Atrophy colpitis. Age-related colpitis (atrophic vaginitis): causes, symptoms, methods of diagnosis and treatment. How to restore the joy of intimacy: video

Translated from Latin, colpitis and vaginitis mean inflammation of the vagina. There are several types of vaginitis that occur against the background of inflammatory processes, when infection and pathogenic microorganisms penetrate the microflora of the woman’s genital organs. However, there is atrophic vaginitis, which in some way differs from all others, occurring with certain characteristics. This is senile colpitis.

The basis of the development of senile vaginitis

A disease such as senile vaginitis occurs only against the background of a decrease in the production of sex hormones: estrogens. As a rule, this occurs during the period of artificial or early menopause, then early aging of the female body begins. With the onset of menopause after 3–4 years, in 40% of cases women face this problem.

The etiology of the development of senile colpitis is based on physiological changes due to decreased estrogen production, leading to inflammatory reactions in the vaginal mucosa. In this case, healthy microflora is disrupted.

This vaginitis/colpitis/vaginosis is often called:

• senile or age-related due to the fact that it often manifests itself in old age;
• postmenopausal, since the disease begins to develop after the onset of menopause;
• senile, which is synonymous with decrepitude;
• atrophic, due to a decrease in the functional functioning of organs and tissues, as well as their deformation.

The cause of senile vaginitis may not only be old age. It happens that the disease occurs even during childbearing age; this phenomenon is associated with disturbances in the functioning of the body.

Atrophic vaginitis: comparison with healthy organs and mucous membrane. Photo gallery

Causes of the disease

The basis for the development of atrophic colpitis can be:

• chemotherapy and radiation;
• uterine prolapse;
• gynecological surgery;
• immunodeficiency;
• suppression of female hormones due to testosterone intake;
• venereal diseases;
• lack of personal hygiene or, conversely, too frequent washing with regular soap;
• endocrine pathologies:
  • obesity;
  • diabetes;
  • hypothyroidism
• ovariotomy (removal of the ovaries, regardless of the reason).

The acceleration of the development of senile vaginosis can be accompanied by wearing underwear made of low-quality synthetics.

A little about colpitis: a specialist’s opinion. Video material

Clinical picture of senile vaginosis

Initially, the disease in most cases is inactive, without obvious symptoms. The absence of a clinical picture often becomes the cause of the development of chronic colpitis.

Gradually, over time, scanty discharge appears in the form of leucorrhoea with an unpleasant odor. Occasionally, sharp pain and cramping in the lower abdomen is noted, intensifying after emptying the bladder or during water hygiene procedures.

The mucous membrane becomes fragile and thinned. Her vulnerability is immediately manifested by the release of ichor from the walls of the vagina. Bloody discharge and pain begin to torment constantly: during sex, during bowel movements and taking smears. Microcracks do not heal, and bleeding becomes a constant companion.

Due to atrophy of the pelvic muscles, the following occurs:

• prolapse of the uterus, bladder, kidneys;
• reduction in the secretion of the vaginal glands with a simultaneous slowdown in epithelial growth;
• increased pH levels, which causes pathogenic microflora to develop in the vagina;
• itching and burning in the vulva area;
• reducing the number of lactobacilli;
• redness and swelling of the vaginal mucosa;
• manifestation of petechial rashes, pigment formations, erosive areas;
• increased frequency of urination, which over time turns into urinary incontinence;
• the occurrence of vaginal dryness, which leads to discomfort and pain during sexual intercourse.

All these are the main symptoms of atrophic colpitis. As a result, against the background of dysfunction and atrophy of the organs of the genitourinary system, a secondary infection can join the disease, which in such a situation can easily penetrate from the outside or easily spread from other foci.

The pH of the vaginal mucosa in women of reproductive age ranges from 3.5 to 5.5. With senile vaginosis, this figure can reach up to 7.

Weakening of the body's defenses, as well as extragenital diseases with a chronic course, lead to the development of a nonspecific inflammatory reaction of the vaginal mucosa.

Diagnosis of the disease

Often women associate all these symptoms with other ailments, which ultimately leads to the development of pathologies. Timely diagnosis of this disease will help prevent the development of complications and irreversible processes.

Diagnosis is carried out using tests, examination and examination of the material taken.

1. Initially, the gynecologist interviews the patient, collecting anamnesis based on a description of symptoms and sensations.
2. Then a gynecological examination is performed using speculum. If the examination causes discomfort or pain, use a colposcope.
3. During a visual examination, a vaginal smear is taken for analysis to examine the microflora (cytogram).
4. During a gynecological examination, the doctor, at his discretion, may conduct an examination of the genital organs using palpation.
5. At the same time, the examination involves taking material for the purpose of cytological analysis.
6. At the same time, a smear is taken for bacteriological examination:
   1. for bacterioscopy;
   2. for cultural sowing;
   3. for leukocyte analysis.
7. A mandatory condition is a urine and blood test: general and biochemical.
8. If nonspecific vaginitis is suspected, a blood test for hormones is performed.
9. If there is a clear suspicion of atrophic vaginitis, an ultrasound of the pelvic organs is performed.
10. Examination of the rectum using sigmoidoscopy and colonoscopy is performed provided that seals are detected to exclude the presence of tumors and other diseases.
11. To exclude sexually transmitted diseases and other specific causes of vaginosis, the polymerase chain reaction (PCR) technique is used.

Based on a complete examination, a diagnosis is made.

Therapeutic effect

If senile colpitis is not burdened by a secondary infection, then treatment is carried out using hormone replacement therapy and agents that restore the microflora of the mucous membranes. It is possible to use immunomodulators.

Drug therapy

The basis of treatment of atrophic vaginitis:

1. Local medications in the form of suppositories, creams, ointments, vaginal tablets and suppositories. Typically used:
   1. Ovestin;
   2. Gistan;
   3. Estriol;
   4. Orniona;
   5. Estrocad;
   6. Gynodean Depot.
2. Systemic treatment is based on long-term use (sometimes up to 5 years) of hormonal drugs, such as:
   1. Estradiol;
   2. Angelique;
   3. Femoston;
   4. Climodien;
   5. Individual;
   6. Cliogest;
   7. Tibolone.
3. Additional therapy with phytoestrogens (herbal medicines);
4. For frequent urination, uroseptics are used:
   1. antibiotics:
      1. amoxicillin;
      2. ampicillin;
      3. azithromycin;
      4. ceftriaxone;
      5. ciprofloxacin;
      6. josamycin;
      7. tobramycin;
      8. ofloxacin and others.
   2. sulfonamides:
      1. co-trimoxazole;
      2. sulfametrol;
      3. sulfadimethoxine;
      4. sulfalene
   3. nutrofurans.
5. For disinfection, douching is used no more than twice a day based on:
   1. Miramistina;
   2. Chlorhexidine;
   3. Chlorophyllipta;
   4. Furacilina;
   5. Protargola;
   6. Rivanola.
6. At the same time, restorative therapy of the natural biocenosis of the vagina is carried out. To do this, use intravaginally:
   1. Bifidumbacterin;
   2. Bificol;
   3. Lactobacterin;
   4. Colibacterin;
   5. Acylact;
   6. Vagilak.
7. The following will help increase your immune defense:
   1. Cycloferon;
   2. Viferon;
   3. Immunal.
8. Allergic manifestations and mild inflammation will be relieved by ointments and gels:
   1. Solcoseryl;
   2. Fenistil;
   3. Actovegin;
   4. Bepanten.

If the presence of a secondary infection is detected, then, depending on the type of pathogenic microorganisms present, appropriate treatment is carried out. Often in such cases, Metronidazole, Terzhinan, Methyluracil or Fluomizin are used.

Vitamin therapy will also not hurt:

• Vitamin C in combination with vitamin A;
• Multivitamins:
  • Centrum;
  • Uni-cap;
  • Multitabs;
  • Vitrum.

How to treat age-related illness with folk remedies

Self-medication for senile vaginitis is strictly prohibited, including even folk methods. Before using products based on medicinal herbs and/or products of animal origin, you should consult with your gynecologist. Usually, doctors themselves advise using folk remedies, especially when the patient is prohibited from taking estrogen, since there are chronic diseases such as:

• liver and/or kidney failure;
• venous and/or arterial thromboembolism;
• oncology;
• myocardial infarction.

In such cases, traditional medicine comes to the rescue. Vaginal baths and douches based on decoctions and infusions of herbs have excellent disinfectant and anti-inflammatory properties.

