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Cucinella L, Tiranini L, Cassani C, Martini E, Cumetti A, Memoli S, Tedeschi S, Nappi RE. Insights into the vulvar component of the genitourinary syndrome of menopause (GSM). Maturitas 2024; 186:108006. [PMID: 38704313 DOI: 10.1016/j.maturitas.2024.108006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with a crucial impact on quality of life of midlife women. While this broad definition captures the common underlying physiopathology and the frequent overlap of symptomatology, improving knowledge about different components of genitourinary syndrome of menopause may be relevant for individualized treatment, with possible implications for efficacy, compliance and satisfaction. This narrative review focuses on the vulvar component of genitourinary syndrome of menopause, highlighting anatomical and functional peculiarities of the vulva that are responsible for some of the self-reported symptoms, as well as specific signs at physical examination. Increasing evidence points towards a pivotal role of vulvar vestibular health in the occurrence of sexual pain, one of the most common and distressing symptoms of genitourinary syndrome of menopause, which should be evaluated with validated scales taking a biopsychosocial perspective. This is an essential step in the recognition of different phenotypes of genitourinary syndrome of menopause and in the assessment of the most effective diagnostic and therapeutic algorithm. Menopausal vulvar health deserves more research into tailored non-hormonal and hormonal treatment options.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Cumetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy; Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Stefano Memoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy; Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Sara Tedeschi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy; Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy.
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Ghorbani Z, Mirghafourvand M, Farshbaf Khalili A, Javadzadeh Y, Shakouri SK, Dastranj Tabrizi A. The Effect of Panax ginseng on Genitourinary Syndrome in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Complement Med Res 2021; 28:419-426. [PMID: 33730722 DOI: 10.1159/000514944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Menopause and estrogen deprivation cause a rise in the number of urogenital tract complaints. OBJECTIVE This study was conducted to assess the effectiveness of ginseng on genitourinary syndrome. METHODS This randomized trial was conducted on 60 postmenopausal women with genitourinary syndrome. The participants were randomly allocated to ginseng and placebo groups twice daily for 4 weeks. Vaginal maturation index and vaginal pH were evaluated before and 4 weeks after intervention as the primary outcomes. Also, the atrophic vaginitis and incontinence questionnaires were completed before and after intervention as the secondary outcomes. The safety of intervention was assessed by the side effects checklist. RESULTS No significant differences were observed between the 2 groups in objective symptoms after the intervention, but the difference was statistically significant (p < 0.001) in terms of subjective symptoms of atrophic vaginitis. One case of insomnia and palpitation and 2 cases of hot flashes were reported in the intervention group, and 1 case of gastric discomfort and change in urine appearance was reported in the placebo group. CONCLUSION Ginseng only improved the patient-assessed symptoms and had no significant effect on the clinician-assessed outcomes. Further studies are required to determine the precise pharmacological mechanisms of ginseng on genitourinary syndrome.
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Affiliation(s)
- Zahra Ghorbani
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
| | - Azizeh Farshbaf Khalili
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Javadzadeh
- Pharmacy Department, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Kazem Shakouri
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
OBJECTIVE Receptors for estrogen and progesterone are present in the pelvic floor, and therefore, postmenopausal hormone therapy may affect its function. We compared the former use of estradiol-progestogen postmenopausal hormone therapy in nonhysterectomized women with a uterine prolapse surgery (N = 12,072) and control women (N = 33,704). METHODS The women with a history of uterine prolapse operation were identified from the Finnish National Hospital Discharge Register, and the control women from the Finnish Central Population Register. The use of hormone therapy was traced from the national drug reimbursement register, and the odd ratios with 95% CIs for prolapse were calculated by using the conditional logistic regression analysis. RESULTS The women with uterine prolapse had used hormone therapy more often than control women (N = 4,127; 34.2% vs N = 9,189; 27.3%; P < 0.005). The use of hormone therapy was accompanied by significant (23%-53%) elevations in the risk for prolapse, being higher with longer exposure. The risk elevations (33%-23%) were comparable between sole norethisteroneacetate-estradiol and sole medroxyprogesteroneacetate-estradiol therapy. The use of estradiol in combination with a levonorgestrel releasing intrauterine device was accompanied by a 52% elevation. CONCLUSIONS The postmenopausal use of estradiol in combination with various progestogen regimens may weaken the pelvic floor, resulting in uterine prolapse. This data should be incorporated into the information given to the users of estradiol-progestogen hormone therapy.
