plants with anti-inflammatory and antiseptic properties are used. It is also necessary to prescribe a diet, increase the amount of natural vitamins.

An effective way to treat atrophic vaginitis is to visit the bathhouse.

A combination of humidity and high temperature provides a positive effect. Due to the heat, relaxation of smooth muscles is observed, which improves blood circulation and secretion production - an improvement in metabolic processes is noticed, the work of the glands is stimulated. Dousing with cool water leads to sharp muscle contractions and vasoconstriction, resulting in increased tissue elasticity. At the same time, it is necessary to remember about contraindications - this type of treatment is not suitable for patients with problems of the cardiovascular system, with the presence of varicose veins and thrombophlebitis.

Recipes offered by traditional medicine

Consider the treatment of atrophic colpitis with folk remedies using medicinal plants that can be used to prepare baths, tampons, douches and medicinal drinks:

A popular recipe is a decoction of pink Rhodiola. It is necessary to take 100 grams of the root system of the plant and pour the ingredient with a liter of water brought to a boil, then cook the product over low heat for ten minutes. Next, the broth is cooled, filtered, and sitz baths are taken. The duration of each procedure is 30 minutes in the morning and before going to bed. It is permissible to replace bathing with douching. But at the same time, the procedure is carried out in a horizontal position on the back in order to exclude the creation of pressure and the supply of decoction along the posterior vaginal wall.
For the preparation of medicinal baths, juniper berries are used - two glasses of fruits should be poured with three liters of boiled water and kept for 30 minutes on low heat. The decoction is then cooled while preparing a bath, the temperature of the liquid in which is approximately 38 or 39°C. The cooled broth is filtered and poured into the bath. The duration of the further procedure is 40 minutes, it is necessary to take baths daily to obtain a positive effect. After the bath, it is recommended to drink mint tea with honey.
In the treatment of atrophic colpitis in women, it is recommended to use aloe to stimulate biological processes. With the help of plant juice, medical tampons are made by soaking rolled gauze with liquid. The swab is introduced at night, you can use not only juice, but also crushed pulp, wrapping it in gauze before use. The course of treatment lasts ten days, after which they take a break for five days, and repeat the course.
The therapy is carried out by means of sitz baths with willow decoction - four handfuls of a pre-crushed plant must be poured with water in the amount of three liters, brought to a boil and boiled for 30 minutes. Then the broth is cooled to an acceptable temperature and a bath is prepared, taking it until the solution has completely cooled.

Healing drinks for atrophic colpitis

From many medicinal plants, you can make not only decoctions for baths, they are taken orally as healing drinks:

An effective treatment with folk remedies suggests using freshly squeezed aloe juice - it should be drunk in the morning before a meal in the amount of one small spoon.
You can use the following medicinal collection - mix 100 grams of Baikal skullcap with the same amount of nettle, add 150 grams of peppermint and the same amount of rose hips, add 50 grams of licorice root and sage here. All ingredients are thoroughly mixed, then two large spoons of the mixture are poured into a glass of boiled water and kept in a water bath for another 20 minutes, then the healing liquid is infused until cool and filtered. Drink the drink three times a day for 1/3 cup, the reception should be carried out 30 minutes before the meal. The treatment is carried out for two months, after which they take a two-week break and repeat the therapy.
Chamomile color and willow leaves should be mixed in equal amounts, then pour half a large spoonful of the composition into 200 ml of boiled water and leave under the lid for five minutes. Honey is added to the resulting drink to taste. It is necessary to drink the remedy at night for two months.
Treatment is carried out using raspberry leaves for making herbal tea. Half a large spoonful of the crushed plant is poured into 200 ml of boiled water and infused for several minutes, after which they drink the drink. The remedy has a contraindication - such tea is not recommended for women who have recently given birth, since the drink can cause uterine bleeding.
An alcohol tincture is prepared on lily of the valley, without exceeding the dosage, since the plant is quite poisonous. Crush 20 grams of flowers, pour them into a glass container and pour 250 ml of vodka. A tightly closed vessel is kept in the dark for 10 days, after which the product is filtered. It should be taken in the morning, afternoon and evening hours 60 minutes before meals in the amount of 10 drops. After 14 days, treatment is stopped for 7 days, after which the course is repeated.

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Definition of the term and types of disease

Atrophic colpitis is a change in the vaginal epithelium, which is associated with functional and structural changes, against which the vaginal epithelium becomes thinner, which ultimately causes the development of characteristic symptoms (repeated inflammation, itching, dyspareunia, dryness). This condition is provoked by a significant decrease in estrogen levels, which can be associated with both physiological causes (physiological menopause) and artificial cessation of the secretion of female sex hormones (atrophic colpitis in reproductive age or artificial menopause).

The very name of the pathology "vaginitis", or "colpitis", arose from the Greek word "colpos" and the Latin "vagina", which literally translates as "vagina". The suffix "it" indicates inflammation of the organ. Other synonyms of this disease are senile, or senile colpitis, atrophic vaginitis.

A little about the physiology and pathogenesis of the disease

The female vagina is lined with stratified squamous epithelium, which performs a significant number of functions that are required to protect the genital organs from various infectious diseases. The vaginal epithelium, due to its multi-layered nature, is constantly updated, the upper cells begin to die and slough off, taking pathogenic microorganisms and toxins with them, which are replaced by new cells.