Several recipes:

1. Decoction of plantain and chamomile. Plant raw materials in equal proportions are taken in the amount of two tablespoons and steamed with boiling water in a volume of 500 ml. Cool to room temperature and use after filtration for douching.
2. Product for tampons based on St. John's wort. Fresh flowers and leaves of St. John's wort in an amount of 500 grams are poured into 1 liter of vegetable oil. Insist for 20 days in a dark place. Strain. Soak cotton or gauze swabs in this oil solution.
3. Sea buckthorn oil. Prepared pharmaceutical sea buckthorn oil is soaked into tampons and inserted into the vagina overnight. The course of treatment is half a month.
4. Rhodiola rosea decoction. Prepare a saturated decoction from plant materials: 2 tbsp. spoons of the crushed root of this plant are poured into a liter of boiling water, simmered over low heat for 10 minutes, and then infused for 2–3 hours. Strain and use for vaginal baths.
5. Aloe for colpitis. A gauze swab is soaked in freshly squeezed aloe juice. Inserted into the vagina at night.

With your doctor's permission, you can use classic decoctions of sage, chamomile, and calendula for douching. Baths made from celandine, juniper, and oak bark will have a positive effect.

Medicinal plants and herbs used in the treatment of colpitis: photos

Sage kills pathogenic microflora, restores immunity Juniper has a positive effect on the skin Oak bark heals wounds, restores mucous membranes Chamomile has anti-inflammatory properties Calendula is known for its anti-inflammatory properties Aloe perfectly heals wounds Celandine is an excellent disinfectant St. John's wort - a herb for many ailments Rhodiola rosea stops bleeding, restores tissue structure Oil sea ​​buckthorn has many healing properties; plantain perfectly heals cracks and damage to the mucous membrane

Treatment prognosis and complications in the absence of timely therapeutic measures

If you consult a gynecologist in a timely manner about senile vaginitis, the prognosis for life is usually favorable. Especially if the disease is not burdened by chronic illnesses.

Uncontrolled self-medication often leads to irreparable consequences, due to which full recovery may become unrealistic. Advanced senile colpitis leads to complete atrophy of the genital organs and the inability to have sex due to pathological deformation of the vagina and inflammatory processes that cause pain and bleeding. The result of inaction can be fusion of the vaginal walls.

Timely treatment and prevention of the disease will help prolong the youth of the female body.

How to restore the joy of intimacy: video

Prevention of disease development

So that senile vaginitis is not taken by surprise, doctors recommend some preventive measures that can prevent its earlier development:

• carefully comply with all personal and intimate hygiene requirements;
• periodically, at least twice a year, undergo a routine gynecological examination;
• do not use regular soap for intimate hygiene that contains dyes and fragrances;
• wear underwear only made from natural fibers, and tights with a cotton insert;
• try to avoid sudden and large weight gain;
• give up bad habits and lead an active lifestyle;
• maintain a diet, giving preference to a high content of dairy products, fruits, and vegetables;
• strictly adhere to prescribed courses of treatment for chronic illnesses;
• constant care for the immune system;
• try to keep the level of estrogen in the body within normal limits.

Paying attention to yourself and your health will help prevent many diseases.

Atrophic/senile vaginitis is not a death sentence, since the disease is highly treatable. The main thing is to diagnose the disease in time, which will help to avoid complications, as well as follow all the recommendations of the attending gynecologist.

How to live and fight senile colpitis? This question worries many. Many people probably know some information about what senile colpitis is, its symptoms and treatment. The female body, especially the genitals, is susceptible to all kinds of diseases. These include inflammatory processes, allergic manifestations, and all kinds of fungal infections.

To prevent complications from gynecological diseases, you must regularly visit your doctor. Systematic examinations and observation by a gynecologist should occur twice a year.

Main signs of colpitis

Age-related colpitis is one of the gynecological diseases. This is an inflammatory process of the female genital organs. During menopause, a woman may experience some discomfort, itching and burning in the vagina. Colpitis in elderly women is caused by atrophic changes in the mucous membrane of the vagina and genital organs. The functionality of the ovaries decreases, the acidity of the vaginal microflora can drop to a catastrophic level. In especially severe cases, the secret fluid no longer contains an acidic, but an alkaline environment. Pathological flora begins to develop.

Colpitis can pass unnoticed, without causing concern and without revealing itself in any way. Sometimes mucous discharge appears, bloody, with obvious signs of pus. But a woman usually associates these symptoms with other diseases. More common signs include:

• burning;
• swelling of the labia;
• strong mucous discharge, which may have a milky or cheesy consistency, with obvious signs of blood or pus;
• disgusting smell;
• pain in the lower abdomen;
• frequent urine output;
• lethargy;
• fast fatiguability;
• in severe cases, fever.

With senile colpitis (colpitis during menopause), dryness in the genitals is most often observed. Sometimes the dryness is so progressive that itching occurs. If there is severe itching, purulent-bloody discharge and other symptoms, you should consult a doctor to check for the formation of malignant tumors.

Causes of the disease and diagnosis

A number of categories of elderly women are susceptible to colpitis:

• with untimely onset of menopause;
• with normal (age-related) menopause;
• those who have undergone chemical therapy for the pelvic organs;
• HIV-infected;
• patients with diabetes mellitus;
• with reduced immunity;
• having reduced thyroid function.

Disease-provoking actions can be added to these risk groups. During a medical examination, minor damage to the vaginal mucosa may occur. The infection can occur through sexual contact without using a contraceptive. These reasons can also provoke senile colpitis or aggravate its course. With additional factors that worsen the course of the disease, colpitis can develop into a form that will produce constant relapses (recurrences) after stages of remission (recovery).

Read also: Thrush in girls and women - causes and treatment

In order for the remission stage to last as long as possible, it is necessary to carry out treatment in a timely manner and maintain personal hygiene. Unprotected sexual intercourse should be avoided and chemical scented gels and bactericidal soaps should be avoided. These products contribute to an imbalance in the acid-base environment of the vagina. You should make a clear choice in favor of underwear made from natural materials. Synthetics do not allow air to circulate freely, thereby creating all the conditions for the viability of bad microbes.

To diagnose senile (senile) colpitis, the following manipulations are performed in the gynecological office: examination with a mirror, determination of the acidity level, and other tests. If necessary, cervical and vaginal secretions are diagnosed. This is done if there is a suspicion of specific factors in the occurrence and development of colpitis, for example, sexually transmitted diseases.

Treatment using folk remedies

Non-traditional methods of treating various female diseases are always offered and used as more gentle. Natural components do not harm other organs and systems of the human body.

For senile colpitis, the use of cauterizing liquids and ointments is prohibited, and the use of tampons is also prohibited. Douching with chamomile infusion or decoction is indicated. When suffering from senile colpitis, the vagina must be moisturized with vitamin ointments. These can be ointments containing aloe juice, rosehip oil, sea buckthorn extract. You can use baby cream.

Colpitis in old age can be successfully treated with herbs:

1. Mix 50 g of knotweed grass, 50 g of nettle (leaves), 10 g each of cinquefoil root, oak bark and 20 g of chamomile (inflorescence). Place the dry mixture in a hermetically sealed container to prevent moisture from entering. From this mixture you will need 2 tbsp. spoons, which need to be poured with a liter of water, boil and continue cooking for 10 minutes. To douche, you need to cool the resulting medicinal liquid, then strain. It is always best to do douching before going to bed.
2. Pour cut marigold flowers (medicinal calendula) into a glass of hot (100°C) water and leave for one hour. You need to take 2 tbsp. spoons of calendula. Cool and then strain. This calendula infusion is suitable for douching. It is also indicated for oral use (2 tablespoons or 5 teaspoons 2-3 times a day).
3. Place 20 g of immortelle (sandy) in boiling drinking water and leave for one hour. You need to take 0.5 liters of water. This medicinal infusion is used for douching.
4. You need to take 1 tablespoon or 3 teaspoons (without top) of oak bark, chop well, pour a glass of boiling (100 ° C) water, and keep in a water bath. Then leave the resulting liquid for 10-12 hours. Strain and douche. The duration of such procedures is 10 days.
5. A very good decoction is a mixture of the following herbs and plants: garden peony, creeping clover, white water lily, field cornflower, chamomile, willow (grass), cat's paws (flowers), garden rose petals, knotweed. Everything is taken little by little and in equal quantities. Take a tablespoon from this dry mass and add a liter of boiling water (100°C). It is boiled for 10 minutes, then allowed to brew and filtered. You should drink the resulting folk medicine before meals 3 times a day. Drink half a glass at the same time. You can also add honey or sugar. The course of treatment is 3 months, then a break is taken for 2 weeks. After this, treatment is repeated (3 months).

Colpitis is a common chronic disease that is diagnosed in every second elderly woman. This disease develops during menopause and is characterized by a combination of age-related degenerative changes and inflammatory phenomena in the vagina. Atrophic colpitis (vaginitis) reduces a woman’s quality of life, especially if it is not prevented in the initial stages. It is important to know the signs of the disease, diagnostic methods and treatment methods, so as not to start the process.

