Quality of life and vulvovaginal health in postmenopausal women of high risk group for thromboembolic disorders

Introduction. Postmenopausal vulvovaginal health has the significant impact on quality of life of women in this age cohort, including interpersonal relationships, sexual function and working capacity. The problem is that many women do not appeal for a consultation by a doctor for advice on this, but try to cope with pathological symptoms on their own [8,9,10]. So, in spite of approximately half of postmenopausal women experience dryness, irritation, itching, dysuria, and dyspareunia, they are uninformed about natural hypoestrogenic postmenopausal vulvovaginal changes and the necessity to obtain safe, effective, and well-tolerated treatments.

Regarding the choice of moisturizers  women should be advised to choose a product with balance   in both osmolality and pH, and naturally the most similar to  vaginal discharge [2,5,6,8].

There were 188 postmenopausal women (52-58 years of age) in the observation group, among them 38,3 % were diagnosed with mild arterial hypertension and 23,9%  – with diabetes type 2. The criteria for inclusion in the observation group are the presence of symptoms of atrophic vulvovaginitis, an increased risk of thromboembolic complications (heterozygous or homozygous carriage of congenital thrombophilia genes, the presence of previous history of VTE, the presence of first-line relatives who died from thromboembolic complications up to age 50). The understanding of personal high risk of thromboembolic disorders led to the refusal to use any form of estrogen containing  medicines (both  oral or transdermal).The degree of VVA was evaluated by vaginal health index (Table 1) [1]. We used the complex approach for treatment: consultation with a medical psychologist, consultation of obstetrician-gynecologist about the physiology of postmenopausal changes in sex hormones metabolism and  women with mild to moderate vaginal dryness were advised to use Gynorm  (based on hyaluronic acid) for 14 days, once a day.

The use of Gynorm as the medicine based on hyaluronic acid allows to obtain the significant improvement of quality of life due to influence on the possibility of vaginal epithelium to keep the liquid, counteract the development of infection, which, as a result, leads to a reduction in tissue trauma.

We strongly advice  to start the treatment as early as the first symptoms of VVA occur and to maintaine it  over time, due to the chronicity of the conditions. We do believe that gynecologists and psychologists in a team can do much to improve VVA by giving appropriate time and attention to this condition, thereby restoring sexual health and QoL of many menopausal women especially with high thromboembolic risks.

Symptom Before treatment, % After treatment, %
Vaginal dryness 82.90% 28.70%
Soreness 45.20% 7.90%
Itching 23.40% 11.70%
Burning 22.30% 4.70%
Pain during sexual contact 46.80% 9.50%
Parameter Before treatment, % After treatment, %
Withdrawal of intercourse 23.90% 1.10%
Reduction of working capacity 51.10% 7.40%
Mood disorders 89.40% 4.70%
Reduction of daily activities 83.50% 5.80%

More information:

  1. Efficacy of a medical device containing liposomal hyaluronic acid against vulvo-vaginal dryness.
  2. A comparison between vaginal estrogen and vaginal hyaluronic for the treatment of dyspareunia in women using hormonal contraceptive.
  3. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial.
  4. Role of high molecular weight hyaluronic acid in postmenopausal vaginal discomfort.
  5. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women.