Update: November 2018
Up to 40% of women after menopause experience symptoms
atrophic vaginitis (itching and burning, dryness in the vagina and pain
during intimacy). It is characteristic that the longer the period
menopause, the higher the risk of this disease. So,
the percentage of patients with this disease rises to about 75
10 years after the date of the last menstruation.
Since the atrophic changes of the vaginal epithelium, as
usually associated with physiological termination of hormone production
ovaries, then atrophic colpitis is considered as pathology only
in case of pronounced clinical signs (appearance
Definition of the term and types of disease
Atrophic colpitis is called a change in the vaginal epithelium,
associated with structural and functional restructuring, in
the result of which the vaginal epithelium becomes thinner, which is what holds
to the appearance of characteristic symptoms (dryness, dyspareunia, itching and
recurring inflammation). This condition is associated with significant
decreased estrogen levels, which may be due to both
physiological reasons (physiological menopause), and with
artificially stopping the production of female sex hormones
(artificial menopause or atrophic colpitis of the reproductive
The name “colpitis” or “vaginitis” is a disease received from
the Greek word kolpos or from the Latin vagina that translates
like a vagina. The suffix “it” refers to inflammation.
Other synonyms of the disease are atrophic vaginitis,
senile or senile colpit.
Excursion to the physiology and pathogenesis of the disease
ATлагалище выстилается многослойным плоским эпителием, который
performs a large number of functions necessary to protect
genital organs from infectious pathogens. ATлагалищный эпителий
due to the multi-layer is constantly updated, the upper cells
die and slough off, taking pathogens with them and
their toxins, and in their place “come” new.
In addition, the vaginal epithelium maintains consistency of the environment. AT норме
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). Lactobacillus warn
penetration of pathogens and activation
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
With the onset of menopause, the cyclical update stops.
vaginal epithelium, which is associated with a decrease in the synthesis of estrogen
and completion of menstrual function. Epithelial cells are exfoliated in
small amounts leading to glycogen deficiency, and,
accordingly, to reduce the number of lactobacilli. AT связи с данными
the processes of pH of the vagina is shifted to the alkaline side, which leads
to contamination by conditionally pathogenic microorganisms and
penetration of pathogenic pathogens. ATсе перечисленное вызывает
local inflammatory reaction of the mucous, that is, coleitis.
Thinning of the epithelium and reducing the secretion of vaginal secretions
glands lead to fragility and easy viscosity of the mucous
vagina, which further contributes to the revitalization
conditionally pathogenic flora, and also leads to a narrowing of the lumen
AT основе развития заболевания лежит гипоэстрогения, которая
can be both physiological (after the last menstruation) and
artificial (operations and other manipulations on the ovaries). Among women
age of childbearing hypoestrogenism may develop with the following
After childbirth, especially in lactating women
AT послеродовом периоде восстановление гормонального баланса
occurs gradually, especially in mothers who are breastfeeding
(produced by prolactin), which leads to a long-existing
hypoestrogenism and often to the development of atrophic colpitis.
Hormonal ovarian dysfunction
Long-existing hormonal imbalance causes persistent
hypoestrogenism and the development of the disease.
- Strong psycho-emotional experiences (violate the level
- Endocrine pathology
Women suffering from diseases of the thyroid, sugar
diabetes, adrenal pathologies are prone to
- Ovariectomy (removal of the ovaries). Ovaries synthesize
estrogens, and in their absence, the production of female sex hormones
- Radiotherapy of the pelvic organs. Pelvic irradiation
also affects the female gonad, which contributes to the violation of
hormones, including estrogen.
- Носительницы ATИЧ или больные СПИДОМ.
- Weakened immunity (adversely affects
hormonal ovarian function).