The essence of pathology

Atrophic colpitis (vaginitis) has many synonyms that reflect its essence. In the medical literature you can find such terms as age-related, postmenopausal, senile, senile colpitis (vaginitis). The basis of the disease is menopausal hormonal imbalance with a gradually increasing estrogen deficiency. This leads to atrophic changes in the tissues of the female genital organs and thinning of the vaginal epithelium. Degenerative changes are accompanied by inflammation and disturbances of the microflora of the vaginal environment. Women have a lot of complaints, the disease becomes chronic, gradually progresses, and threatens with serious complications.

Atrophic vaginitis. How to bring back the joy of intimacy - video

Etiology and stages of the disease

The main factor leading to the disease is a decrease in the level of estrogen in the blood. This may be due to the natural aging of a woman or caused by medical intervention (removal of the ovaries or their irradiation due to malignant degeneration).

The consequence of hormonal imbalance is not only menopause and the decline of reproductive function, but also other points:

1. Decreased ability of the vaginal epithelium to restore, renew and reduce the secretion of the vaginal glands. The mucous membranes of the genital organs become thin, dry, and easily damaged.
2. Deterioration of blood supply to vaginal tissues, due to which the cells of the mucous membranes and muscles suffer from a lack of nutrients and oxygen. This leads to compensatory growth of the capillary network. The newly formed small blood vessels have little functionality. They are located superficially, their walls are easily injured with the formation of petechial hemorrhages.
3. Changes in microflora: lactobacilli disappear, providing an acidic environment in the vaginal secretion, which plays a protective role, which promotes the proliferation of opportunistic microorganisms. Aseptic inflammation develops, erosions and small ulcers form.
4. As the body ages, the bleeding of the vaginal walls increases, their dryness and vulnerability, if there is no treatment. Local immunity drops sharply, so a secondary infection often occurs and bacterial vaginitis develops.

Predisposing factors include endocrine diseases (thyroid diseases, diabetes mellitus, pituitary adenoma), immunodeficiency conditions, vitamin deficiencies (mainly lack of vitamins A, E, group B). Unsanitary conditions play a role, especially in relation to sexual hygiene.

Symptoms of the disease

The pathology has a hormonal basis, develops slowly, and sometimes appears 3-5 years after the end of menstruation.

According to statistics, the first symptom that begins to bother a woman with atrophic colpitis is a feeling of dryness, pain, itching in the vagina and in the area of ​​the external genitalia. The phenomena intensify after urination and washing with antibacterial soap or gel with synthetic aromatic additives.

In addition, pain in the lower abdomen of an indeterminate, nagging nature is bothersome. They often radiate (give) to the lumbosacral region and lower extremities. They intensify after sex, defecation, with physical fatigue, stress, hypothermia or overheating.

Vaginal discharge at the beginning of the disease is not abundant, mucous in nature, often mixed with blood. They intensify after contact with the mucous membrane (sexual intercourse, examination by a gynecologist) and with exacerbations of concomitant diseases of the gynecological area or other organs.

Painful sexual intercourse (dyspareunia) is observed, after which bloody discharge from the vagina increases.

There is a urge to urinate frequently, which, as the process progresses, turns into urinary incontinence (especially against the background of hypothermia, physical overload, excitement and laughter).

Diagnosis of age-related colpitis

A gynecological examination allows you to visually assess degenerative and inflammatory changes in the vagina. The degree of their severity depends on the duration of menopause.

If less than five years have passed since menstruation, the gynecologist sees dryness, thinning of the vaginal walls, areas of inflammatory changes with redness and swelling of the mucous membranes.

With menopause over 5 years, atrophy and inflammation are more pronounced. Characterized by the presence of erosions and ulcers, often containing purulent plaque. The superficial newly formed capillary network with areas of petechial hemorrhages is clearly visible. Contact bleeding occurs easily, even from the cervix. A typical phenomenon is prolapse and fusion of the vaginal walls.

Other diagnostic methods:

1. Cytological examination. The smear reveals a large number of leukocytes, opportunistic bacteria, and dead epithelial cells of varying degrees of maturity. The main purpose of the examination is to exclude malignant degeneration.
2. Determination of pH of vaginal contents (pH-metry). Correlates (interconnects) with the degree of estrogen deficiency. The lower the hormone content in the blood, the more pronounced the pH shift towards the alkaline side.
3. Colposcopy (an extended version of the study is used). Reveals pallor of the vaginal mucous membranes, the presence of a superficial capillary mesh with foci of petechial hemorrhages. Erosion-ulcerative and atrophied areas are clearly visible.

It is mandatory to take a general and biochemical blood test, PCR of cervical secretions, and a general urine test. It is necessary to dynamically monitor the level of estrogen in the blood, especially when prescribing hormonal therapy.

Differential diagnosis

Age-related colpitis must be distinguished from the following diseases:

• sexually transmitted infections (trichomoniasis, chlamydia and others);
• oncology of the reproductive sphere.

To exclude sexually transmitted infections, microbiological analysis of vaginal discharge (bacterioscopy) is used. In addition, this method detects herpes simplex virus and human papillomavirus.

In order to visualize the uterus and exclude cancer, an ultrasound of the pelvic organs is performed through the abdominal wall and intravaginally.

Treatment methods

Therapy for age-related changes in the female genital organs involves the use of systemic and local medications. Folk remedies are also used.

Drug therapy

Treatment with medications has the following goals:

• optimization of hormonal levels (in the absence of contraindications);
• improvement of metabolism and microcirculation in vaginal tissues;
• destruction of pathogenic microflora;
• accelerating the restoration of vaginal and external genitalia cells;
• antiseptic effect;
• normalization of intravaginal microflora;
• reducing bleeding of the walls of the vagina and cervix by stopping the formation of new capillaries.

Hormone therapy

Since the cause of dystrophic changes in the mucous membranes of the genital organs during menopause is a sharp decrease in estrogen concentration, hormone replacement therapy is needed. Female hormones should be used for several years in injections, tablets or patches for optimal results. This has a systemic effect on the body.

But the use of synthetic estrogens and estrogen-like herbal preparations is allowed only after a thorough examination of the woman. The drugs have a number of serious limitations in use. They are strictly contraindicated in the following conditions:

• malignant tumors of the breast, uterus and appendages or suspicion of them;
• vaginal bleeding of unknown origin;
• history of thromboembolism (arterial, venous);
• exacerbation of chronic liver and kidney diseases;
• significant pathological abnormalities in the results of liver tests;
• severe arterial hypertension;
• acute and subacute stage of myocardial infarction and stroke.

With caution and under medical supervision, synthetic estrogens are prescribed for diabetes mellitus and systematic use of drugs based on St. John's wort. In addition, the prescription of such drugs is limited when using corticosteroid hormones and long-term use of Theophylline.

An overdose of synthetic estrogens, in addition to symptoms of general intoxication, is dangerous due to the development of bleeding from the vagina. Treatment is symptomatic only.

If there are contraindications for the prescription of estrogens in the treatment of degenerative tissue processes, the main role passes to non-hormonal agents for intravaginal use.

Local preparations

To combat dysbiosis, Acylact vaginal suppositories, which contain live acidophilic lactic acid bacteria, have proven themselves well. Their use helps to destroy pathogenic microflora and restore a normal environment. The clear advantage of the drug is only its local effect - it is practically not absorbed into the blood.

To relieve inflammatory manifestations, Fluomizin vaginal tablets are used. They have a wide spectrum of antimicrobial activity, but this antiseptic cannot be used in the presence of erosions and ulcers in the vagina.

In addition, Gistan cream is used; it is classified as a dietary supplement. Made on the basis of plant extracts with anti-inflammatory and wound-healing activity - lily of the valley, birch buds, string, lupine.

If you have increased frequency of urination, a tendency to urinary incontinence, or other kidney problems, you should consult a urologist or nephrologist. Specialists will prescribe a course of uroseptics, including herbal teas and physiotherapeutic procedures.

Phytoestrogens

These substances can enter a woman’s body through diet. Gynecologists recommend necessarily increasing the consumption of legumes and cereals, including rice and oats. It is very useful to add flax seeds, carrots, apples, and pomegranates to your diet.

Vaginal suppositories based on calendula, sea buckthorn, and string are widely used. They have an anti-inflammatory, healing effect, stimulate local immunity.

