16 apr. 2007 ATROFIA GENITOURINARA IN MENOPAUZA
Anca S. Dumitrache *, M. Moga**, Gh. Preda*
*Spitalul Clinic Obstetrica Ginecologie „ I. A. Sbârcea”, Brasov
**Facultatea de Medicina, Universitatea „Transilvania”, Brasov
Rezumat
Scaderea nivelurilor estrogenilor dupa menopauza are numeroase consecinse clinice. Modificarile genitourinare sunt comune femeilor postmenopauzice. O treime din femeile peste 50 ani prezinta probleme urogenitale, si pâna la 40% din ele au simptome determinate de vaginita atrofica.
Atrofia si subsierea epiteliului vaginal poate determina aparisia unor simptome variate: senzasia de uscaciune vaginala, dispareunie, prurit vaginal, disurie, nocturie, polakiurie. Netratata, atrofia genitourinara se agraveaza progresiv. Utilizarea terapiei hormonale estrogenice este indicata în tratamentul atrofiei vulvare si vaginale asociate cu instalarea menopauzei.
Terapia estrogenica determina o crestere si maturare a celulelor epiteliale vaginale, creste fuxul sanguin vaginal, reduce pH-ul si astfel reface epiteliul normal si scade aparisia infecsiilor urinare. Preparatele hormonale cu administrare locala (intravaginala), care s-a dovedit ca au un efect mai bun decât preparatele sistemice sau transdermice asupra simptomelor vaginale, trebuie sa fie primaopsiune atunci când tratamentul se adreseaza exclusiv simptomelor genitourinare.
Abstarct
Estrogen level decreases after the menopause, and this has several clinical consequences. Genitourinary changes associated with estrogen depletion are common in postmenopausal women. One third of postmenopausal women, 50 years age or older, complain from urogenital problems, and up to 40% have symptoms due to atrophic vaginitis.
Atrophy and thinning of the vaginal epithelium can lead to a variety of symptoms: vaginal dryness, dyspareunia, pruritus, dysuria, urinary frequency, nocturia. If untreated, vaginal atrophy progressively worsens over time. The use of estrogen hormone therapy is indicated for the treatment of vulvar and vaginal atrophy associated with menopause.
Estrogen therapy reverses vaginal atrophy, promotes cell growth and maturation in estrogen-sensitive cells, enhances blood flow in vaginal tissue and reduces pH, and reduces urinary tract infections. Topical vaginal formulations, which have been shown to achieve greater symptom relief than oral, transdermal, or parenteral routes of administration, should be considered when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy.