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Disruption of the structure and function of the vulvovaginal epithelium in women of reproductive age is accompanied by impaired sexual function and a decrease in the quality of life. This review analyses research on the use of hyaluronic acid (HA) for women of reproductive age with conditions and diseases manifesting as vulvovaginal atrophy. HA is involved in various physiological processes, including tissue regeneration, cell migration and proliferation during inflammation, and helps maintain water balance and tissue integrity. Local therapy with HA is effective in treating the symptoms of vulvovaginal atrophy in women of reproductive age associated with hypoestrogenism, both as a monotherapy and in combination with other treatments. It improves sexual function and quality of life, helping women to improve their sexual lives and living standards.

The data on managing patients with vulvovaginal atrophy and abnormal cytological results are provided for obstetrician-gynecologists.

Background. The study of the recovery and restoration of the mucous membranes of the genital tract with vaginal intimate gels is presented. Aim. To determine the clinical effectiveness of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal for restoration of the mucous membranes of the vulva and vagina. Materials and methods. Two groups of women were formed, Floragel and Vagizhenal, to analyze the clinical efficacy of cosmetic gels for intimate hygiene. Group 1 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes and the absence of normal vaginal microflora. For intimate hygiene, this group regularly used the gel for intimate hygiene Floragel for 1 month. Group 2 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes of various etiologies. For intimate hygiene, this group regularly used the gel for intimate hygiene Vagizhenal for 1 month. The gels were applied regularly, two times a day in the morning and evening, in a thin layer after hygienic procedures. Evaluation of the clinical effectiveness of special cosmetic gels for intimate hygiene Floragel and Vagizhenal included assessment of clinical efficacy, indicators of gynecological status, findings of microscopic and microbiological examination of vaginal discharge (Femoflor system), determination of the vaginal health index, and measurement of nonspecific immune protection of the vagina levels of interferon , interleukin (IL)-1, IL-6, IL-10 in the vaginal discharge using enzyme-linked immunosorbent assay. Results. As shown by the questionnaires and interviews with patients, the use of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal was associated with a significant improvement (p0.05) in clinical symptoms: an improvement of vaginal discharge, the disappearance of unpleasant odor and itching, and an improvement in the state of the vaginal mucous membranes and vulva. A special gynecological examination showed significant changes in the visual morphological and functional state characteristics of the vaginal mucosa and vulva. An improvement was reported in 90% (27) patients (p0.05) who used Floragel and in 80% (24) patients who used Vagizhenal. Conclusion. The results demonstrate Floragel and Vagizhenal gels' high efficiency in restoring normal microflora and moisturizing mucous membranes by optimizing microbiological indicators, improving the vaginal health index and local immunity factors, indicating that special gels for intimate hygiene Floragel and Vagizhenal have not only cosmetic but also therapeutic properties.

Hypoestrogenism associated with menopause has a strong negative effect on the condition of the vagina and urinary tract, and often leads to the development of genitourinary menopausal syndrome, significantly disrupting the quality of life of women. Menopausal vulvovaginal atrophy is diagnosed in 36 to 90% of peri- and postmenopausal women. In recent years, it has been revealed that this condition is also present in 19% of women aged 4045 years during premenopause. Aim. The aim of the study was to study the relationship between the dynamics of the severity of symptoms and their impact on the quality of life of women, and the clinical manifestations of postmenopausal atrophic vaginitis, depending on the stage of postmenopause. Results. Patients in the early postmenopausal period had a vaginal health index consistent with moderate atrophy. Throughout the postmenopausal period studied, clinical manifestations of vaginal atrophy progressed, and in the late menopausal period, the vaginal health index was consistent with severe atrophy. Conclusion. In our opinion the therapy of vulvovaginal atrophy should begin with the period of early menopause. At this time, women are most interested in treatment, as their quality of life suffers significantly due to the newly appeared extremely unpleasant sensations. At the same time, minor atrophic changes in the tissues of the vagina and vulva are easier to treat.

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice. Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.

Vulvovaginal atrophy (VVA) is detected in more than 50% of postmenopausal women, and at 4049 years of age, 15-19% of women have relevant signs. Atrophic changes in the female urogenital system are associated with hypoestrogenism, which results in the defective synthesis of collagen and elastin due to reduced functional activity of fibroblasts. Although the symptoms of genitourinary syndrome of menopause significantly impair the quality of life, women rarely seek medical help for urogenital symptoms, considering them a normal condition for the period of aging. We searched Cochrane Library, PubMed, Science Direct, and ELibrary databases for the keywords vulvovaginal atrophy, genitourinary syndrome of menopause, quality of life, epidemiology, and postmenopausal age for 20122022. The literature review suggests that the prevalence of VVA is extremely high but underestimated due to the infrequent seeking of medical care by female patients with relevant symptoms. The genitourinary syndrome of menopause dramatically impacts patients' quality of life, but not all women eligible for treatment receive it. One of the reasons for refusing hormonal treatment is patients' fear of the systemic effects of hormonal drugs. There is an unmet need for alternative non-hormonal therapies. The objective is to analyze and systematize the scientific data accumulated over the past ten years on the epidemiology of VVA, its impact on patients' quality of life, and the challenges in diagnosing and treating the disease.