What to choose for treatment, how long to use this or that remedy, only the treating gynecologist will tell you. Self-medication is unacceptable, as it can lead to irreparable complications.

ethnoscience

The use of folk recipes is an important component in the treatment of postmenopausal dystrophic-inflammatory processes. But one cannot hope for positive changes in the clinical picture using only herbal infusions. By refusing medications and neglecting medical recommendations, a woman can miss valuable time and start the process.

Herbal infusions are used for douching. To do this, mix calendula, chamomile and St. John's wort in equal quantities (1 tablespoon each), pour 1 liter of boiling water and leave for 12 hours. Then the composition is filtered through a double layer of sterile gauze and used as directed in the morning or evening for 10 days. If necessary, the procedure is repeated after 3 months. Herbs have an anti-inflammatory, hemostatic and disinfectant effect.

Aloe juice and sea buckthorn oil have a good wound healing effect. Tampons soaked in these solutions are inserted into the vagina overnight.

Douching with a decoction of Rhodiola rosea has a positive effect. You need 1 tbsp. pour a spoonful of dry crushed root into 300 ml of hot water, bring to a boil and leave to simmer for 8–12 minutes. Then let the broth brew for 2 hours and strain. Before the procedure, a glass of the prepared solution is diluted in 0.5 liters of boiled (warm) water. You need to douche every day before bed for no more than two weeks.

A gynecologist will help you choose the right method of traditional treatment and determine its duration.

Positive effects of herbs

St. John's wort has a calming effect, reduces burning and itching in the vagina
Calendula stimulates nutrition of the vaginal mucosa, accelerates tissue regeneration and healing of ulcers
Chamomile promotes the production of female hormones and alleviates menopause

Treatment prognosis and possible complications

Age-related colpitis is dangerous not only due to a decrease in the quality of life, but also due to its complications:

• malignant degeneration of genital tissues;
• vaginitis against the background of a secondary infection with purulent discharge and a violation of the general condition;
• spread of inflammation to the uterus and ovaries;
• sepsis.

Most often, colpitis recurs with reduced immunity, the presence of extragenital diseases and lack of treatment.

With timely diagnosis and adequate drug therapy, the prognosis for the life and health of women of any age is favorable. In order to prevent the development of colpitis and its relapses, it is important to follow some rules of life.

Prevention of pathology

Specific prevention includes regular visits to the gynecologist and monitoring the level of estrogen in the blood. Due to menopause or other circumstances, hormonal levels decrease. In this case, the gynecologist prescribes adequate hormone replacement therapy.

Nonspecific prevention includes the following measures:

• healthy lifestyle;
• proper balanced nutrition;
• a full sex life with safe sex;
• use of underwear made from natural fabrics;
• compliance with the rules of intimate and general hygiene;
• taking hormonal medications only under medical supervision;
• exclusion of physical overload, stress, hypothermia.

All systems of the body are subject to age-related changes. In postmenopause, the gynecological area is very vulnerable. Almost every woman experiences many problems at this time. Atrophic colpitis is dangerous due to frequent relapses and malignant degeneration. Regular observation by a gynecologist, early detection of hormonal changes and the prescription of adequate therapy will help a woman survive this difficult period and restore the joy of a full life.

Menopause is a difficult, inevitable period in the life of every woman. Changes in hormonal levels affect almost all organs and systems, and immune defense weakens. In a woman’s body, the likelihood of the occurrence and development of inflammatory processes associated with menopausal age-related transformations increases.

Colpitis (vaginitis) is an inflammatory disease that is associated with a violation of the vaginal microflora, caused by the thinning of the stratified epithelium under the influence of a decrease in estrogen hormones. Colpitis during menopause is called atrophic, senile or senile. After 6-8 years of menopause, every second patient suffers from colpitis. Over the next 10 years, the chances of this disease occurring increase and amount to 70-80% among the female population during the menopausal period.

Senile colpitis is characterized by inflammatory reactions in the vaginal mucosa (tunica mucosa) and has a pronounced symptom complex caused by the introduction and development of secondary pathogenic flora. Vaginal discharge becomes more abundant, sometimes with ichor (due to the thinning and increased vulnerability of the vaginal mucosa), with a strong fetid odor, and during intimate relations painful discomfort occurs, as well as burning and itching sensations. The urge to urinate becomes more frequent. Conducting a microscopic analysis and cytological examination of the discharge from the genitourinary organ confirms changes in the flora of the vagina, the addition of secondary microflora and the presence of changes in the acidity of the vaginal environment. In very rare cases, senile colpitis is asymptomatic.

ICD-10 code

N95.1 Menopause and menopause in women

N95.2 Postmenopausal atrophic vaginitis

Epidemiology

The reason that provokes the appearance and progression of senile colpitis is that the walls of the vagina are formed by stratified squamous non-keratinizing epithelium and with a decrease in the amount of estrogens in the bloodstream, thinning of the epithelial layer may occur, leading to a decrease in cells producing glycogen, which is the source of nutrition for lactobacilli.

The main metabolite of lactobacilli is lactic acid, which maintains a certain internal acidity of the vaginal environment. A decrease in glycogen polysaccharide provokes a decrease or almost complete extinction of lactobacilli strains. As a result, the acidity of the vagina decreases, and favorable conditions arise for the attachment and development of pathogenic microbes, causing a local inflammatory reaction in the mucous membrane.

Pathogenic and conditionally pathogenic flora provokes the development of bacterial prussic colpitis (viruses, certain types of bacteria and mycotic cultures).

Pathogens - Escherichia coli, streptococci, gardnerella, give impetus to the appearance of atypical senile colpitis with mixed infection. The difficulty in diagnosing atypical colpitis lies in differentiating the type and type of pathogen.

Among mycotic microorganisms, in most cases, colpitis during menopause is caused by fungi of the Candida family, which provoke the development of candidomycosis (thrush).

Viruses cause colpitis with accompanying symptoms and characteristic changes that determine the type of pathogen. For example, gonorrhea, ureaplasmosis, trichomoniasis, mycoplasmosis, chlamydia. Most often in this situation, the causative agents of colpitis are Trichomonas and cytomegalovirus.

Causes of colpitis during menopause

Factors that precede and create suitable conditions for the appearance of senile colpitis are: natural menopause, ovarian ablation, partial or complete hysterectomy (surgical excision of the uterus).

The main reason for the appearance of colpitis during menopause is the appearance of estrogen deficiency, which is accompanied by a decrease in the growth of the vaginal epithelium, a decrease in the secretory function of the vaginal glands, a reduction in the thickness of the mucosa, its dryness and quite severe damage.

Changes in vaginal microflora occur due to a significant decrease in glycogen, leading to a decrease in the number of lactobacilli and changes in pH, which helps stimulate the growth of opportunistic microorganisms and the invasion of external bacterial flora. Provoking factors that contribute to the addition of a secondary infection are sexual intercourse, failure to comply with hygiene rules, or home gynecological procedures (douching). In the presence of weakened immunity and extragenital diseases that have a chronic course, senile colpitis during menopause becomes recurrent and persistent.

Patients who have experienced early menopause, have a history of endocrinological diseases (diabetes mellitus, thyroid disease) or who have undergone oophorectomy are most likely to develop senile colpitis.

The reasons that provoke senile colpitis are as follows:

• Weakening of the immune system, as a result of which the body becomes more vulnerable and does not provide adequate resistance to the invasion of pathogenic bacteria from the outside;
• Long-term use of synthetic underwear, leading to the greenhouse effect and rapid proliferation of pathological microorganisms that cause inflammatory processes;
• Radiation therapy, which causes almost complete suppression of the immune system;
• A decrease or cessation of ovarian hormone production occurring due to premenopause, menopause, postmenopause, or after oophorectomy.

The risk group for developing atrophic colpitis during menopause includes patients with excess body weight, diabetes mellitus, HIV, and a promiscuous sex life.

Symptoms of colpitis during menopause

In a large number of cases, patients do not complain when atrophic colpitis occurs and progresses. It may have a sluggish course and virtually no severe symptoms until a certain period. Symptom complexes of senile colpitis are classified into subjective and identified by a gynecologist during an examination of the patient.

Subjective ones include:

Scanty, periodic leucorrhoea, itching and burning sensations when urinating or using soap for hygienic purposes, vaginal dryness, painful sexual intercourse and the appearance of sanguineous discharge after it. The presence of blood in vaginal discharge is associated with microtraumas that occur during intimacy. A slight violation of the integrity of the mucous membrane of the vagina and vulva is dangerous due to the imposition of a secondary infection and the occurrence of a pronounced inflammatory process.

