Tinjauan Literatur: PATOGENESIS DAN TERAPI ATROFI VAGINA

Authors

  • I Wayan Sugiritama Fakultas Kedokteran Universitas Udayana
  • Ni Made Linawati Fakultas Kedokteran Universitas Udayana
  • I Gusti Nyoman Sri Wiryawan Fakultas Kedokteran Universitas Udayana
  • Ida Ayu Ika Wahyuniari Fakultas Kedokteran Universitas Udayana
  • Gusti Ayu Dewi Ratnayanti Fakultas Kedokteran Universitas Udayana
  • I Gusti Kamasan Nyoman Arijana Fakultas Kedokteran Universitas Udayana

Keywords:

atrofi vagina, estrogen, fitoestrogen, menopause, seksualitas

Abstract

Atrofi vagina adalah masalah kesehatan yang paling banyak dialami oleh wanita menopause. Patogenesisnya berkorelasi dengan penurunan kadar hormon estrogen, yang mengakibatkan  epitel vagina lebih tipis dengan proporsi sel-sel superfisial yang menurun. Pada dinding vagina terjadi penurunan jumlah serabut kolagen, penurunan massa otot polos dan penurunan vaskularisasi. Konsekuensi dari perubahan tersebut adalah dinding vagina mengalami penurunan dalam ukuran, elastis, lubrikasi, dan integritas lapisan mukosa. Gejala  yang paling sering dialami adalah rasa nyeri pada vagina, yang akhirnya menyebabkan ketakutan untuk melakukan aktivitas seksual.Penanganan gejala atrofi vagina menjadi penting karena populasi wanita menopause yang besar dan akan terus meningkat. Tujuan penulisan tinjauan literatur adalah mengulas patogenesis atrofi vagina dan berbagai macam pilihan terapinya. Literatur didapatkan melalui pencarian pada Google Scholar dan PubMed database selama tahun 2022 dan dipilih terbitan 10 tahun terakhir, baik dalam Bahasa Indonesia maupun Bahasa Inggris. Kata kunci yang digunakan adalah menopause, atrofi vagina, patogenesis atrofi vagina, terapi atrofi vagina, fitoestrogen, Selective Estrogen Estrogen Receptors (SERM), dan terapi sulih hormon. Hasil menemukan bahwa sebagian besar kasus tidak terdiagnosis dan hanya sedikit yang mendapat terapi yang tepat. Sebagian besar wanita menopause mengobati sendiri gejala atrofi vagina yang dialami dengan obat-obat yang dijual bebas dan ada banyak kasus yang tidak diobati. Terapi utama atrofi vagina adalah hormon yang diberikan secara sistemik atau topikal. Salah satu terapi sistemik adalah SERM. Terapi topikal pilihannya sangat banyak yaitu fitoestrogen, asam hialuronat, pelembab, pelumas, kolostrum, vitamin, herbal, terapi laser dan radio frekuensi. Berbagai jenis metode terapi memiliki mekanisme kerja yang berbeda, sebagian besar terbukti efektif mampu memperbaiki struktur dan fisiologi vagina serta mampu mengurangi gejala atrofi vagina dan juga memperbaiki fungsi seksual.

Author Biographies

I Wayan Sugiritama, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

Ni Made Linawati, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

I Gusti Nyoman Sri Wiryawan, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

Ida Ayu Ika Wahyuniari, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

Gusti Ayu Dewi Ratnayanti, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

I Gusti Kamasan Nyoman Arijana, Fakultas Kedokteran Universitas Udayana

Departemen Histologi

References

Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. Journal of Menopausal Medicine. 2015; 21(2): 65-71. doi: 10.6118/jmm.2015.21.2.65

Moral E, Delgado JL, Carmona F, Caballero B, Guillan C, Gonzalez PM, et al. Genitourinary Syndrome of Menopause. Prevalence and Quality of Life in Spanish Postmenopausal Women. The GENISSE study. Climacteric: the Journal of the International Menopause Society. 2018; 21(2):167-73. doi: 10.1080/13697137.2017.1421921

Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary Syndrome of Menopause: an Overview of Clinical Manifestations, Pathophysiology, Etiology, Evaluation, and Management. American Journal of Obstetrics and Gynecology. 2016; 215(6): 704-11. doi: 10.1016/j.ajog.2016.07.045