The study and development of new therapies for genitourinary syndrome of menopause (GSM) remain an area of focus in modern gynecology. The relevance and need for scientific research in this area are undeniable due to the significant negative impact of GSM on patients' quality of life. At this point, however, a great deal of controversy is arising as the knowledge of the treatment of GSM-associated disorders deepens. Local hormonal therapy remains the "gold standard" for vulvovaginal atrophy treatment, but alternative therapies for GSM are launching in the pharmaceutical market. Have we got more answers? Yes. Have we got more questions? Sure. So why does the very fact of studying GMS require us to be so pedantic and focus the attention of the entire global medical community? Let's get to the bottom of this.

The review presents data on the management tactics of women with vulvovaginal atrophy in patients of reproductive age and menopause. The influence of vulvovaginal atrophy on the psycho-emotional and sexual spheres, modern methods of diagnosis and therapy of this pathology are considered. Special attention is paid to the role of rehabilitation and an integrated interdisciplinary approach to patients with symptoms of atrophic changes in the urogenital tract: the experience of rehabilitation measures is highlighted on the example of foreign and local studies, the effectiveness of "prerehabilitation" at the stage of the period from diagnosis to treatment is indicated. There is still a need for further studies of complex rehabilitation and its implementation in clinical recommendations.

Physiological loss of ovarian function during the menopausal transition often leads to the development of unfavorable symptoms associated with vulvovaginal atrophy, recurrent urinary tract infections and dyspareunia. Currently, the scientific community is actively discussing the risks and benefits of prescribing menopausal hormone therapy to relieve the consequences of estrogen deficiency. The study of vaginal microbiota in dynamics made it possible to take a deeper look at the development of genitourinary menopausal syndrome and associate several microorganisms with specific undesirable manifestations. The link between recurrent urinary tract infections during menopause and physiological replacement of microbiota by opportunistic flora with the development of unpleasant symptoms resolves doctors to resort to irrational courses of antibiotic therapy. The review is devoted to the generalization of information on microbiological changes in the vagina during perimenopause, the possibilities of choosing the optimal hormone therapy for the correction of symptoms, the use of new promising methods, including management by modulating the vaginal microbiota.

The aim of the study was to investigate the dynamics of atrophic changes оn the use of low-dose regimens of local therapy with a druge containing only estriol and a druge containing estriol, progesterone and a culture of lactobacilli in patients with postmenopausal vulvovaginal atrophy on the basis of subjective and objective criteria. Materials and methods. 44 patients with vulvovaginal atrophy were randomized into 2 groups of 22 people. In the first group, a drug containing estriol in a dose of 0.5 mg was used, in the second group, a preparation containing a lyophilized culture of lactobacilli, estriol - 0.2 mg; progesterone - 2.0 mg was used. Methods of the study included questioning of patients, cytological examination of the vaginal wall with evaluation of the epithelial maturation index, pH-metrics of the vaginal secretion, definition of the vaginal health index (IVS), PCR diagnostics of the vaginal biocenosis. Results. The use of a low-dose regimen of local therapy with estriol contributed to the restoration of the vaginal epithelium, which was confirmed by a statistically significant increase in ISEV and IVS, in the number of lactobacilli and a decrease in pH, However, the use of a combination drug led to a more effective recovery of lactoflora and normalization of the vaginal microflora.

In the manifestation and development of urogenital atrophic processes associated with the onset of menopause, the leading role is played by the growing deficiency of estrogens. An important circumstance is the fact that genitourinar menopausal disorders are often accompanied by other climacteric disorders. In this regard, a key place in the prevention and correction of hypoestrogenic conditions is systemic menopausal hormone therapy. Among the representatives of systemic menopausal hormone therapy, clinical efficacy and low risk of possible complications were demonstrated by preparations containing 17b-estradiol in combination with drospirenone. In the literature there is a significant number of publications reflecting the positive effect of these drugs on the condition of women with vasomotor, psychoemotional climacteric disorders, with a decrease in bone mass. Also, these drugs are used in the therapy and prevention of atrophic processes of the urogenital tract. This allows us to apply this combination of hormones in the complex correction of systemic and local genitourinary menopausal disorders.

Objective. Determination of effective application of vaginal complex estriol 0,2 mg/progesteron 2 mg/Lactobacillus casei rhamnosus 2¥109 at women with a vulvovaginal atrophy in peri-and postmenopausal women with a evaluation of cervical screening. Materials and methods. 109 patients with a vulvovaginal atrophy (VVA) were examined: the 1st group - 53 patients in a perimenopauza (middle age - 50.11±3.89 years), the 2nd group - 56 women in a postmenopause at the age of 65.8±4.13 years. The complex of researches included an assessment of complaints, the anamnestic and clinical data, bakterioskopic, cytologic and kolposkopic researches with interpretation of results according to the International standards and use of the modern equipment. The medical stage included vaginal application of a complex estriol, progesterone, L. casei rhamnosus on the 2nd capsules once a day during 14 (in the 1st group) and 21 day (in the 2nd group). Control of cervical cytologic inspection was carried out twice (in 4 and 6 weeks) after treatment. Conclusions. After the carried-out local therapy at patients of two groups clinical improvement of a current of VVA, normalization of a biocenosis of a vagina in comparison with basic data is established (p

The article presents current views on the multiple pathogenetic mechanisms of development of dyspareunia in women in pre - and postmenopausal women with positions of biopsychosocial approach. The importance of the study of mental and sexual status of patients. We discussed current approaches to the treatment of vulvovaginal atrophy underlying dyspareunia. The mixed forms of dyspareunia are represented by a multi-disciplinary, pathogenetic-oriented therapeutic approach, which combines flexibility medication, psychopharmacotherapy, sexological psychotherapy and counseling.