During a gynecological examination, the doctor may state:

• Pronounced age-related changes in the vulva, vagina and its mucous membrane. The mucous membrane is pale with focal or total hyperemia and bleeding areas. Areas without epithelial tissue and loose adhesions may be visualized.
• The vagina becomes narrow with undefined arches. Its walls are thin and smooth without folding.
• The cervix is ​​atrophic, the size of the uterine body is reduced, and age-related changes in the vulva are present.
• When a gynecologist takes a smear on the thinned and easily wounded vaginal mucosa, a bleeding area may appear.
• The diagnosis is made on the basis of gynecological examination and bacteriological analysis of vaginal discharge.

First signs

Atrophic colpitis during menopause develops 5-6 years after the natural cessation of the menstrual cycle. Initially, the pathology does not have clearly defined symptoms and can be practically asymptomatic. Patients report periodic vaginal discharge, burning, soreness, and irritation in the genital area, which intensifies during hygiene procedures using soap. Unpleasant sensations may become more intense after the act of emptying the bladder. Weakened tone of the Kegel muscles and bladder (vesica urinaria) cause frequent urge to urinate. Vaginal dryness leads to damage to the mucous membrane during sexual intercourse. Small bloody discharge appears. Microtraumas serve as “entry gates” for various types of infections that cause persistent inflammatory processes. Vaginal discharge with bloody spots is one of the initial manifestations of the disease. If the first manifestations or alarming symptoms of colpitis are detected during menopause, consultation with a specialist is necessary. You should not put off visiting a doctor for a long time due to the risk of developing a secondary infection, which will require long and complex treatment.

Complications and consequences

Failure to promptly seek medical help or prescribe adequate drug therapy for atrophic colpitis can lead to quite serious consequences for the female body and the development of aggressive infectious processes.

The following conditions are particularly dangerous and require long-term therapy:

• The transition from the acute stage of the disease to the chronic stage, which is difficult to treat, reduces a woman’s quality of life and periodically recurs.
• The ability of a pathogenic culture that has caused an inflammatory process to spread to parts of the urinary system and provoke the occurrence of ascending infectious processes (urethritis and cystitis).
• The risk of endometritis (inflammation of the uterine mucosa), parametritis (inflammation of the peri-uterine tissue), perisalpingitis (local inflammation of the peritoneum, blocking the fallopian tube), pyovar (inflammation of the ovary), general peritonitis.

It is possible that a woman with atrophic colpitis may become infected during menopause due to an incorrect invasive gynecological examination or minor surgical intervention with access through the vagina.

The sooner the problem is diagnosed and adequate treatment is prescribed, the less chance of life-threatening complications developing.

Diagnosis of colpitis during menopause

Methods that help diagnose colpitis during menopause include:

• Gynecological examination using speculum;
• Colposcopic method;
• Measurement of acid-base balance;
• Pap test and smear microscopy;
• Ultrasound diagnostics of the pelvic organs for the diagnosis of concomitant pathologies.

The doctor, conducting a visual examination using a special instrument (gynecological speculum), can state: thinning, surface smoothness and pallor of the vaginal mucosa, the presence of small eroded inflamed areas without epithelial cover that begin to bleed on contact, the presence of plaque (serous or serous-purulent), the presence of foci with pronounced inflammatory processes and swelling. If colpitis during menopause is chronic, recurrent or advanced, then the visual symptom complex of defects in the vaginal mucosa may not be clearly expressed, and the discharge is scanty and insignificant.

Colposcopy allows you to examine in more detail the affected areas of the vaginal mucosa, detect a shift in pH levels and determine, using the Schiller test, uneven or weakly colored areas of the mucosa without the presence of glycogen.

With a microscopic analysis of a smear, senile colpitis can be suspected if there is an increase in the level of leukocytes, a significant increase in epithelial cells, a sharp decrease in the content of vaginal lactobacilli and the possible presence of various opportunistic microorganisms.

Additionally, material is collected for cytological examination; a biopsy of questionable areas of the vaginal mucosa may be prescribed to exclude the development of malignant neoplasms, PCR and analysis of secretions to identify STDs and specific factors for the manifestation of colpitis.

Analyzes

To clarify and confirm diagnostic details, the following must be prescribed:

• Hormonal studies.
• Smears for microscopy and cytology.
• PCR (polymerase chain reaction) to detect STD pathogens (chlamydia, ureaplasma, gardnerella, trichomonas, herpes viruses and papillomas).
• Bacteriological study of vaginal microflora.
• Bacteriological analysis of vaginal flora to determine the type of pathogen present and its sensitivity to antibiotics.
• Cytological examination of a cervical smear.
• Bacteriological examination of urine.
• ELISA blood test (chlamydia, mycoplasma, herpes, cytomegalovirus, hepatitis, etc.).
• General blood and urine analysis.
• Blood test for HIV and Wasserman reaction.

Instrumental diagnostics

To confirm the diagnosis of colpitis during menopause, in addition to laboratory microscopic studies, various types of instrumental diagnostic procedures are widely used:

Ultrasound diagnostics pelvic organs (used to identify possible concomitant pathologies);

Colposcopy- this is an examination of the vulva, vaginal walls and cervix at significant magnification using the optical instrument of a colposcope. Carry out to detect mucosal defects and determine their nature.

Schiller test– method of colposcopic testing with chromodiagnostics. Areas of the vagina, with senile colpitis, with reduced glycogen production, will be weakly and unevenly colored.

Vaginal acidity analysis using test strips. If the disease is present, the index will fluctuate between values ​​of 5.5 - 7 conventional units.

Cytological analysis smear Colpitis during menopause is characterized by a significant increase in the number of cells in the prebasal and basal layers.

Microscopic and bacteriological examination vaginal smear. In the drug, the titer of vaginal bacilli drops sharply, an increased number of leukocytes is observed, and the addition of opportunistic flora is possible.

Cystoscopy– therapeutic and diagnostic manipulation of the bladder, performed using a cystoscope. Recommended for the diagnosis of colpitis with associated secondary infection; it is used to determine the possible consequences of the introduction of a pathogen into the bladder according to the ascending type of spread;

Vaginal scraping and diagnosis using PCR.

Differential diagnosis

It is necessary to differentiate atrophic colpitis from a large group of infections and candidomycosis that are sexually transmitted.

Based on the volume and nature of vaginal discharge, the causative agent of the inflammatory process can presumably be diagnosed. The doctor makes the final verdict after receiving the results of a microscopic examination of a smear or bacterial culture.

Antibiotic therapy

Antibacterial drugs are prescribed to a patient with atrophic colpitis in accordance with the results of bacterioscopy of a vaginal smear and bacteriological culture of discharge.

The cultural method (bacteria culture) is the most accurate in identifying the pathogen that caused inflammation in the vagina. During the period of growth of colonies of microorganisms, an analysis of their sensitivity to antibacterial drugs is necessary. Such a study makes it possible to effectively eliminate the pathogens that cause the inflammatory process. The use of broad-spectrum antibiotics is usually recommended.

If the inflammatory process is caused by yeast-like fungi, antimycotic (antifungal) agents are used: Pimafucin, Mycozoral, Irunin, Futsis, Diflazon, etc. In the fight against candidal colpitis (vaginal thrush), medications for internal use (tablet forms of the drug) or locally (ointments, vaginal suppositories, creams).

Local treatment

For local treatment, the use of anti-inflammatory emulsions, ointments, creams, vaginal suppositories, baths, and vaginal douching is recommended. A positive aspect of local use of drugs is the effect of the active substance of the drug on the causative agent of infection directly at the site of inflammation, bypassing the gastrointestinal tract and the barrier function of the liver. Local use of drugs gives a good result if it is combined with drug therapy that eliminates the cause of atrophic changes in the vaginal walls.

For senile vaginitis, the vagina is irrigated with lactic acid, and then tampons with syntomycin emulsion or with oil solutions of estrogen (the drug Sinestrol) are introduced.

To improve the trophism of the vaginal mucosa, suppositories or cream containing estriol, as well as Ovestin, are recommended. At the beginning of treatment, suppositories with antiseptics, such as iodoxide, betadine, hexicon or terzhinan, are used. This local therapy lasts for 7-10 days. It is advisable to carry out all procedures at night.

Acylact suppositories help restore healthy vaginal microflora (1 suppository is administered at night for 10 days).

Warm sitz baths and douching using herbs that have an antiphlogistic effect (sage, calendula, elecampane) bring good results if a secondary infection has not joined the process of inflammation of the atrophied vaginal walls and contacting a gynecologist was timely.

Physiotherapy

Physiotherapeutic methods of treatment are used to treat colpitis during menopause and their complications. The doctor may prescribe UHF therapy or UV irradiation, the use of a laser beam, magnetic therapy, and mud sitz baths. The effect of physiotherapeutic procedures on the body helps to activate the healing of the vaginal mucosa.

General strengthening agents.

To stabilize the body's defenses, various vitamins, vitamin-mineral complexes and drugs that stimulate the immune system (for example, Aflubin) are used.

