Changes in mucosal status, microcirculation parameters, and immunological parameters in response to combined non-hormonal therapy for vulvovaginal atrophy: A prospective study

Background. The relevance of age-related diseases stems from the ongoing aging of the population; in Russia, the share of women over 45 is 57.3%. The typical presentation of age-related changes includes vulvovaginal atrophy (VVA), which has extensive symptoms. The intimate nature of the problem often prevents women from discussing it openly. Hormone therapy is a traditional treatment option for VVA and its symptoms; however, it has some limitations.

Aim. To compare the clinical effect of a combination therapy with hyaluronic acid and a phytoestrogen complex, as well as antimicrobial peptides and cytokines, with traditional local hormonal therapy.

Materials and methods. The study included 68 female patients with VVA symptoms and 72 females without VVA manifestations. VVA patients were divided into two groups: in the test group, women received combined trophic therapy, and in the control group, subjects received traditional local hormone therapy. To assess the effectiveness of treatment at baseline and at 1 and 3 months after the end of therapy, analyses of cytological tests, ultrasound examinations, and enzyme immunoassays were performed, and a vaginal health index was calculated.

Results. The overall treatment effectiveness in the test group was not inferior to that of local hormone therapy, as indicated by laboratory and instrumental parameters. Two therapeutic approaches had different effects on immunological parameters: in the test group, the level of interleukin-6 in vaginal swabs of patients receiving a combination of a protein-peptide complex, cytokines, hyaluronic acid, and phytoestrogens significantly decreased and differed significantly from that in the comparison group.

Conclusion. The described non-hormonal approach to the treatment of VVA manifestations has significantly fewer limitations for use than hormonal agents, a pronounced positive effect on local immunity, and is well tolerated by patients. Therefore, the combination of hyaluronic acid and a phytoestrogen complex, as well as antimicrobial peptides and cytokines, is effective and safe and can become an alternative to traditional hormonal treatment.