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Govender Y, Gabriel I, Minassian V, Fichorova R. The Current Evidence on the Association Between the Urinary Microbiome and Urinary Incontinence in Women. Front Cell Infect Microbiol 2019; 9:133. [PMID: 31119104 PMCID: PMC6504689 DOI: 10.3389/fcimb.2019.00133] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/12/2019] [Indexed: 01/26/2023] Open
Abstract
Urinary incontinence (UI) is a burdensome condition with high prevalence in middle-aged to older women and an unclear etiology. Advances in our understanding of host-microbe interactions in the urogenital tract have stimulated interest in the urinary microbiome. DNA sequencing and enhanced urine culture suggest that similarly to other mucosal sites, the urinary bladder of healthy individuals harbors resident microbial communities that may play distinct roles in bladder function. This review focused on the urobiome (expanded quantitative urine culture-based or genomic sequencing-based urinary microbiome) associated with different subtypes of UI, including stress, urgency and mixed urinary incontinence, and related syndromes, such as interstitial cystitis and overactive bladder in women, contrasted to urinary tract infections. Furthermore, we examined clinical evidence for the association of the urinary microbiome with responses to pharmacotherapy for amelioration of UI symptoms. Although published studies are still relatively limited in number, study design and sample size, cumulative evidence suggests that certain Lactobacillus species may play a role in maintaining a healthy bladder milieu. Higher bacterial diversity in the absence of Lactobacillus dominance was associated with urgency UI and resistance to anticholinergic treatment for this condition. UI may also facilitate the persistence of uropathogens following antibiotic treatment, which in turn can alter the commensal/potentially beneficial microbial communities. Risk factors of UI, including age, menopausal status, sex steroid hormones, and body mass index may also impact the urinary microbiome. However, it is yet unclear whether the effects of these risks factors on UI are mediated by urinary host-microbe interactions and a mechanistic link with the female urogenital microbiome is still to be established. Strategies for future research are suggested.
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Affiliation(s)
- Yashini Govender
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Iwona Gabriel
- Division of Urogynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Vatche Minassian
- Division of Urogynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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New insight into glycation levels and pelvic organ prolapse - A combination of clinical and biochemical studies. Eur J Obstet Gynecol Reprod Biol 2018; 231:129-135. [PMID: 30368090 DOI: 10.1016/j.ejogrb.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/02/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Pelvic Organ Prolapse (POP) is a multifactorial disease with ageing as a most notable risk factor. Advanced Glycation End products (AGEs), biochemical markers of ageing are increased in prolapsed tissues. It is however unclear if AGEs are a cause or outcome of prolapse. By combining analysis of clinically relevant parameters in women with prolapse and POP tissues biochemically, this study aims to bridge the gap between existing clinical and biochemical research on the cause of POP. METHODS Following national and local ethical approval, a case study of 49 POP and 16 control tissues was carried out. The AGEs' marker, pentosidine, was quantified via High Performance Liquid Chromatography. Oestrogen (ER-α) and glyoxalase I (GLO-I) expression of the tissues were studied. Age, obstetric factors and co-morbidities (hypertension, smoking, diabetes mellitus) were recorded and compared with biochemical findings. RESULTS Lower expressions of ER-α and GLO-I were observed in POP tissues in the comparison to the control, which also had significantly higher pentosidine content. Prolapsed tissue population had more notable age-dependent increase in pentosidine with significant differences between the 6th and 7th decade. Hypertension and smoking, which were more prevalent amongst women with POP, were associated with higher amounts of pentosidine in the vaginal tissues. CONCLUSION In the light of recent research regarding the relationship between POP and glycation, the present study shows that age-related oestrogen decline is a key player in glycation accumulation in prolapsed vaginal tissues and that glycation is a cause rather than an effect of prolapse. Hypertension is a significant POP association which is linked to high glycation level.