Diet

During treatment, the diet must be enriched with plant foods and lactic acid products. Salty, fatty, spicy, smoked delicacies are completely excluded.

Traditional treatment

Traditional healers offer a large number of remedies and methods for treating colpitis. But these methods should only be an addition to the main drug therapy. A doctor may recommend the use of herbs if the disease is at an early stage and is not complicated by a secondary infection. Folk remedies are good for the prevention of inflammatory processes during recurrent colpitis. When drawing up a treatment regimen, experts most often recommend using a decoction of one plant or a collection of herbs. Use herbal decoctions for douching, irrigation, and instillation. It is possible to insert tampons soaked in a decoction of herbs into the vagina for the purpose of disinfection and relief of the inflammatory process. For the treatment of colpitis of various etiologies, herbal decoctions and infusions that relieve inflammation, irritation and have an antibacterial effect on the affected areas of the mucosa are ideal.

For senile colpitis, make a herbal mixture of oregano (oregano herb), quercus bark (common oak), dried mallow root (marshmallow). These components are taken in equal proportions. Pour the mixture into 1 liter of clean boiling water and leave for 2-3 minutes, then strain through cheesecloth or a sieve. Use warm for gynecological douching twice a day.

A decoction of coughlegon leaves (coltsfoot). Take 50 g of crushed dry plant, pour 1 liter of boiling water, leave for an hour and strain. It is recommended to use the prepared infusion twice a day.

For douching, anti-inflammatory tampons possible preparing a herbal decoction. Mix in a separate container 25 g of peeled chamomile flowers, 10 g of dried wild mallow flowers, 10 g of dried oak bark, 15 g of dried sage leaves. Pour 2 tbsp. lie mixture of 1 liter of boiling water, let it brew and cool slightly. Then the broth must be filtered and it is ready for use.

For pain accompanying colpitis, it is recommended to take chamomile flowers and plantain leaves in equal proportions. 1 tbsp. pour a spoonful of the mixture into ½ liter of boiling water, leave for 1 hour, strain. Use during douching for the treatment of atrophic colpitis twice a day.

Camomile tea. At 2 tbsp. spoons of plant flowers use 1l. clean water. Boil for a quarter of an hour. Leave to cool, strain (it is best to use several layers of gauze) and use as a solution for douching, which is carried out twice a day, without skipping procedures. The duration of treatment is 14 days.

Instead of chamomile, you can use calendula flowers. The preparation of the infusion and the scheme of use are identical to those described above.

Another method recommended by traditional medicine doctors to relieve pain symptoms of senile colpitis: make a mixture of chamomile flowers (Matricaria chamomilla) and wood mallow (Malva sylvestris), as well as sage leaves (Salvia officinalis), walnut leaves (uglans regia ), dried common oak bark (Quercus) in equal proportions. 2 tbsp. lie Add 1 liter of boiling water to the well-stirred mixture, cool and strain. Use for both douching and wetting vaginal tampons for the treatment of colpitis during menopause.

Homeopathy

Homeopathic doctors offer their methods for treating colpitis during menopause. For this, the following drugs are most often prescribed.

Echinacea compositum S. The homeopathic remedy stimulates the immune system, has an indirect antiviral and antimicrobial effect, has a detoxifying (removes toxins) and antiphlogistic effect on the body. Single dose - 1 ampoule. The drug can be administered from 1 to 3 per week by various injection methods: intravenously, subcutaneously, intravenously, if necessary, intravenously. In acute cases and in severe cases of the disease, the drug is used daily. One of the options for using the drug is oral administration (in the form of “drinking ampoules”).

Gynacoheel. Prescribed for various inflammatory diseases of the external and internal female genital organs: adnexitis, parametritis, myometritis, endometritis, colpitis, vulvitis, cervicitis. The presence of thyroid pathologies is not a contraindication to the use of the drug, but consultation with an endocrinologist is necessary. The homeopathic remedy is contraindicated in case of hypersensitivity to the venom of honey bees, wasps, hornets and bumblebees. The maximum single dose is no more than 10 drops. The drug is taken sublingually (under the tongue) or orally with 1 teaspoon or tablespoon of clean water, three times a day for 15-20 minutes. before meals or 1 hour after meals. In acute cases, take a single dosage every quarter of an hour, not exceeding a two-hour time interval. The treatment regimen and dosage of the drug are recommended by a homeopathic doctor.

In case of pathological processes of an inflammatory nature of a nonspecific etiology (adnexitis, oopharitis, salpingitis, colpitis, parametritis, endometritis, myometritis), which do not require more radical methods of treatment, monotherapy with the homeopathic drug Gynekoheel gives positive dynamics. It is advisable to combine its use with physiotherapeutic procedures. Considering the advanced state of the inflammatory disease, the course of therapy can last from 3 weeks to 1 month, with rare exceptions up to 2-3 months. Treatment time is reduced if you use bicomponent therapy according to the standard regimen:

1. Gynekoheel (10 drops twice a day, course of treatment up to 1.5 months) together with Traumeel S (1 tablet 2-3 times a day, standard course - 3 weeks or 1 amp. twice a week IM or p/ To).
2. For recurrent senile colpitis with a significant amount of leucorrhoea and the absence of a pathogenic inflammatory agent, therapy with Agnus Cosmoplex S in combination with Gynekoheel (10 drops 2-3 times a day) is advisable. These homeopathic medicines enhance each other's anti-inflammatory properties.

Revitax vaginal suppositories. This is a drug that combines natural ingredients with healing, antiseptic, antiphlogistic and immunoactivating effects. They are used in gynecological practice to regenerate the affected vaginal mucosa. The active ingredient of vaginal suppositories is a natural polysaccharide - non-sulfonated glycosaminoglycan (hyaluronic acid). As the suppository dissolves, hyaluronic acid is evenly distributed over the surface of the vaginal mucosa and creates additional protection for the epithelial layer, stimulating the healing of tissue defects. Vaginal suppositories significantly reduce the inflammatory reaction of the vaginal walls (hyperemia, itching, irritation).

The drug can be used to prevent vaginitis after long-term therapy with corticosteroids or antibiotics. Candles are used to avoid infections when visiting swimming pools, saunas, baths or swimming in open, stagnant bodies of water. The use of Revitax is recommended for physiological predisposition to inflammatory reactions due to microtrauma of the vaginal mucosa after sexual intercourse. The use of suppositories is necessary during a prolonged absence of the opportunity to carry out hygienic manipulations (business trips, trips, trips, hikes).

For therapeutic purposes, Revitax vaginal suppositories are prescribed for the regeneration of affected areas of the vaginal mucosa due to inflammatory conditions in atrophic colpitis and the presence of cervical erosions.

Suppositories are used once during the day (preferably before bedtime). The suppository must be inserted into the vagina as deeply as possible. If the consistency of the candle is too soft for insertion, then it must be cooled for several minutes without removing it from the blister.

The duration of use is individual and determined according to indications. Typically, the drug is prescribed for at least 5 days.

Surgical treatment

A number of diseases that could arise and progress as a consequence of advanced colpitis are subject to surgical treatment. These include: pelvioperitonitis (not amenable to therapy within 4-6 hours), pyosalpinx, pyovar, tubo-ovarian saccular formation with the threat of perforation, perforation with the development of pelvio- and peritonitis, peritonitis. The emergence of gynecological diseases that can be treated surgically is caused by untimely contact with a specialist and neglect of the situation. The decision on surgical intervention regarding the emerging acute gynecological pathology is made by the doctor.

Prevention

The main goal of preventive measures comes down to regular observation by a gynecologist and timely detection of pathological processes. If necessary, a specialist will prescribe HRT after the onset of menopause. Hormonal drugs have a direct effect on the epithelial layer of the vagina, endometrium, and help prevent the development of osteoporosis and cardiovascular damage.

Measures to prevent atrophic colpitis include preventing early menopause, giving up bad habits (smoking, drinking alcohol-containing drinks), regular exercise, proper balanced nutrition, and preventing stressful situations. Activating immune reactions, carefully performing hygiene procedures for the intimate area, and wearing cotton underwear will significantly reduce the risk of senile colpitis.

Carrying out preventive measures, regular visits to the gynecologist, timely detection of pathological abnormalities, and compliance with hygiene rules minimize the risk of atrophic colpitis during menopause. Worries about hormonal changes and their consequences should begin after 35-40 years. If you identify and start HRT in time, then the unpleasant sensations associated with the occurrence of senile colpitis can be avoided.

About 40% of women after menopause begin to suffer from signs of atrophic colpitis (burning and itching, vaginal dryness and pain during intimacy). It is also characteristic that the longer the period of menopause, the higher the chances of developing this pathology. Thus, the percentage of patients with this disease increases to 75 10 years after the cessation of menstruation.