Of predisposing factors for the development of the disease should
- incorrect intimate hygiene;
- frequent, promiscuous and unprotected sex;
- use of aromatics for intimate hygiene,
fragrances, antibacterial soaps, lubricants;
- wearing tight synthetic underwear (impedes access
air and contributes to the development of anaerobic flora);
- errors in the diet (lack of fermented milk products,
the use of unwashed vegetables and fruits, drinking substandard
- chronic inflammation of the genitals;
- common chronic diseases.
The first signs of atrophic vaginitis occur approximately after
5 лет после наступления последних monthly Usually,
the disease is sluggish, symptoms mild. Gain
clinical manifestations associated with the accession of secondary infection
and the activation of opportunistic bacteria, aided by
mucosal microtraumas due to its mild vulnerability (for example, after
gynecological examination, coitus or leaching / douching). TO
The main features include:
Manifested as a feeling of dryness, tightness of the vagina,
some cases of pain. With присоединении
pathogenic microflora appear significant itching and burning.
Pain during and after sexual intercourse is due to exhaustion.
stratified squamous vaginal epithelium, exposing the nerve
endings and reduced secretion of the vaginal glands, so
With данном заболевании влагалищные выделения носят умеренный
temper, mucous or closer to watery. AT случае инфицирования
whites acquire qualities characteristic of a particular species.
bacteria (cheesy, greenish, frothy) and have an unpleasant
the smell. Also characteristic of atrophic vaginitis is bloody
highlight. Usually, они незначительные, в виде нескольких
drops of blood and are caused by mucosal trauma (sexual
contact, medical examination, douching). Appearance of any
bleeding (both minor and abundant) in
postmenopausal reason to immediately appeal to
to the doctor.
Senile vaginitis is always accompanied by thinning of the wall.
bladder and a weakening of the tone of the muscles of the pelvic floor. These
processes are accompanied by increased urination, although the number
urine output per day does not change (does not increase). Besides
In addition, weak pelvic muscles contribute to the development of
urinary incontinence (when coughing, laughing, sneezing).
Inspection data in gynecological mirrors
The vaginal mucosa is pale pink, with numerous punctate
hemorrhages. With контакте с медицинскими инструментами
mucous bleeds easily. AT случае присоединения вторичной
infections are observed swelling and redness of the vagina, grayish or
Diagnostics заболевания должна быть комплексной и включает:
- Inspection of the vaginal walls and cervical mucosa in
- ATзятие мазков на микробиологическое исследование
ATыявляется (при присоединении вторичной инфекции) большое
white blood cell count, which indicates inflammation,
almost complete absence of lactic acid bacteria, high
the content of conditionally pathogenic flora, possible determination
specific pathogens (Trichomonas, fungi, gardnerella,
�”Key cells”, etc.).
With явном воспалительном процессе во влагалище и сомнительных
microbiological results of smears the patient is sent to the surrender
анализов методом PCR� (гинекологические мазки, моча, кровь) для
identify hidden genital infections. ATозможно выявление хламидий,
uro – and mycoplasmas, cytomegalovirus, genital herpes virus and
human papillomas and other pathogens.
Determination of vaginal acidity
It is carried out by a special test strip. AT норме рН должна
correspond to the numbers of 3.5 – 5.5. AT случае атрофического вагинита
The pH rises to 5.5 – 7 or even becomes alkaline (more
Examination of the cervix and vaginal walls under magnification
(colposcope). ATыявляются бледность и атрофичность слизистых
vagina and neck, the smallest injuries (cracks), mild
vascular pattern, possibly foci of dysplasia on the vaginal walls and
cervix. Schiller’s sample (staining with lugol solution)
weak positive or uneven staining (exhaustion
epithelial layer, an indirect sign of dysplasia).
ATзятие мазка с шейки матки и из заднего свода влагалища на
The mucosa of the cervix consists of several types of cells:
- keratinizing (those who exfoliate – this is the top
- intermediate (represented by 2 layers, are under
keratinizing and replace them later);
- basal (mature, become parabasal, then
intermediate, and, finally, keratinizing).