In addition, the vaginal epithelium maintains a constant pH level of the environment. Normally, in women of reproductive age, the environment in the vagina is always acidic (pH 3.8-4.5), while the microflora is 98% composed of lactic acid bacteria. Lactobacilli prevent the attachment of pathogenic pathogens and the activation of opportunistic microorganisms by maintaining a constant acidic environment in the vagina. Such lactic acid bacteria feed on glycogen present in large quantities in the desquamated epithelium.

With the onset of menopause, the cyclic renewal of the vaginal epithelium begins to stop, which is associated with a decrease in the amount of synthesized estrogen and the completion of menstrual activity. Epithelial cells are able to exfoliate only in small quantities, which leads to the development of glycogen deficiency and, accordingly, causes a decrease in the number of lactobacilli. In connection with such processes, the pH of the vagina begins to shift towards alkalization, which ultimately leads to its seeding with opportunistic microflora and the penetration of pathogenic pathogens into the mucous membrane. All of these changes provoke the development of a local inflammatory reaction, namely colpitis.

Thinning of the epithelium and a decrease in secretion production by the glands of the vagina lead to slight vulnerability and fragility of the vaginal mucosa, which only contributes to the activation of opportunistic microorganisms and leads to a narrowing of the vaginal lumen.

Causes

The formation of this pathology is based on hypoestrogenism, which can be both physiological after the cessation of menstruation, and artificial (surgery and other manipulations on the ovaries). In girls of reproductive age, hypoestrogenism is possible under the following circumstances:

After childbirth, especially when breastfeeding

In the postpartum period, there is a gradual restoration of hormonal balance, especially in those women who breastfeed their babies (prolactin is synthesized), which ultimately leads to a long-term estrogen deficiency and often eventually causes the development of atrophic colpitis.

Hormonal ovarian dysfunction

A long-term hormonal imbalance provokes persistent hypoestrogenism and the formation of pathology.

Endocrine pathology.

Strong psycho-emotional experiences (hormonal imbalance occurs).

Women who suffer from thyroid diseases, adrenal pathologies, diabetes mellitus are prone to developing atrophic vaginitis.

Other reasons

Weakened immunity (negatively affects the hormone-forming function of the ovaries).

Carriers of HIV infection or patients with AIDS.

Radiation therapy of the pelvic organs. When the pelvic region is irradiated, the female gonads are also involved in the process, which provokes a violation of the secretion of hormones, including estrogens.

Removal of the ovaries (ovariectomy). The ovaries synthesize estrogens, while in their absence, the secretion of these sex hormones automatically stops.

Predisposing factors

Among the many predisposing factors, it is especially worth noting:

unprotected, frequent and indiscriminate sexual intercourse;

incorrect intimate hygiene;

the use of aromatic products for the hygiene of intimate places, lubricants, antibacterial soaps, fragrances;

wearing tight synthetic underwear (obstruction of oxygen access and promotes the development of anaerobic flora);

general chronic diseases;

chronic inflammatory diseases of the genital organs;

errors in the diet (lack of sour-milk products, drinking low-quality water, eating unwashed fruits and vegetables).

Clinical picture of the disease

The first signs of the development of atrophic colpitis appear approximately 5 years after the end of menstruation. Usually, the pathology is characterized by a sluggish course, the symptoms are mild. An increase in clinical signs is associated with the addition of a secondary infection to the focus and the activation of opportunistic microflora, which is only facilitated by microtrauma of the mucosa due to its mild vulnerability (for example, after douching, washing, coitus, gynecological examination). Among the main features are:

Vaginal discomfort

It occurs as a feeling of dryness and tightness in the vagina, sometimes painful sensations may be present. In the case of accession of pathogenic vaginal microflora, severe burning and itching occurs.

Dyspareunia

Pain during or immediately after intercourse is due to depletion of the stratified epithelium of the vagina, exposure of nerve endings, and decreased secretion of vaginal gland products commonly referred to as lubrication.

Vaginal discharge

With this pathology, vaginal leucorrhea is moderate in nature, are mucous and tend to be watery. In the case of infection, the discharge acquires qualities that are characteristic of a certain type of microorganisms (foamy, greenish, curdled) and are accompanied by an unpleasant odor. Also, for atrophic colpitis, the presence of bloody discharge is characteristic. Usually they are insignificant in the form of a few drops of blood and are caused by trauma to the mucous membrane (douching, medical examination, sexual contact). The occurrence of any spotting (both profuse and insignificant) in the postmenopausal period is a reason for an immediate visit to the doctor.

Frequent urination

Senile vaginitis is always characterized by thinning of the walls of the bladder with a weakening of the tone of the muscles of the pelvic floor. These processes are accompanied by frequent urination, in which the amount of urine separated remains unchanged. In addition, with the weakening of the muscles of the pelvic floor, urinary incontinence begins to appear (when sneezing, laughing, coughing).

Examination data in gynecological mirrors

The vagina, and specifically its mucous membrane, has a pale pink color with numerous petechial hemorrhages. Upon contact with medical instruments, bleeding of new areas appears. In the case of a secondary infection, there is hyperemia and swelling of the vagina, purulent or grayish discharge.