Since atrophic changes in the vaginal epithelium are usually associated with the physiological completion of hormone production by the ovaries, atrophic colpitis is considered as a pathology only in the presence of pronounced clinical manifestations (significant discomfort).

Definition of the term and types of disease

Atrophic colpitis is a change in the vaginal epithelium that is associated with functional and structural changes, against which the vaginal epithelium becomes thinner, which ultimately causes the development of characteristic symptoms (repeated inflammation, itching, dyspareunia, dryness). This condition is provoked by a significant decrease in estrogen levels, which can be associated with both physiological reasons (physiological menopause) and artificial cessation of the secretion of female sex hormones (atrophic colpitis during reproductive age or artificial menopause).

The very name of the pathology “vaginitis”, or “colpitis”, arose from the Greek word “colpos” and the Latin “vagina”, which literally translates as “vagina”. The suffix “itis” indicates inflammation of the organ. Other synonyms for this disease are senile, or senile colpitis, atrophic vaginitis.

A little about the physiology and pathogenesis of the disease

A woman's vagina is lined with stratified squamous epithelium, which performs a significant number of functions that are required to protect the genital organs from various infectious diseases. Due to its multilayered nature, the vaginal epithelium is constantly renewed; the upper cells begin to die and slough off, taking with them pathogenic microorganisms and toxins, which are replaced by new cells.

In addition, the vaginal epithelium maintains a constant pH level. Normally, in women of reproductive age, the environment in the vagina is always acidic (pH 3.8-4.5), while the microflora is 98% lactic acid bacteria. Lactobacilli prevent the addition of pathogenic pathogens and the activation of opportunistic microorganisms by maintaining a constant acidic environment in the vagina. Such lactic acid bacteria feed on glycogen present in large quantities in the desquamated epithelium.

With the onset of menopause, the cyclic renewal of the vaginal epithelium begins to cease, which is associated with a decrease in the amount of synthesized estrogen and the end of menstrual activity. Epithelial cells are able to exfoliate only in small quantities, which leads to the development of glycogen deficiency and, accordingly, causes a decrease in the number of lactobacilli. In connection with such processes, the pH of the vagina begins to shift towards alkalization, which ultimately leads to its contamination with opportunistic microflora and the penetration of pathogenic pathogens into the mucosa. All of these changes provoke the development of a local inflammatory reaction, namely colpitis.

Thinning of the epithelium and a decrease in the production of secretions by the vaginal glands lead to slight vulnerability and fragility of the vaginal mucosa, which only contributes to the activation of opportunistic microorganisms and leads to a narrowing of the vaginal lumen.

Causes

The formation of this pathology is based on hypoestrogenism, which can be either physiological after the cessation of menstruation or artificial (surgeries and other manipulations on the ovaries). In girls of reproductive age, hypoestrogenism is possible under the following circumstances:

After labor, especially during breastfeeding

In the postpartum period, there is a gradual restoration of hormonal balance, especially in those women who breastfeed their babies (prolactin is synthesized), which ultimately leads to a long-term estrogen deficiency and often ultimately becomes the cause of the development of atrophic colpitis.

Hormonal ovarian dysfunction

Long-term hormonal imbalance provokes persistent hypoestrogenism and the formation of pathology.

Endocrine pathology.

Strong psycho-emotional experiences (hormonal imbalance occurs).

Women who suffer from thyroid diseases, adrenal gland pathologies, and diabetes are prone to developing atrophic vaginitis.

Other reasons

Weakened immunity (negatively affects the hormone-forming function of the ovaries).

Carriers of HIV infection or patients with AIDS.

Radiation therapy of the pelvic organs. When the pelvic area is irradiated, the female reproductive glands are also involved in the process, which provokes a disruption in the secretion of hormones, including estrogens.

Removal of the ovaries (oophorectomy). The ovaries synthesize estrogens, whereas in their absence, the secretion of these sex hormones automatically stops.

Predisposing factors

Among the many predisposing factors, it is especially worth noting:

unprotected, frequent and promiscuous sexual intercourse;

incorrect intimate hygiene;

use of aromatic products for hygiene of intimate places, lubricants, antibacterial soap, fragrances;

wearing tight synthetic underwear (obstructs oxygen access and promotes the development of anaerobic flora);

common chronic diseases;

chronic inflammatory diseases of the genital organs;

errors in the diet (lack of fermented milk products, drinking poor-quality water, eating unwashed fruits and vegetables).

Clinical picture of the disease

The first signs of the development of atrophic colpitis appear approximately 5 years after the end of menstruation. Usually the pathology is characterized by a sluggish course, the symptoms are mild. An increase in clinical signs is associated with the attachment of a secondary infection to the focus and the activation of opportunistic microflora, which is only facilitated by microtrauma of the mucous membrane due to its slight vulnerability (for example, after douching, washing, coitus, gynecological examination). Among the main features are:

Vaginal discomfort

It occurs as a feeling of dryness and tightness in the vagina, sometimes painful sensations may be present. If pathogenic vaginal microflora is attached, severe burning and itching occurs.

Dyspareunia

Pain during or immediately after sexual intercourse is caused by depletion of the stratified epithelium of the vagina, exposure of nerve endings and a decrease in the secretion of vaginal gland products, which are usually called lubrication.

Vaginal discharge

With this pathology, vaginal leucorrhoea is moderate in nature, mucous and tends to be watery. In case of infection, the discharge acquires qualities that are characteristic of a certain type of microorganism (foamy, greenish, cheesy) and is accompanied by an unpleasant odor. Also, atrophic colpitis is characterized by the presence of bloody discharge. Usually they are insignificant in the form of a few drops of blood and are caused by trauma to the mucous membrane (douching, medical examination, sexual contact). The occurrence of any bleeding (both heavy and minor) during the postmenopausal period is a reason to immediately visit a doctor.

Frequent urination

Senile vaginitis is always characterized by thinning of the walls of the bladder with weakening of the tone of the pelvic floor muscles. These processes are accompanied by frequent urination, in which the amount of urine released remains unchanged. In addition, when the pelvic floor muscles weaken, urinary incontinence begins to appear (when sneezing, laughing, coughing).

Examination data in gynecological speculum

The vagina, and specifically its mucous membrane, has a pale pink color with the presence of numerous pinpoint hemorrhages. When contacting medical instruments, new areas begin to bleed. If a secondary infection occurs, vaginal hyperemia and swelling, purulent or grayish discharge appear.

Diagnostics

Diagnosis of this disease should be comprehensive and include:

examination of the mucous membrane of the cervix and vaginal walls in the speculum;

collection of smears for microbiological examination.

A large number of leukocytes are determined (in the case of a secondary infection), which indicates inflammation, lactic acid bacteria are almost completely absent, a high content of opportunistic microorganisms is observed, and it is possible to identify specific pathogens (Gardnerella, fungi, Trichomonas).

PCR

If there is an obvious inflammatory process in the vaginal mucosa and questionable results of microbiological examination of smears are obtained, the patient is referred for a PCR test (blood, urine, gynecological smears) to determine hidden sexually transmitted infectious diseases. It is possible to detect human papillomavirus and herpes, cytomegalovirus, myco- and uroplasmas, chlamydia, as well as other pathogens.

Determination of vaginal acidity

This is done using a special test strip. Normally, the pH should correspond to the reading of 3.5-5.5. In the presence of atrophic colpitis, the pH increases to 5.5-7 or even becomes alkaline (more than 7).

Colposcopy

Examination of the vaginal walls and cervix with magnification using a colposcope. Pallor and atrophy of the mucous membranes of the cervix and vagina, small cracks, a weak vascular pattern are determined; there may be foci of dysplasia on the cervix and vaginal walls. When performing the Schiller test (Lugol staining), uneven staining or a weakly positive test is observed (depletion of the epithelial layer is an indirect sign of the development of dysplasia).

Taking a smear from the posterior vaginal vault and cervix for cytology

The cervical mucosa is represented by several types of cells:

basal (ripe and turn into parabasal, then intermediate, and keratinizing);

parabasal;

intermediate (made in two layers and located under the keratinizing cells, as a result replacing them);

keratinizing (they are directly exfoliated and are the top layer of the mucosa).

Thus, with this pathology, the epithelial layer is depleted (not only on the walls of the vagina, but also on the cervix itself); accordingly, in the cytogram in the presence of atrophic vaginitis, parabasal and basal cells prevail.

