Vaginal atrophy or Atrophic vaginitis commonly affects women in menopause or perimenopausal years. It’s a condition where the lining of the vagina gets thinner and dry due to a decrease in estrogen concentration. Urinary symptoms and infections are common, and the entire symptom complex is now referred to as the Genitourinary Syndrome of Menopause.
Symptoms
The tissues that line the walls of the vagina become dry, thin and inflamed. The first symptom is vaginal dryness with other symptoms following. Such as.
A. Burning and Itching
B. Dyspareunia which is painful intercourse.
C. Vaginal bleeding
D. Urinary tract infections
E. Incontinence
F. Hematuria
G. Dysuria which is painful burning urination
Causes
The primary cause of genitourinary syndrome of menopause is a decrease or lack of estrogen. Estrogen keeps the vaginal tissue pliable, moist and elastic. Without estrogen, the tissue becomes thin, less elastic and the vaginal canal narrows. Overall, the pH balance of the tissue is disrupted and the tissue become delicate and subsequently easily irritated.
Although estrogen levels drop during menopause, they can also decrease during chemotherapy for cancers, breastfeeding or post ovarian removal.
Other causes.
A. Chemotherapy or radiation
B. Antiestrogen drugs such as tamoxifen
C. Birth control pills
D. Autoimmune disorders
E. Smoking
F. Lack of sex (sex promotes blood flow to the tissues in the area and the vaginal tissue become more elastic)
Diagnosis
Pelvic exam is the most common exam to make a diagnosis of vaginal atrophy.
Classic signs include.
A. Dryness, red inflamed tissue with swelling
B. Loss of tissue elasticity
C. White or pale tissue
D. Vulvar lesions
E. Minor lacerations
F. Vaginal canal short, narrowed or stenotic
Testing
A. Pap smear
B. Urine culture
C. Ultrasound to examine ovarian tissues.
D. Vaginal pH
E. Vaginal culture
F. Lab testing for estrogen levels and other chemistries
Management and treatment modalities
Estrogen and dehydroepiandrosterone (DHEA) are the primary treatment modalities.
Estrogen can be given systemically or topically depending on the systems.
Vaginal topical creams, tablets or longer acting intravaginal rings are used if the symptoms are local. If hot flashes, mood changes, lack of sleep and other systemic symptoms are present, then systemic therapy is usually prescribed unless contraindicated.
Non-Estrogen Treatments
A. Lubricants for vaginal dryness
B. Laser treatments for vaginal tissue rejuvenation
C. Dilators to aid in the canal narrowing.
D. Non-estrogenic drugs such as Osphena. This drug is in the class called selective estrogen receptor modulators. The side effects of this drug are hot flashes and increased risk of blood clotting.
Platelet Rich Plasma is an autologous blood concentrate with concentrations of cytokines, growth factors and bioactive proteins that is higher than the normal circulating blood. PRP has been used in all fields of medicine to promote healing and rejuvenation of damaged tissues. Collagen and elastin are increased as well as the stimulation of angiogenesis. PRP is now being used in the treatment of vaginal atrophy especially in patients where estrogens are contraindicated as in cancer.
Studies
Menopause 2018 Oct;25(10):1124-1130 PMID 29738415
Objective: Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy. For those who cannot take hormone therapy, autologous
platelet rich plasma combined with hyaluronic acid may provide a new alternative therapy for the treatment of VVA in postmenopausal women with a history of breast cancer.
Conclusions: The injection of PRP with hyaluronic acid appears to be a promising method to improve the trophicity and hydration of the vaginal mucosa for the treatment of vulvovaginal atrophy in postmenopausal breast cancer survivors with contraindications to hormone therapy.
- Clinical Evaluation of Autologous Platelet Rich Plasma Injection in Postmenopausal Vulvovaginal Atrophy: A Pilot Study
Background: There is a lack of published data investigating injection of autologous platelet rich plasma alone in the treatment of postmenopausal VVA. In this study, we aimed to investigate the safety and efficacy of injection of PRP alone in postmenopausal VVA women without the history of breast cancer to explore its utility as a hormone free therapy for postmenopausal VVA and for vulvovaginal rejuvenation.
Conclusions: Autologous platelet rich plasma injection is safe and effective as minimally invasive monotherapy for postmenopausal VVA without a history of breast cancer and hence for vulvovaginal rejuvenation.
J Womens Health 2023 Sep;32(9):1006-1020 PMID 3737417970
Background: Cancer survivors are often reluctant to discuss sexual complaints with their oncologists and treatment is frequently unsatisfactory due to the paucity of controlled studies and inapplicability of vaginal estrogen. We aimed to evaluate efficacy and tolerability of platelet rich plasma injections alone or in combination with noncross-linked hyaluronic acid compared with standard therapy with topical hyaluronic acid gel in the management of cancer therapy induced or aggravated vulvovaginal atrophy.
Conclusion: Both PRP and PRP-HA have comparable efficacy and patient reported satisfaction.
Aesthetic Plast Surg 2023 Aug 14 doi: 10.1007/s00266-023-03550-5 PMID 37580562
Background: Injection treatments have been proposed as novel treatment options for vulvovaginal atrophy also known as genitourinary syndrome of menopause. However, to date data about these treatments are poor. We aimed to assess all available injection treatments for VVA
Conclusion: All assessed injection treatments (including PRP and PRP with noncross -linked HA) seem to lead to significant improvement in VVA symptoms.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative cascade.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins from the alpha granules on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This activation by LED light also provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation guideline of the FDA.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment and can be used confidently in inflammatory conditions.
Juventix Regenerative Medical offers a PRP kit that contains noncross-linked hyaluronic acid. This combination can be used as a filler injected into areas of volume loss. This has been extensively deployed in the aesthetic field as well as the gynecologic arena.
Juventix Regenerative Medical has many products, services and devices for the regenerative medical professional including tissue based therapeutic products such as exosomes.
RESTORE, REVIVE, REGENERATE – JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