Diagnostics

Diagnosis of this disease should be complex and implies:

examination of the mucous membrane of the cervix and the walls of the vagina in the mirrors;

collection of smears for microbiological examination.

A large number of leukocytes is determined (in the case of a secondary infection), which indicates inflammation, lactic acid bacteria are almost completely absent, a high content of opportunistic microorganisms is observed, specific pathogens (gardnerella, fungi, Trichomonas) can be identified.

In the presence of an obvious inflammatory process in the vaginal mucosa and obtaining questionable results of microbiological examination of smears, the patient is sent for PCR (blood, urine, gynecological smears) to determine hidden sexual infectious diseases. It is possible to detect human papillomavirus and herpes, cytomegalovirus, myco- and uroplasmas, chlamydia, and other pathogens.

Determination of acidity of the vagina

It is performed using a special test strip. Normally, the pH should correspond to the readings of 3.5-5.5. In the presence of atrophic colpitis, the pH increases to 5.5-7 or even goes into alkali (more than 7).

Colposcopy

Examination of the vaginal walls and cervix with magnification using a colposcope. Pallor and atrophy of the mucous membranes of the cervix and vagina, small cracks, a mild vascular pattern are determined, foci of dysplasia on the cervix and vaginal walls may be present. When performing the Schiller test (staining with Lugol), uneven staining or a weakly positive test is observed (depletion of the epithelium layer is an indirect sign of the development of dysplasia).

Taking a smear from the posterior fornix of the vagina and cervix for cytology

The cervical mucosa is represented by several types of cells:

basal (mature and turn into parabasal, then into intermediate, and keratinizing);

parabasal;

intermediate (made in two layers and located under the keratinizing cells, as a result replacing them);

keratinizing (they are directly exfoliated and are the upper layer of the mucosa).

Thus, with this pathology, the epithelial layer is depleted (not only on the walls of the vagina, but also on the cervix itself), respectively, in the cytogram in the presence of atrophic vaginitis, parabasal and basal cells prevail.

Classification of cytology of smears:

the first type - atypical cells are absent, the cytological picture is normal;

the second type - the structure of epithelial cells is slightly changed as a result of the presence of an inflammatory process in the neck or vagina;

the third type - there are cells with a modified nucleus, but only in a single amount (repeated cytological examination is required) and colposcopy;

the fourth type - there are individual epithelial cells with obvious signs of malignancy - histology and colposcopy are necessary;

the fifth type is the multiple presence of atypical cells.

In the presence of atrophic vaginitis, a cytogram of the inflammatory process is usually diagnosed, which does not imply the appointment of anti-inflammatory therapy.

Treatment

What and how to treat in the presence of atrophic colpitis can only be determined by a gynecologist. The most effective and main method of treating atrophic colpitis in women both in the postmenopausal period and in childbearing age is the appointment of HRT (hormone replacement therapy). It is the intake of hormonal drugs that allows misleading the vaginal mucosa and forcing the epithelium to be renewed cyclically, which improves the trophism of the mucosa, reduces the severity of atrophy and prevents the formation of microtraumas.

Hormone replacement therapy can be carried out in two ways: systemic administration of hormones in the form of injections, tablets or hormonal patches, local creams, ointments, suppositories. Hormone therapy should continue for a long time, at least 1.5-3 years, although it is worth noting that a positive effect is observed already after 3-6 months from the start of therapy. However, if the course of hormonal therapy is stopped, the symptoms of atrophic vaginitis return and are quite often complicated by the addition of a secondary infection.

Local treatment

Estriol.

Suppositories contain the main active ingredient - estriol (directly the estrogenic component) and as an additional substance - dimethyl sulfoxide. Release this drug without a prescription. Scheme of therapy: the first month intravaginal administration once a day, then twice a week. The drug can reduce the severity of vaginal itching, eliminates dyspareunia, excessive dryness. Candles are also effective in case of urination disorders, as well as urinary incontinence, which are provoked by atrophic processes in the vaginal mucosa.

"Ovestin".

Produced in the form of suppositories, tablets and vaginal cream. The active ingredient is estriol, additionally: lactic acid, acetyl palmitate, potato starch. The drug has properties similar to estriol. The treatment regimen is also similar (first, intravaginal administration of suppositories daily for 4 weeks, after which, if the general condition improves, the dosage is reduced to 2 suppositories per week). It is released in a pharmacy without a prescription.

"Gynoflor E".

Produced in the form of tablets for insertion into the vagina. The drug contains a lyophilisate of acidophilic lactobacilli with a dosage of 50 mg, as well as estriol - 0.03 mg. Effectively restores the vaginal microflora (the action of acidophilic lactobacilli), and also improves the nutrition of the vaginal epithelium, stimulates its growth due to glycogen, which is present in the preparation, supports the growth and formation of its own lactic acid bacteria on the vaginal mucosa. Scheme of therapy: the introduction of intravaginally one tablet for 6-12 days daily, after which one tablet is administered twice a week. Available in pharmacies without a prescription.

"Elvagin".