Classification of smear cytology:

first type – there are no atypical cells, the cytological picture is normal;

the second type - the structure of epithelial cells is slightly changed as a result of the presence of an inflammatory process in the cervix or vagina;

third type - cells with an altered nucleus are present, but only in a single quantity (repeated cytological examination is required) and colposcopy;

fourth type - there are individual epithelial cells with obvious signs of malignancy - histology and colposcopy are necessary;

the fifth type is the multiple presence of atypical cells.

In the presence of atrophic vaginitis, a cytogram of the inflammatory process is usually diagnosed, which does not imply the prescription of anti-inflammatory therapy.

Treatment

What and how to treat in the presence of atrophic colpitis can only be determined by a gynecologist. The most effective and main method of treating atrophic colpitis in women both during the postmenopausal period and during childbearing age is the prescription of HRT (hormone replacement therapy). It is the use of hormonal drugs that makes it possible to mislead the vaginal mucosa and force the epithelium to renew itself cyclically, which improves the trophism of the mucosa, reduces the severity of atrophy and prevents the formation of microtraumas.

Hormone replacement therapy can be carried out in two ways: systemic administration of hormones in the form of injections, tablets or hormonal patches, local creams, ointments, suppositories. Hormonal therapy should continue for a long time, at least 1.5-3 years, although it is worth noting that a positive effect is observed after 3-6 months from the start of therapy. However, if the course of hormonal therapy is stopped, the symptoms of atrophic vaginitis return and are quite often complicated by the addition of a secondary infection.

Local treatment

Suppositories that are prescribed in the presence of atrophic colpitis:

"Estriol."

Suppositories contain the main active ingredient - estriol (directly estrogenic component) and as an additional substance - dimethyl sulfoxide. This drug is available without a prescription. Treatment regimen: intravaginal administration once a day for the first month, then twice a week. The drug can reduce the severity of vaginal itching, eliminate dyspareunia, and excessive dryness. Suppositories are also effective in cases of urinary disorders, as well as urinary incontinence, which are provoked by atrophic processes in the vaginal mucosa.

"Ovestin".

Available in the form of suppositories, tablets and vaginal cream. The active ingredient is estriol, additionally: lactic acid, acetyl palmitate, potato starch. The drug has properties similar to estriol. The treatment regimen is also similar (first, intravaginal administration of suppositories daily for 4 weeks, after which, if the general condition improves, the dosage is reduced to 2 suppositories per week). Available in pharmacies without a prescription.

"Gynoflor E".

It is produced in the form of tablets for insertion into the vagina. The drug contains lyophilisate of lactobacilli acidophilus with a dosage of 50 mg, as well as estriol - 0.03 mg. Effectively restores the vaginal microflora (the action of lactobacilli acidophilus), and also improves the nutrition of the vaginal epithelium, stimulates its growth due to glycogen, which is present in the drug, supports the growth and formation of its own lactic acid bacteria on the vaginal mucosa. Treatment regimen: intravaginal administration of one tablet for 6-12 days daily, after which one tablet is administered twice a week. Available in pharmacies without a prescription.

"Elvagin."

Available in the form of cream and suppositories. The main active ingredient is estriol. Injected into the vagina every day for 2-3 weeks, after which the dose is reduced to twice a week. Sold without a prescription.

"Ortho-ginest."

Available in the form of tablets, suppositories and vaginal cream. The drug contains estriol. Course of therapy: administration of the drug (regardless of the form) at a dosage of 0.5-1 mg daily for 20 days, after which a week-long break is taken; if symptoms weaken, treatment is continued for 7 days a month. The course of treatment should be at least six months.

"Ovipol Clio" (suppositories).

"Estrovagin" (vaginal suppositories, cream).

"Estrocard" (suppositories and cream).

Systemic treatment

Drugs prescribed for systemic therapy:

"Climodien."

Available in the form of tablets for oral administration. One package contains 28 tablets. The drug contains dienogest and estradiol. The drug is taken one tablet every day, it is advisable to take the drug at the same time. After finishing the package, start taking a new one. Climodien is prescribed to women who have severe menopausal symptoms (increased sweating, disturbed sleep, hot flashes) and signs of atrophic vaginitis, but not earlier than a year after menopause. The drug is available at the pharmacy without a prescription.

"Cliogest".

One blister of the drug contains 28 tablets. Reception can be started on any day, but not earlier than a year after the last menstruation. The drug contains norethisterone acetate and estradiol propionate. The drug is prescribed as hormone replacement therapy after 55 years of age to prevent the development of osteoporosis and for the treatment of atrophic colpitis. The drug is available in pharmacies without a prescription.

"Davina."

Available in the form of blue (10 pieces) or white (11 pieces) tablets. The package contains 21 tablets. White tablets contain estradiol, while blue tablets contain methoxyprogesterone and estradiol. They are taken every day for 3 weeks at the same time, after this period a week break is taken, which is accompanied by the development of menstrual-like bleeding. The drug is prescribed in the presence of estrogen deficiency, for the prevention of postmenopausal osteoporosis and menopausal syndrome. Available at the pharmacy without a prescription.

"Pauzogest."

The product contains norethisterone and estradiol. The package contains 28 tablets. The drug is taken daily, one tablet for four weeks. Upon completion of the package, they immediately begin to receive a new one. Pauzogest is prescribed no earlier than one year after the cessation of menstruation. The drug is available at the pharmacy without a prescription.

"Eviana".

"Revmelid".

"Activel".

Herbal preparations (use of phytohormone therapy)

"Cliophyte".

Available in the form of an elixir or syrup. The composition of the product includes: chamomile, chaga, coriander seeds, hawthorn, cedar seeds, rose hips and other components of plant origin. Treatment regimen: 10-15 ml of the product is diluted with 100 ml of water and taken three times a day 15 minutes before meals for 2-3 weeks. If necessary, the course of therapy is repeated after 1-2 weeks. The product is available without a prescription.

"Klimadinon".

The drug contains cohosh rhizomes, a plant that has anti-menopausal and estrogen-like effects. The blister contains 15 tablets; a regular package contains 4 or 6 such blisters. The drug is taken twice a day, one tablet at a time, the duration of therapy is determined by the doctor. The product is available in pharmacies without a prescription.

"Qi-klim."

The drug is based on black cohosh root extract and is produced in the form of tablets, body and face cream. Take 1-2 tablets daily for a month. The duration of the course is adjusted by the attending physician.

• "Inoklim".

  "Estrovel".

  "Tribestan".

  "Bonisan."

  "Menopace Plus" (herbal component).

  "Menopace" (minerals and multivitamins).

  "Remens" (in the form of drops).

  "Feminal"

  "Climaxan".

  "Klimadinon Uno".

FAQ

Is it possible to use alternative treatment in the presence of atrophic vaginitis?

Yes, the use of folk remedies is allowed, but only in the form of an addition to the main therapy with hormonal drugs. Folk remedies are usually used in the presence of a pronounced inflammatory reaction of the vaginal mucosa to eliminate itching and redness, relieve swelling, and better heal microcracks in the mucosa. Use warm baths with decoctions of Rhodiola rosea, juniper fruits, sage, calendula, chamomile and other medicines. You can also insert tampons soaked in aloe juice intravaginally, take an infusion of a mixture of rose hips, sweet clover, nettle, sage, mint or celandine herb. You can also drink tea from raspberry leaf, chamomile and willow leaves.

I am 35 years old, and about a year ago I had my ovaries removed for endometriosis and was prescribed hormonal contraceptives. About 2 weeks ago, itching and burning appeared in the vagina, with yellowish discharge that had an unpleasant odor. Are such symptoms a manifestation of atrophic colpitis?

In this case, it is necessary to visit a gynecologist as soon as possible and take smears for the vaginal microflora. In all likelihood, it is not atrophic, but nonspecific vaginitis, and the development of candidiasis is also possible. This disease requires at least a year from the date of surgery, and it was said that the patient is taking hormonal medications. The doctor will evaluate the results of the smears and, when determining the pathogen, will prescribe anti-inflammatory treatment appropriate to the situation. Regarding hormone replacement therapy, you should wait a little.

Is it possible to prevent the development of atrophic vaginitis, and how to do it?

Yes, as a preventive measure, you need to regularly visit a gynecologist, give up bad habits, wear synthetic and tight underwear, adhere to proper nutrition, and take multivitamin complexes (only if you have doctor’s recommendations). It is also worth excluding the use of scented products for intimate hygiene, avoiding unprotected sexual intercourse and engaging in physical restorative exercises and Kegel exercises (for local strengthening of the pelvic floor muscles); it is better to replace taking a bath with a shower.

How is the effectiveness of therapy for atrophic colpitis determined?

To determine the negative or positive dynamics of the pathology, regular colposcopy (once every 3-6 months), cytological examination of smears of vaginal microflora, and measurement of vaginal pH are required.