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Rahkola-Soisalo P, Savolainen-Peltonen H, Gissler M, Hoti F, Vattulainen P, Ylikorkala O, Mikkola TS. Increased risk for stress urinary incontinence in women with postmenopausal hormone therapy. Int Urogynecol J 2018; 30:251-256. [PMID: 29946829 DOI: 10.1007/s00192-018-3682-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of estradiol-based hormone therapy (HT) on the incidence of stress urinary incontinence (SUI) is unknown. Therefore, we compared the use of such HT regimens and tibolone in women with and without SUI. METHODS The women with a history of SUI operation (N = 15,002) were identified from the Finnish National Hospital Discharge Register, and the control women without such an operation (N = 44,389) from the Finnish Central Population Register. The use of HT was traced from the National Drug Reimbursement Register, and the odd ratios (ORs) with 95% confidence intervals (95% CIs) for SUI were calculated by using the conditional logistic regression analysis. RESULTS The cases had used any HT more often than the controls. The use of systemic estradiol-only or estradiol-progestin therapy was accompanied by an increased SUI risk (OR 3.8, 95% CI: 3.6-4.0 and OR 2.7, 95% CI: 2.6-2.9 respectively). The use of estradiol with noretisterone acetate showed a higher risk of increase than that with medroxyprogesterone acetate. Age over 55 years at the initiation of systemic HT was accompanied by a higher SUI risk increase than that under 55 years of age. The use of tibolone, an estradiol + levonorgestrel-releasing intrauterine device, or vaginal estradiol also increased the risk. CONCLUSIONS The use of HT regimens may predispose to the de novo development or worsening of pre-existing SUI. Thus, caution is needed when these regimens are prescribed to women with mild stress-related urine leakage or with established SUI risk factors.
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Affiliation(s)
- Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Hanna Savolainen-Peltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00029, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fabian Hoti
- EPID Research Oy, Metsäneidonkuja 12, 02130, Espoo, Finland
| | | | - Olavi Ylikorkala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Tomi S Mikkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland. .,Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00029, Helsinki, Finland.
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Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018; 6:558-571. [PMID: 29631981 DOI: 10.1016/j.sxmr.2018.03.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Genitourinary conditions in women increase in prevalence with age. Androgens are prerequisite hormones of estrogen biosynthesis, are produced in larger amounts than estrogens in women, and decrease throughout adulthood. However, research and treatment for genitourinary complaints have traditionally focused on estrogens to the exclusion of other potential hormonal influences. AIM To summarize and evaluate the evidence that androgens are important for maintaining genitourinary health in women and that lack of androgenic activity can contribute to the development of symptoms of the genitourinary syndrome of menopause. METHODS The role of androgens in the pathophysiology, diagnosis, and treatment of genitourinary syndrome of menopause was discussed by an international and multidisciplinary panel during a consensus conference organized by the International Society for the Study of Women's Sexual Health. A subgroup further examined publications from the PubMed database, giving preference to clinical studies or to basic science studies in human tissues. MAIN OUTCOME MEASURES Expert opinion evaluating trophic and functional effects of androgens, their differences from estrogenic effects, and regulation of androgen and estrogen receptor expression in female genitourinary tissues. RESULTS Androgen receptors have been detected throughout the genitourinary system using immunohistochemical, western blot, ligand binding, and gene expression analyses. Lower circulating testosterone and estradiol concentrations and various genitourinary conditions have been associated with differential expression of androgen and estrogen receptors. Supplementation of androgen and/or estrogen in postmenopausal women (local administration) or in ovariectomized animals (systemic administration) induces tissue-specific responses that include changes in androgen and estrogen receptor expression, cell growth, mucin production, collagen turnover, increased perfusion, and neurotransmitter synthesis. CONCLUSION Androgens contribute to the maintenance of genitourinary tissue structure and function. The effects of androgens can be distinct from those of estrogens or can complement estrogenic action. Androgen-mediated processes might be involved in the full or partial resolution of genitourinary syndrome of menopause symptoms in women. Traish AM, Vignozzi L, Simon JA, et al. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018;6:558-571.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | - Linda Vignozzi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - James A Simon
- Women's Health & Research Consultants, Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA.