Produced in the form of cream and suppositories. The main active ingredient is estriol. Enter into the vagina every day for 2-3 weeks, after which the dose is reduced to twice a week. Sold without a prescription.

"Ortho-gynest".

Available in the form of tablets, suppositories and vaginal cream. The composition of the drug contains estriol. The course of therapy: the introduction of the drug (regardless of the form) at a dosage of 0.5-1 mg daily for 20 days, after which a week-long break is taken, with the weakening of symptoms, treatment is continued for 7 days a month. The course of treatment should be at least six months.

"Ovipol Clio" (suppositories).

"Estrovagin" (vaginal suppositories, cream).

"Estrocard" (suppositories and cream).

Systemic treatment

"Climodien".

Produced in the form of tablets for oral administration. One package contains 28 tablets. The drug contains dienogest and estradiol. The drug is taken on a tablet every day, it is advisable to take the drug at the same time. After the end of the package, start taking a new one. Klimodien is prescribed to women who have pronounced menopausal symptoms (increased sweating, disturbed sleep, hot flashes) and signs of atrophic vaginitis, but not earlier than a year after the onset of menopause. In the pharmacy, the drug is dispensed without a prescription.

"Cliogest".

One blister contains 28 tablets. Reception can be started on any day, but not earlier than one year after the last menstruation. The composition of the drug includes norethisterone acetate and estradiol propionate. A remedy is prescribed as hormone replacement therapy after 55 years for the prevention of the development of osteoporosis and for the treatment of atrophic colpitis. The drug is dispensed in a pharmacy without a prescription.

"Davina".

Produced in the form of tablets of blue (10 pieces each) or white (11 pieces each) color. The package contains 21 tablets. The white tablets contain estradiol, while the blue tablets contain methoxyprogesterone and estradiol. They are taken every day for 3 weeks at the same time, after this period a week break is made, which is accompanied by the development of menstrual bleeding. The drug is prescribed in the presence of estrogen deficiency, for the prevention of postmenopausal osteoporosis and in menopausal syndrome. The pharmacy is released without a prescription.

"Pausegest".

The composition of the drug includes norethisterone and estradiol. The package contains 28 tablets. The drug is taken daily, one tablet for four weeks. Upon completion of the packaging, they immediately begin taking a new one. "Pauzogest" is appointed no earlier than one year after the cessation of menstruation. In the pharmacy, the drug is dispensed without a prescription.

Eviana.

"Revmelid".

"Active".

Herbal preparations (application of phytohormone therapy)

"Kliofit".

Released in the form of an elixir or syrup. The composition of the product includes: chamomile, chaga, coriander seeds, hawthorn, cedar seeds, wild rose and other components of plant origin. Scheme of therapy: 10-15 ml of the product is diluted with 100 ml of water and taken three times a day 15 minutes before meals for 2-3 weeks. If necessary, the course of therapy is repeated after 1-2 weeks. The tool is released without a prescription.

"Klimadinon".

The composition of the drug includes rhizomes of cimicifuga - a plant that has anti-menopausal and estrogen-like effects. The blister contains 15 tablets, the usual package contains 4 or 6 of these blisters. The drug is taken twice a day, one tablet at a time, the duration of therapy is determined by the doctor. The drug is dispensed in a pharmacy without a prescription.

Qi-clim.

The basis of the drug contains an extract of cimicifuga roots, produced in the form of tablets, cream for the body and face. Reception is performed daily, 1-2 tablets for a month. The duration of the course is adjusted by the attending physician.

"Inoklim".

"Estrovel".

Tribestan.

"Bonisan".

Menopace Plus (vegetable component).

Menopace (minerals and multivitamins).

"Remens" (in the form of drops).

"Feminal".

"Climaxan".

Klimadinon Uno.

Frequently asked Questions

Can alternative treatment be used in the presence of atrophic vaginitis?

Yes, the use of folk remedies is allowed, but only in the form of an addition to the main therapy with hormonal drugs. Folk remedies are usually used in the presence of a pronounced inflammatory reaction of the vaginal mucosa to eliminate itching and redness, relieve swelling, and better heal microcracks in the mucosa. They use warm baths with decoctions of Rhodiola rosea, juniper fruits, sage, calendula, chamomile and other medicinal preparations. You can also intravaginally introduce tampons moistened with aloe juice, take an infusion from a mixture of rose hips, sweet clover, nettle, sage, mint or celandine herb. It is also allowed to drink tea from raspberry leaf, chamomile and willow leaves.

I am 35 years old, and about a year ago I had an ovaries removed for endometriosis, and hormonal contraceptives were prescribed. Approximately 2 weeks ago, itching and burning in the vagina appeared, while there are yellowish discharges that have an unpleasant odor. Are such symptoms a manifestation of atrophic colpitis?

In this case, it is necessary to visit a gynecologist as soon as possible and perform smears on the vaginal microflora. In all likelihood, not atrophic, but nonspecific vaginitis is present, and the development of candidiasis is also possible. This disease requires at least a year since the operation, while it was said that the patient is taking hormonal drugs. The doctor will evaluate the results of smears and, when determining the pathogen, will prescribe an anti-inflammatory treatment appropriate to the situation. With regard to hormone replacement therapy, it is worth a little time.