Since in this disease the epithelial layer is exhausted (not
only on the vaginal walls, but also on the cervix), then
cytogram with atrophic colpitis will prevail
parabasal and basal cells.
TOлассификация цитологических мазков:
- 1 species – no atypical cells, cytological picture in
- 2 view – the structure of epithelial cells is somewhat changed due to
inflammatory process in the vagina and / or neck;
- 3 species – there are cells with altered nuclei, but in
single quantity (it is necessary repeated cytologic
research) and colposcopy;
- 4 type – separate epithelial cells with obvious
signs of atypia (malignancy) – colposcopy and histology
- 5 type – a set of atypical (cancer) cells.
When atrophic colpitis is usually diagnosed
cytogram of inflammation that requires the appointment
What and how to treat with atrophic colpitis will be able to determine
only gynecologist. The main and effective treatment
atrophic vaginitis in women, both postmenopausal and
reproductive age is the appointment of substitution
hormone therapy or HRT. It is hormone administration that helps to introduce
delusion of the vaginal mucosa, forcing the epithelium to cyclically
updated (the effect of estrogen), which improves the nutrition of the mucous membranes,
reduces the degree of atrophy and prevents the formation of
Conducting HRT is possible in two ways: the introduction of hormones
systemically, in the form of tablets, injections or hormonal patches or
topically (candles, ointments, creams). Hormone therapy should be carried out.
long, at least 1.5 – 3 years, although the positive effect
observed after 3 to 6 months from the start of treatment. But in the case of
discontinuation of HRT symptoms of senile vaginitis return
again, and often complicated by the accession of a secondary infection.
Candles, which are prescribed for atrophic colpitis:
Suppositories contain the main active ingredient – estriol.
(estrogen component) and additional – dimethyl sulfoxide.
The drug is released without a prescription. Treatment regimen: 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. Effectively with violations
urination and urinary incontinence caused by atrophic
processes of 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. Scheme
treatment is similar to estriol (first daily intravaginal
the introduction of suppositories for 4 weeks, then, provided
Improve the dosage reduced to 2 candles per week).
Holidays in pharmacies without a prescription.
- Gynoflor E
Available in tablet form for intravaginal administration.
The drug contains a lyophilisate of acidophilic lactobacilli in the dosage
50 mg and estriol in the amount of 0.03 mg. Effectively restore
normal vaginal microflora (the action of acidophilic
lactobacilli), improve trophism of the vaginal epithelium, stimulate
growth of the epithelium (the effect of estriol), due to glycogen, which is part of
the composition of the drug, support the growth and development of their own
lactic acid bacteria of the vagina. Scheme лечения: введение во
the vagina of one tablet daily for 6 to 12 days, then by
одной таблетке twice a week. It is released without a prescription.
Available in the form of vaginal suppositories and cream. The main
the active substance is estriol. Inserted into the vagina
daily once a day for 2 to 3 weeks, then a dose
reduced to twice a week. Dispensing from pharmacies without
Available in the form of vaginal cream, suppositories and tablets.
The drug includes estriol. Method of administration: introduction
cream (tablets or candles) at a dosage of 0.5-1 mg per day per
20 days, then a week off, in case of weakening
symptoms continue treatment for 7 days a month. Therapy should
last at least 6 months.
- Estrokard (cream and suppositories)
- Estrovagin (cream, vaginal suppositories)
- Ovipol Clio (suppositories).
Assigned drugs for systemic treatment:
Available in the form of tablets for oral administration. One
pack contains 28 tablets. The drug contains estradiol
and dienogest. Drug intake is carried out on one tablet.
daily, preferably at the same time. At the end of the packaging
Immediately begin to receive a new one. Klimodien назначается женщинам с
severe climacteric symptoms (hot flashes, disturbed
sleep, increased sweating) and signs of senile vaginitis, but
not earlier than one year after menopause. In pharmacies
One blister contains 28 tablets. Taking the drug can
start any day, but not earlier than one year after the last
monthly The drug contains estradiol propionate and
Norethisterone acetate. The drug is prescribed as HRT for women.