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Lo TS, Huang YH, Dass AK, Karim N, Uy-Patrimonio MC. Rectovaginal fistula: Twenty years of rectovaginal repair. J Obstet Gynaecol Res 2016; 42:1361-1368. [DOI: 10.1111/jog.13066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/03/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital, Keelung, Medical Center; Keelung Taiwan
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital, Taipei, Medical Center; Taipei Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Hsin Huang
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital, Taipei, Medical Center; Taipei Taiwan
| | - Anil Krishna Dass
- Division of Urogynecology, Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, Penang Hospital; Penang Malaysia
| | - Nazura Karim
- Division of Urogynecology, Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Obstetrics and Gynecology; Hospital Tuanku Jaafar; Negeri Sembilan Malaysia
| | - Ma. Clarissa Uy-Patrimonio
- Division of Urogynecology, Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Obstetrics and Gynecology; Dr Pablo O. Torre Memorial Hospital; Bacolod Philippines
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Tzur T, Yohai D, Weintraub AY. The role of local estrogen therapy in the management of pelvic floor disorders. Climacteric 2016; 19:162-71. [PMID: 26830033 DOI: 10.3109/13697137.2015.1132199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pelvic floor disorders are common and bothersome problems that include a variety of conditions. These conditions greatly affect the performance of daily activities and social function such as work, traveling, physical exercise, sleep and sexual function. Aging is a well-known factor affecting the pelvic floor and lower urinary tract anatomy and function. It is clear that the pelvic organs and their surrounding muscular and connective tissue support are estrogen-responsive. Treatment of pelvic floor disorders requires significant health-care resources and their impact is likely to increase in the near future. This literature review aims to provide an overview of both research and clinical aspects of the pathophysiology of urogenital estrogen deficiency and the role of local estrogen therapy as part of the management strategy of different pelvic floor disorders. The safety and risk concerns regarding the use of local estrogen therapy are addressed as well.
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Affiliation(s)
- T Tzur
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Israel
| | - D Yohai
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Israel
| | - A Y Weintraub
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Israel
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Lee HH, Kim TH, Park J, Lee A, Park Y, Byun DW, Kim MJ, Lim H. Expression of ezrin in vagina cells of postmenopausal rats after dietary administration of omega-3 Fatty Acid formula. J Menopausal Med 2015; 20:97-103. [PMID: 25580420 PMCID: PMC4286661 DOI: 10.6118/jmm.2014.20.3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/18/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
Objectives To see the effect of dietary administration of omega 3-fatty acid formula on the vaginal cells of postmenopausal rats. Methods Three-week-old female Wistar/ST rats were raised after one week of adjustment period. The rats were then divided into three groups, for three different kinds of diet; general diet, 1% omega-3 fatty acid diet, and 2% omega-3 fatty acid diet. After eight weeks of having assigned diet, after the oophorectomy, with the same diet previously they had Immunohistochemistry, Immunofluorescence, and Western Blot about ezrin, merlin were done. Results In immunohistochemistry, estrogen injection group revealed thicker and well differentiated features. In Immunofluorescence, Omega-3 fatty acid composition in diet did not effect expression of ezrin and merlin in rat vagina in estrogen injection group, their vaginal epithelium showed full layers (from basal to apical layer). In Western Blot analysis, Omega-3 fatty acid composition in diet did not affect expression of ezrin and merlin in rat vagina estrogen presented significant impact on expression of ezrin and merlin. Conclusion Although omega-3 fatty acid composition changed in diet, vaginal epithelial morphology unchanged. Estrogen did effect on vagina cell, but omega-3 fatty acid did not effect on ezrin and merlin in vagina.