Is it possible to prevent the development of atrophic vaginitis, and how to do it?

Yes, as a preventive measure, you need to regularly visit a gynecologist, give up addictions, wear synthetic and tight underwear, adhere to proper nutrition, take multivitamin complexes (only if there is a doctor's recommendation). It is also worth excluding the use of flavored products as intimate hygiene, abandoning unprotected sexual intercourse and engaging in physical general strengthening exercises and Kegel exercises (for local strengthening of the muscles of the pelvic floor), it is better to replace the bath with a shower.

How is the effectiveness of therapy for atrophic colpitis determined?

To determine the negative or positive dynamics of the pathology, regular colposcopy (once every 3-6 months), cytological examination of smears of the vaginal microflora, and measurement of the pH of the vagina are required.

doctoroff.ru

Senile (atrophic) colpitis is a disease associated with an inflammatory process in the vaginal mucosa. Other names: atrophic postmenopausal vaginitis, senile vaginitis.

Pathology is associated primarily with a decrease in the level of estrogens in the body, leading to a significant thinning of the squamous stratified epithelium lining the inner walls of the vagina.

The main symptoms of the disease are vaginal dryness, itching, dyspareunia. Often there is an inflammatory reaction of a recurrent nature. Atrophic colpitis affects approximately 40% of women entering the menopause.

What is it in simple words?

Atrophic colpitis is a process of thinning of the wall of the vaginal epithelium as a result of a decrease in estrogen levels. Such atrophy occurs most often in women during menopause, however, the disease can also affect young mothers during breastfeeding, when the production of female hormones in the body decreases.

For many patients, the symptoms of atrophic colpitis are the reason for the rejection of intimate life. Sexual intercourse becomes painful, as a result of which interest in sex decreases. Appears dryness of the vagina and itching of the pubis. Moreover, the proper functioning of the genital organs is very closely related to the health of the urinary tract.

Reasons for the development of the disease

The development of atrophic colpitis, as a rule, is preceded by the onset of natural menopause, oophorectomy, adnexectomy, ovarian irradiation. The leading cause of atrophic colpitis is hypoestrogenism - estrogen deficiency, accompanied by a cessation of the proliferation of the vaginal epithelium, a decrease in the secretion of the vaginal glands, thinning of the mucosa, its increased vulnerability and dryness.

Women at the age of menopause;
Women who have undergone surgery, the result of which was the amputation of the ovaries;
Patients who have undergone radiation therapy of the genital organs or small pelvis;
HIV-infected;
Women with disorders in the thyroid gland and with any disease of the endocrine system;
Women with weakened immune systems.

Changes in the vaginal biocenosis associated with the disappearance of glycogen, a decrease in lactobacilli and an increase in pH cause the activation of the local opportunistic flora and the penetration of bacteria from the outside. Microtrauma of the mucosa during gynecological manipulations or sexual intercourse are the entrance gates for infection.

Against the background of a weakening of general immunity and chronic extragenital diseases, a local non-specific inflammatory reaction of the vaginal mucosa develops; atrophic colpitis acquires a recurrent stubborn course.

First signs

As the pathological process develops, the following first signs of atrophic colpitis are observed:

dryness of the vagina;
itching in the vulva;
pain during intercourse;
redness of the mucous membrane of the vagina;
pain in the vulva, most often burning - its intensity increases during urination and during hygiene procedures;
frequent urination (appears due to trophic changes in the walls of the bladder and pelvic floor muscles);
vaginal discharge, most often whitish, with an admixture of blood and an unpleasant odor;
Urinary incontinence may also occur during exercise.

Symptoms

The main features include:

Vaginal discharge. With this disease, vaginal discharge is mild, mucous or closer to watery. In the case of infection, whites acquire qualities characteristic of a certain type of bacteria (curdled, greenish, foamy) and have an unpleasant odor. Also for atrophic vaginitis is characterized by spotting. As a rule, they are insignificant, in the form of a few drops of blood and are caused by traumatization of the mucous membrane (sexual contact, medical examination, douching). The appearance of any spotting (both minor and profuse) in postmenopause is a reason for immediate medical attention.
Vaginal discomfort. Manifested as a feeling of dryness, tightness of the vagina, in some cases, pain. When pathogenic microflora is attached, significant itching and burning appear.
Frequent urination. Senile vaginitis is always accompanied by thinning of the bladder wall and weakening of the tone of the pelvic floor muscles. These processes are accompanied by an increase in urination, although the amount of urine excreted per day does not change (does not increase). In addition, weakened pelvic floor muscles contribute to the development of urinary incontinence (when coughing, laughing, sneezing).
Dyspareunia. Pain during and after sexual intercourse is due to depletion of the stratified squamous vaginal epithelium, exposure of nerve endings and a decrease in secretion production by the vaginal glands, the so-called lubrication.

Also, examination data in gynecological mirrors will help to determine the disease. They show that the vaginal mucosa is pale pink, with numerous pinpoint hemorrhages. Upon contact with medical instruments, the mucous membrane bleeds easily. In the case of a secondary infection, swelling and redness of the vagina, grayish or purulent discharge are observed.

Diagnostics

When the first signs of a violation are detected, a woman is obliged to visit a gynecologist for a thorough examination and collection of the necessary tests.