over 55 years old, for the prevention of osteoporosis and the treatment of senile
Available in the form of white tablets (11 pieces) and blue (10
pieces) color. The package contains 21 tablets. The composition of whites
pills includes estradiol, and blue pills consist of estradiol
and medroxyprogesterone. Accepted daily at the same time.
for 3 weeks, then you need a 7-day break, during
which will cause menstrual bleeding. Assigned
drug for estrogen deficiency (atrophic vaginitis),
menopausal syndrome and for the prevention of postmenopausal
The drug contains estradiol и норэтистерон (препарат
monophasic). The package contains 28 tablets. Accepted
pause a daily test, one tablet for 4 weeks.
После завершения упаковки Immediately begin to receive a new one. Pausogest
appoint not earlier than one year after the last menstruation.
Herbal preparations (phytohormonotherapy)
Available in syrup or elixir. The composition of the drug
includes: dog rose, cedar seeds, hawthorn, coriander seeds,
chaga, chamomile, and other vegetable components. Scheme
treatment: 10 – 15 ml of the drug diluted in 100 ml of water and take
three times a day 15 minutes before meals for 2 – 3 weeks. With
If necessary, repeat the treatment after 7-14 days. Released
The composition of the drug includes rhizomes of cimicifuga, which
has an estrogen-like and anti-menopausal effect. AT
one blister contains 15 tablets, in package 4 or 6
blisters. Withнимать препарат следует по 1 таблетке два раза в день
at the same time, the duration of treatment is determined by the doctor.
It is released without a prescription.
The preparation contains extract of cimicifoura root, is produced in
tablets, in the form of face and body creams. Withем осуществляют
daily, 1 to 2 tablets, at least a month. Course duration
prescribed by a doctor.
- Klimadinon Уно
- Remens (drops)
- Menopace (multivitamins and minerals)
- Menopace Plus (herbal ingredients)
ATопрос – ответ
Is it possible to apply the treatment of people with senile colpitis
by means of?
Yes, it is possible, but only as an addition to the main treatment.
(hormone therapy). Folk remedies are used when expressed
inflammatory reaction in the vagina, to relieve swelling, eliminate
redness and itching and healing of microtraumas of the vaginal mucosa.
Warm baths are used with chamomile decoction,
calendula, sage, juniper fruits, rhodiola rosea and others
medicinal plants. You can intravaginally enter tampons with
aloe juice (accelerates the regeneration of the mucous membrane), take an infusion of
herbs of celandine or a mixture of mint, sage, nettle, sweet clover, fruits
rose hips. Also allowed tea from raspberry leaf
willow and chamomile.
I am 35 years old, half a year ago both ovaries were removed (endometriosis
ovaries) and prescribed hormonal birth control pills.
About 2 weeks ago, I began to feel burning and itching in the vagina,
there was a yellowish discharge with an unpleasant odor. These are signs
ATам следует как можно скорее посетить гинеколога и сдать мазки
on the microflora of the vagina. Most likely you are not atrophic
vaginitis, and non-specific, possibly thrush. For development
This disease requires at least a year after surgery,
more you take a hormonal drug. ATрач после сдачи мазков
and identify the causative agent will assign you the appropriate
anti-inflammatory treatment. But HRT should continue.
Is it possible to prevent the development of hay fever and how?
Yes, as a disease prevention should be regularly
visit a gynecologist, give up bad habits and wearing
close synthetic underwear, adhere to proper nutrition,
take a multivitamin. You should also exclude the use of
flavored means for intimate hygiene, refuse
unprotected sexual intercourse, exercise and
Kegel exercises (for strengthening the muscles of the pelvic floor), bathing
replace the shower in the shower.
How to determine the effectiveness of treatment of senile vaginitis?
To identify positive or negative dynamics
diseases, regular colposcopy is carried out (1 time in 3 – 6
months), measuring the pH of the vaginal environment, cytological