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Affiliation(s)
- Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Junsik Park
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Arum Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea. ; Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University, Asan, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea. ; Department of Food and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Heesook Lim
- Department of Nutrition, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Goldstein I, Dicks B, Kim NN, Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med 2014; 1:44-53. [PMID: 25356287 PMCID: PMC4184497 DOI: 10.1002/sm2.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction Vaginal atrophy, which may affect up to 45% of postmenopausal women, is often associated with one or more urinary symptoms, including urgency, increased frequency, nocturia, dysuria, incontinence, and recurrent urinary tract infection. Aims To provide an overview of the current literature regarding cellular and clinical aspects of vaginal atrophy and response to treatment with local vaginal estrogen therapy. Methods PubMed searches through February 2012 were conducted using the terms “vaginal atrophy,” “atrophic vaginitis,” and “vulvovaginal atrophy.” Expert opinion was based on review of the relevant scientific and medical literature. Main Outcome Measure Genitourinary symptoms and treatment of vaginal atrophy from peer-reviewed published literature. Results Typically, a diagnosis of vaginal atrophy is made based on patient-reported symptoms, including genitourinary symptoms, and an examination that reveals signs of the disorder; however, many women are hesitant to report vaginal-related symptoms, primarily because of embarrassment. Conclusions Physicians in various disciplines are encouraged to initiate open discussions about vulvovaginal health with postmenopausal women, including recommended treatment options. Goldstein I, Dicks B, Kim NN, and Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med 2013;1:44–53.
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Affiliation(s)
| | - Brian Dicks
- San Diego Sexual Medicine San Diego, CA, USA
| | - Noel N Kim
- Institute for Sexual Medicine San Diego, CA, USA
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Jaroenporn S, Urasopon N, Watanabe G, Malaivijitnond S. Improvements of vaginal atrophy without systemic side effects after topical application of Pueraria mirifica, a phytoestrogen-rich herb, in postmenopausal cynomolgus macaques. J Reprod Dev 2014; 60:238-45. [PMID: 24748397 PMCID: PMC4085389 DOI: 10.1262/jrd.2013-144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The estrogenic efficacy of topical vaginal application of Pueraria mirifica extract (PM) on the restoration
of vaginal atrophy, and the presence of any systemic side effects, were investigated in postmenopausal cynomolgus macaques.
Twelve postmenopausal cynomolgus macaques, with complete cessation of menstruation for at least 5 years before start of this
experiment, were divided into three groups. They received a topical vaginal application daily of 0.1 or 1% (w/w) PM cream or
a conjugated equine estrogen (CEE) cream (a mixture of estrone, equilin, 17β-dihydroequilin, 17α-estradiol and
17α-dihydroequilin at 0.625 mg total estrogen/g cream) for 28 days. Estrogenic efficacy was assessed weekly by vaginal
cytology assay and vaginal pH measurement, whilst the plasma luteinizing hormone (LH) and sex skin coloration levels were
determined at the end of each treatment period to evaluate the systemic side effects. PM significantly increased the
proportion of superficial cells in a dose-dependent manner, with a similar efficacy between 1% (w/w) PM and CEE. Together
with increased vaginal maturation, PM decreased the vaginal pH to acidic levels, as observed in the CEE group. PM induced no
detected systemic side effects, whilst CEE decreased the plasma LH level and increased the reddish color of the sex skin
during the posttreatment period. Topical vaginal treatment with PM stimulated the maturation of the vaginal epithelium
without causing systemic side effects in postmenopausal monkeys. The implication is that PM could be a safer alternative to
treat vaginal atrophy in postmenopausal women.