What examinations will be required:

Visual examination of the vulva and cervix in the mirror - assessment of the condition of the mucous membrane, the presence of purulent deposits on its walls, microcracks and other types of damage.
The study of smears under a microscope, the presence of bacteria, leukocytes, dead epithelial cells. Using the polymerase chain reaction method, it is possible to determine the type of infection (pathogen) with great accuracy.
Colposcopy - an examination of the vagina with an optical preparation, in the presence of an inflammatory process, redness and vulnerability of the cervix are noted, the acidity of the vagina is determined.
Ultrasound of the pelvic organs - in order to identify an inflammatory focus of the uterine appendages.

Thanks to timely and effective treatment, it is possible to restore the nutrition of the vaginal epithelium, to avoid relapses in the future.

The danger of the disease lies in the fact that in more advanced stages, mucosal atrophy extends to the muscle tissues of the bladder, urinary incontinence occurs. In addition, there is a high risk of joining any infectious disease, sexually transmitted.

The disease with timely treatment to the doctor is favorable.

Type of cervix with colpitis

Complications

The negative consequences of colpitis include the following:

flow into a chronic or acute form;
ectopia of the cervix;
cystitis, urethritis, endocervicitis (inflammation of the cervical canal);
endometritis (inflammation of the uterus), salpingitis (inflammation of the fallopian tubes), oophoritis (inflammation of the ovaries);
infertility;
ectopic pregnancies.

How to treat?

The main objectives of therapeutic treatment are the elimination of unpleasant symptoms of atrophic colpitis, the restoration of the vaginal epithelium, and the prevention of vaginitis. Hormonal treatment is more often prescribed, especially if the patient is older than 60 years. You need to restore the level of estrogen, which will eliminate the inflammation of the mucous membrane and normalize the general condition of the body. Another option is treatment with folk remedies, but doctors do not advise abandoning traditional medicine.

Drugs that are prescribed for systemic therapy:

"Kliogest". One blister of the drug contains 28 tablets. Reception can be started on any day, but not earlier than one year after the last menstruation. The composition of the drug includes norethisterone acetate and estradiol propionate. A remedy is prescribed as hormone replacement therapy after 55 years for the prevention of the development of osteoporosis and for the treatment of atrophic colpitis. The drug is dispensed in a pharmacy without a prescription.
"Climodien". Produced in the form of tablets for oral administration. One package contains 28 tablets. The drug contains dienogest and estradiol. The drug is taken on a tablet every day, it is advisable to take the drug at the same time. After the end of the package, start taking a new one. Klimodien is prescribed to women who have pronounced menopausal symptoms (increased sweating, disturbed sleep, hot flashes) and signs of atrophic vaginitis, but not earlier than a year after the onset of menopause. In the pharmacy, the drug is dispensed without a prescription.
"Davina". Produced in the form of tablets of blue (10 pieces each) or white (11 pieces each) color. The package contains 21 tablets. The white tablets contain estradiol, while the blue tablets contain methoxyprogesterone and estradiol. They are taken every day for 3 weeks at the same time, after this period a week break is made, which is accompanied by the development of menstrual bleeding. The drug is prescribed in the presence of estrogen deficiency, for the prevention of postmenopausal osteoporosis and in menopausal syndrome. The pharmacy is released without a prescription.

Candles that are prescribed in the presence of atrophic colpitis:

"Ovestin". Produced in the form of suppositories, tablets and vaginal cream. The active ingredient is estriol, additionally: lactic acid, acetyl palmitate, potato starch. The drug has properties similar to estriol. The treatment regimen is also similar (first, intravaginal administration of suppositories daily for 4 weeks, after which, if the general condition improves, the dosage is reduced to 2 suppositories per week). It is released in a pharmacy without a prescription.
Estriol. Suppositories contain the main active ingredient - estriol (directly the estrogenic component) and as an additional substance - dimethyl sulfoxide. Release this drug without a prescription. Scheme of therapy: the first month intravaginal administration once a day, then twice a week. The drug can reduce the severity of vaginal itching, eliminates dyspareunia, excessive dryness. Candles are also effective in case of urination disorders, as well as urinary incontinence, which are provoked by atrophic processes in the vaginal mucosa.
"Gynoflor E". Produced in the form of tablets for insertion into the vagina. The drug contains a lyophilisate of acidophilic lactobacilli with a dosage of 50 mg, as well as estriol - 0.03 mg. Effectively restores the vaginal microflora (the action of acidophilic lactobacilli), and also improves the nutrition of the vaginal epithelium, stimulates its growth due to glycogen, which is present in the preparation, supports the growth and formation of its own lactic acid bacteria on the vaginal mucosa. Scheme of therapy: the introduction of intravaginally one tablet for 6-12 days daily, after which one tablet is administered twice a week. Available in pharmacies without a prescription.
Ortho-gynest". Available in the form of tablets, suppositories and vaginal cream. The composition of the drug contains estriol. The course of therapy: the introduction of the drug (regardless of the form) at a dosage of 0.5-1 mg daily for 20 days, after which a week-long break is taken, with the weakening of symptoms, treatment is continued for 7 days a month. The course of treatment should be at least six months.

