Evaluation of the effectiveness of local hormone therapy in older patients with pelvic descension

Vollständiger Abstract

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Objective. To evaluate the results of pelvic descension correction in patients of the older age group on the background of combined treatment, including surgical intervention in combination with the use of local hormone therapy at the stages of preoperative preparation and postoperative rehabilitation. Materials and methods. The prospective study was conducted from 2024 to 2025 on the basis of the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky. The study included 54 elderly and senile patients who underwent surgery for pelvic organ prolapse. The choice of surgical treatment volume depended on the prevailing point of genital prolapse. For the purpose of preoperative preparation and postoperative rehabilitation, various forms of estrogen-containing drugs were used in the form of vaginal suppositories, capsules and creams, the active ingredient of which was micronized estriol. A therapeutic dose of the drug was administered for 14 days, after which the patients were transferred to a maintenance therapy regimen. The effectiveness of hormone therapy was monitored at the stage of hospitalization, as well as 2 and 6 months after surgical treatment. During the gynecological examination, the acidity of the vaginal environment was assessed using a colpotest and pH determination, followed by calculation of the vaginal health index. The character of the vaginal microbiome was assessed based on the results of microscopic examination of vaginal smears, as well as a comprehensive analysis of the microflora using polymerase chain reaction (PCR). In addition, according to the results of the cytological study, the percentage of vaginal epithelial cells with pycnotic nuclei and cells that had not undergone karyopycnosis was determined, which directly correlates with the estrogen saturation of the vaginal mucosa. Results. According to pH-metric data, at the start of the study, the median (Me) pH was 6.5 with a range (difference between maximum and minimum values) of 0.5, which also confirmed vaginal and vesicourethral atrophy. The result of hormone therapy at the stage of preoperative preparation was a decrease in the median pH to 6 with a range of 0, further local replacement therapy at the stage of postoperative rehabilitation led to a progressive decrease in the median pH to 6 with a range of 0.5, and 5.5 with a range of 0.125 after 2 and 6 months, respectively. At the initial stage of the study, all patients had low values of the G. Bochman vaginal health index (Me 7, range 2 points), which indicated a decrease in the reparative potential of the tissues of the urogenital tract. The median index of vaginal health increased significantly as a result of preoperative preparation, reaching 9 points (with a range of 2 points). The further use of local hormone therapy in the postoperative period was accompanied by a subsequent improvement in the condition of the vaginal mucosa. So, during the follow-up examination after 2 months after surgical treatment, the vaginal health index was 11.5 points (range 4 points), and 6 months after surgery, this indicator increased to 15 points (range 5 points). Clinically, all patients noted relief of the initial symptoms; during checkups, there were no complaints of any manifestations of genitourinary menopausal syndrome, including dryness of the vaginal mucosa, discomfort, itching and burning during sexual intercourse, postcoital spotting from the genital tract in the presence of sexual activity, nocturia. Conclusion. Taking into account the above correlation of estrogen deficiency and pelvic organ prolapse, as well as the involvement of structures of the urethra and bladder in the pathological process against the background of the development of genitourinary menopausal syndrome, all patients of the older age group, including elderly and senile women, are indicated to prescribe local estrogen-containing therapy at the stage of preoperative preparation and postoperative rehabilitation.