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Affiliation(s)
- Sukanya Jaroenporn
- Primate Research Unit, Department of Biology, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
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Robinson D, Cardozo L, Milsom I, Pons ME, Kirby M, Koelbl H, Vierhout M. Oestrogens and overactive bladder. Neurourol Urodyn 2013; 33:1086-91. [DOI: 10.1002/nau.22464] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 06/13/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology; Kings College Hospital; London United Kingdom
| | - Linda Cardozo
- Department of Urogynaecology; Kings College Hospital; London United Kingdom
| | - Ian Milsom
- Department of Obstetrics and Gynaecology; Sahgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | | | | | - Heinz Koelbl
- Department of Obstetrics and Gynaecology; Medical University of Vienna; Vienna Austria
| | - Mark Vierhout
- Department of Obstetrics and Gynaecology; UMC St Radboud; Nijmegen The Netherlands
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Gamé X, Rischmann P, Arnal JF, Malavaud B. [Role of estrogens in lower urinary tract physiology and physiopathology]. Prog Urol 2013; 23:502-10. [PMID: 23725580 DOI: 10.1016/j.purol.2013.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
GOAL The aim was to review the literature on estrogens and lower urinary tract. MATERIAL A review of literature through the PubMed library until December 31, 2012 was carried out using the following keywords: lower urinary tract, bladder, urethra, nervous central system, innervation, female, women, estrogen, estradiol, urogenital atrophy, urinary incontinence, overactive bladder, urinary tract infection. RESULTS On the bladder, estrogens are involved in the trophicity, vascularisation, alpha-adrenergic, cholinergic and muscarinic receptor density, detrusor contractility and inflammation. On the urethra, they impact vascularisation, contractility, urethral pulse and tone, anatomical and functional length. On the neurological control, they act on capsaicin-sensitive afferent fibres, neurological regeneration, nerve growth factor expression and viscerovisceral sensitisation. CONCLUSION Estrogens play a major role on the lower urinary tract physiology and physiopathology both on the urethra and the bladder.
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Affiliation(s)
- X Gamé
- Département d'urologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
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15
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Shynlova O, Bortolini MAT, Alarab M. Genes responsible for vaginal extracellular matrix metabolism are modulated by women's reproductive cycle and menopause. Int Braz J Urol 2013; 39:257-67. [DOI: 10.1590/s1677-5538.ibju.2013.02.15] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 01/10/2013] [Indexed: 01/04/2023] Open
Affiliation(s)
| | | | - May Alarab
- University of Toronto (MATB, MA); University of Toronto, Canada
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Kumar R, Vicari M, Gori I, Achtari C, Fiche M, Surbeck I, Damnon F, Canny GO. Compartmentalized secretory leukocyte protease inhibitor expression and hormone responses along the reproductive tract of postmenopausal women. J Reprod Immunol 2011; 92:88-96. [PMID: 21940052 DOI: 10.1016/j.jri.2011.06.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/20/2011] [Accepted: 06/04/2011] [Indexed: 01/22/2023]
Abstract
Immunity and hormonal responses in the reproductive tissues of postmenopausal women are poorly understood. Secretory leukocyte protease inhibitor (SLPI), a multifunctional antimicrobial protein expressed at mucosal surfaces, is thought to play a key role in infectious and inflammatory contexts. The aim of this study was to measure SLPI production along the female reproductive tract in postmenopausal women with and without hormonal treatment. We additionally quantified estrogen receptor alpha (ERα) and progesterone receptor A (PRA) in these tissues. Expression of SLPI was decreased in the vagina and ectocervix of women under hormonal treatment. Endocervical ERα mRNA expression was increased while this did not reach significance at the protein level. SLPI expression in the endometrium was not influenced by hormonal treatment. We observed attenuated ERα expression in the cervix and endometrium of hormonally treated women, whereas vaginal expression was increased. PRA expression was augmented in the cervix and endometrium and unchanged in the vagina. Taken together, our results indicate that hormonal responses and receptor expression are differentially regulated in vaginal tissue compared with the cervix and endometrium.
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Affiliation(s)
- Rajesh Kumar
- Department of Gynecology, Obstetrics and Medical Genetics, University Hospital Center and University of Lausanne, 1011 Lausanne, Switzerland
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Skala CE, Petry IB, Albrich S, Puhl A, Naumann G, Koelbl H. The effect of genital and lower urinary tract symptoms on steroid receptor expression in women with genital prolapse. Int Urogynecol J 2010; 22:705-12. [DOI: 10.1007/s00192-010-1327-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 11/07/2010] [Indexed: 10/18/2022]
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