As for alternative methods of treatment, their use is allowed, but only in the form of an addition to the main therapy with hormonal drugs. Folk remedies are usually used in the presence of a pronounced inflammatory reaction of the vaginal mucosa to eliminate itching and redness, relieve swelling, and better heal microcracks in the mucosa.

They use warm baths with decoctions of Rhodiola rosea, juniper fruits, sage, calendula, chamomile and other medicinal preparations. You can also intravaginally introduce tampons moistened with aloe juice, take an infusion from a mixture of rose hips, sweet clover, nettle, sage, mint or celandine herb. It is also allowed to drink tea from raspberry leaf, chamomile and willow leaves.

Prevention

Preventive measures are an integral part of the treatment of atrophic colpitis, and with the constant observance of certain measures, the risk of developing pathology is reduced to zero:

monitor overweight, try to prevent obesity;
it is preferable to replace taking a bath with a shower;
after using the toilet, it is advisable to wash from front to back, and not vice versa;
for the hygiene of intimate places, use specialized lotions, deodorants or foams;
in case of diabetes mellitus, it is necessary to strictly adhere to the course of treatment;
wear cotton underwear, tights with a cotton insert;
after bathing, it is recommended to immediately remove the swimsuit, to exclude being in it for a long time;
it is necessary to carefully observe the hygiene of the genital organs. When washing, it is advisable to use a simple unscented soap;
maintain hormonal balance (estrogen levels) with special (estrogen replacement) therapy.

simptomy-treatment.net

The main cause of the disease is hormonal dysfunction. Basically, atrophic colpitis develops in women during menopause, however, its symptoms can also be observed in young mothers during lactation, which should not exclude treatment.

In these cases, there is a decrease in estrogen levels, due to this, the vaginal mucosa becomes more vulnerable to external factors.

Pathology and the causes of its development

As a rule, the first symptomatology of colpitis is observed approximately 4-5 years after the onset of menopause, including artificially induced. Pathology develops against the background of a significant lack of estrogen and related changes. Atrophic colpitis has certain symptoms and their special treatment:

the formation of epithelial cells is reduced, and then the process stops completely;
there is a thinning of the mucosa;
the secretion of the vaginal glands is reduced;
the level of ph-balance is disturbed, which leads to pathological changes in the microflora, dysbacteriosis develops;
increased dryness of the vagina;
the risk of developing pathogenic microflora increases significantly.

You should also remember about the factors that aggravate the course of the disease and provoke its earlier development:

hygiene rules that are not followed;
neglect of means intended for the hygiene of the female genital organs;
constant wearing of synthetic underwear;
sexual intercourse without the use of contraception;
injury to the vaginal mucosa during gynecological procedures.

It should be noted that not all menopausal women develop atrophic colpitis and its symptoms. According to medical research, the disease occurs in 35-40% of women. The following categories of patients are most susceptible to colpitis:

who have undergone an oophorectomy (removal of the ovary);
earlier onset of menopause;
various stages of obesity;
after radiation therapy of the pelvic organs;
with impaired functioning of the immune system;
having HIV status;
in thyroid diseases.

Symptoms of the disease

In almost all cases, the disease does not have clear symptoms that can immediately diagnose colpitis. Occasionally, a woman may be disturbed by discharge of a mucous and transparent type. Sometimes there is a burning sensation or itching on the external genitalia, which can be aggravated by the use of soapy hygiene products or urination.

Since the mucosa becomes thinner, it is easy to damage it. Therefore, after sexual intercourse or a gynecological examination, bleeding may be observed.
Methods for diagnosing atrophic colpitis

Diagnostic measures for the detection of colpitis should include such manipulations:

general gynecological examination;

detailed examination of the vagina and uterus by colposcopy;

cytological examination;

diagnosis of acid-base balance.

During a gynecological examination, the doctor can visually observe the pallor of the vaginal mucosa, microcracks, the development of bleeding with little contact. If an infection joins the colpitis, then you can notice the discharge of a purulent nature.

Laboratory research in the presence of colpitis shows the following:

the level of leukocytes is significantly increased;

microorganisms of conditionally pathogenic species are observed;

bacteria useful for the vagina are practically absent.

After confirming the diagnosis of atrophic colpitis, the patient should additionally undergo a biopsy to exclude atypical (cancerous) cells and then begin treatment.

Atrophic colpitis: treatment methods

The first step in the treatment of atrophic colpitis will be to restore the nutrition of the epithelium, stop the process of thinning of the mucosa. For this purpose, a course of hormonal drugs is prescribed. Treatment will include the use of topical agents in the form of ointments or suppositories, as well as oral preparations: Estradiol, Angelik, Utrozhestan. It should be noted that therapy has a long period and can last several years.

legumes;

apples;

ginger;

nuts;

licorice;

boron mother.

In the case when hormone therapy cannot be used, for example, oncopathology, severe heart disease, bleeding, douching with a decoction of chamomile / calendula is prescribed. Herbs relieve inflammation, are natural antiseptics.

If colpitis is accompanied by an infectious disease, then antifungal and antibacterial drugs are prescribed.

Preventive measures of colpitis

Preventive measures for atrophic colpitis are quite simple. First of all, it is necessary to observe the rules of personal hygiene, use only special products containing lactic acid. Reconsider your diet, introduce healthy foods: fresh fruits, vegetables, dairy products. It is also necessary to refuse to wear uncomfortable and synthetic underwear, giving preference to cotton. With frequent change of sexual partners, it is necessary to use contraceptive methods. It is necessary to regularly visit a gynecologist and treat the diseases of the pelvic organs that have arisen.

Update: November 2018

Definition of the term and types of disease

The disease got its name "colpitis" or "vaginitis" from the Greek word colpos or from the Latin vagina, which translates as the vagina. The suffix "it" means inflammation.

Other synonyms of the disease are atrophic vaginitis, senile or senile colpitis.

An excursion into the physiology and pathogenesis of the disease

Causes

Postpartum, especially in lactating women

Hormonal ovarian dysfunction

A long-term hormonal imbalance causes persistent hypoestrogenism and the development of the disease.

Strong psycho-emotional experiences (violate the level of the ratio of hormones).
Endocrine pathology

Women suffering from thyroid diseases, diabetes mellitus, adrenal pathology are prone to the occurrence of atrophic colpitis.

Other reasons

Ovariectomy (removal of the ovaries). The ovaries synthesize estrogens, and in their absence, the production of female sex hormones stops automatically.
Radiation therapy of the pelvic organs. Irradiation of the pelvic region also affects the female gonads, which contributes to the disruption of the production of hormones, including estrogen.
HIV carriers or AIDS patients.
Weakened immunity (negatively affects the hormone-forming function of the ovaries).

Predisposing factors

Of the predisposing factors for the development of the disease, it should be noted:

incorrect intimate hygiene;
frequent, promiscuous and unprotected sexual intercourse;
the use of aromatic products for intimate hygiene, fragrances, antibacterial soaps, lubricants;
wearing tight synthetic underwear (prevents air access and promotes the development of anaerobic flora);
errors in the diet (lack of fermented milk products, eating unwashed vegetables and fruits, drinking low-quality water);
chronic inflammatory processes of the genitals;
common chronic diseases.

Clinical picture

Vaginal discomfort

Manifested as a feeling of dryness, tightness of the vagina, in some cases, pain. When pathogenic microflora is attached, significant itching and burning appear.

Dyspareunia

Vaginal discharge

Frequent urination

Examination data in gynecological mirrors

Diagnostics

Diagnosis of the disease should be comprehensive and include:

Inspection of the walls of the vagina and cervical mucosa in the mirrors;
Taking smears for microbiological examination

PCR

Determination of acidity of the vagina

Colposcopy

Taking a smear from the cervix and from the posterior fornix of the vagina for cytological examination

The cervical mucosa consists of several types of cells:

keratinizing (those that exfoliate - this is the topmost layer);
intermediate (represented by 2 layers, are under keratinizing and replace them subsequently);
parabasal;
basal (mature, become parabasal, then intermediate, and finally keratinizing).

Since in this disease the epithelial layer is depleted (not only on the vaginal walls, but also on the cervix), parabasal and basal cells will predominate in the cytogram with atrophic colpitis.

Classification of cytological smears:

type 1 - no atypical cells, the cytological picture is normal;
type 2 - the structure of epithelial cells is somewhat changed due to the inflammatory process in the vagina and / or in the neck;
type 3 - cells with altered nuclei are present, but in a single amount (repeated cytological examination is necessary) and colposcopy;
Type 4 - individual epithelial cells are detected with obvious signs of atypia (malignancy) - colposcopy and histology are necessary;
Type 5 - a lot of atypical (cancerous) cells.

In atrophic colpitis, as a rule, an inflammation cytogram is diagnosed, which requires the appointment of anti-inflammatory treatment.

Treatment

Local treatment

Candles that are prescribed for atrophic colpitis:

Estriol

Ovestin

Gynoflor E

Elvagin

Ortho-gynest

Estrocard (cream and suppositories)
Estrovagin (cream, vaginal suppositories)
Ovipol Clio (suppositories).

Systemic therapy

Prescribed drugs for systemic treatment:

climodien

Cliogest

Divina

pausegest

Activel
Revmelid
Evian.

Herbal preparations (phytohormonotherapy)

Kliofit

Available as a syrup or elixir. The composition of the drug includes: cedar seeds, coriander seeds, chaga, chamomile and other plant components. Treatment regimen: 10-15 ml of the drug is diluted in 100 ml of water and taken three times a day 15 minutes before meals for 2-3 weeks. If necessary, the course of treatment is repeated after 7 to 14 days. Released without a prescription.

Klimadinon

Qi-clim

Klimadinon Uno
Climaxan
Feminal
Remens (drops)
Menopace (multivitamins and minerals)
Menopace Plus (herbal ingredients)
Bonisan
Tribestan
Estrovel
Inoklim
Lephem.

Question answer

Is it possible to use folk remedies for senile colpitis?

I am 35 years old, six months ago, both ovaries were removed (ovarian endometriosis) and hormonal birth control pills were prescribed. About 2 weeks ago, I began to feel a burning sensation and itching in the vagina, yellowish discharge with an unpleasant odor appeared. Are these signs of atrophic colpitis?