Donders GGG, Ruban K, Bellen G, Grinceviciene S. Pharmacotherapy for the Treatment of Vaginal Atrophy. Expert Opin Pharmacother. 2019; 20(7): 821-35. doi: 10.1080/14656566.2019.1574752

Nappi RE, Palacios S, Panay N, Particco M, Krychman ML. Vulvar and Vaginal Atrophy in Four European Countries: Evidence from the European REVIVE Survey. Climacteric: the Journal of the International Menopause Society. 2016; 19(2): 188-97. doi: 10.3109/13697137.2015.1107039

Palacios S, Cancelo MJ, Castelo Branco C, Llaneza P, Molero F, Borrego RS. Vulvar and Vaginal Atrophy as Viewed by the Spanish REVIVE Participants: Symptoms, Management and Treatment Perceptions. Climacteric: the Journal of the International Menopause Society. 2017; 20(1): 55-61. doi: 10.1080/13697137.2016.1262840

Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) Survey: Implications of Vaginal Discomfort in Postmenopausal Women and in Male Partners. The Journal of Sexual medicine. 2013; 10(9): 2232-41. doi: 10.1111/jsm.12235

Freedman MA. Perceptions of Dyspareunia in Postmenopausal Women with Vulvar and Vaginal Atrophy: Findings from the REVIVE Survey. Womens Health (Lond). 2014; 10(4): 445-54. doi: 10.2217/whe.14.29

Pinkerton JV, Stanczyk FZ. Clinical Effects of Selective Estrogen Receptor Modulators on Vulvar and Vaginal Atrophy. Menopause. 2014; 21(3): 309-19. doi: 10.1097/GME.0b013e31829755ed

Paton DM. Ospemifene for the Treatment of Dyspareunia in Postmenopausal Women. Drugs Today (Barc). 2014; 50(5): 357-64. doi: 10.1358/dot.2014.50.5.2134451

Constantine GD, Goldstein SR, Archer DF. Endometrial Safety of Ospemifene: Results of the Phase 2/3 Clinical Development Program. Menopause. 2015; 22(1): 36-43. doi: 10.1097/GME.0000000000000275

De Franciscis P, Colacurci N, Riemma G, Conte A, Pittana E, Guida M, et al. A Nutraceutical Approach to Menopausal Complaints. Medicina (Kaunas). 2019; 55(9):544. doi: 10.3390/medicina55090544

Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020; 12(4):1-9. doi: 10.7759/cureus.7586

Nappi RE, Kokot-Kierepa M. Women's Voices in the Menopause: Results from an International Survey on Vaginal Atrophy. Maturitas. 2010; 67(3):233-8. doi: 10.1016/j.maturitas.2010.08.001

Phillips NA, Bachmann GA. Genitourinary Syndrome of Menopause: Common Problem, Effective Treatments. Cleveland Clinic Journal of Medicine. 2018; 85(5):390-8. doi: 10.3949/ccjm.85a.15081

Takashina R, Nakajima T, Umezu T, Komatsu K, Banba T, Asada T, et al. Stratification of Mouse Vaginal Epithelium 2. Identification of Factors Inducing Stratification. Biology of Reproduction. 2018; 99(4):727-34. doi: 10.1093/biolre/ioy113

Portman DJ, Gass ML. Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014; 21(10):1063-8. doi: 10.1097/GME.0000000000000329

de Landsheere L, Brieu M, Blacher S, Munaut C, Nusgens B, Rubod C, et al. Elastin Density: Link Between Histological and Biomechanical Properties of Vaginal Tissue in Women with Pelvic Organ Prolapse? International Urogynecology Journal. 2016; 27(4):629-35. doi: 10.1007/s00192-015-2901-8

Vetuschi A, D'Alfonso A, Sferra R, Zanelli D, Pompili S, Patacchiola F, et al. Changes in Muscularis Propria of Anterior Vaginal Wall in Women with Pelvic Organ Prolapse. European Journal of Histochemistry: EJH. 2016; 60(1): 2604. doi: 10.4081/ejh.2016.2604

Min K, Munarriz R, Kim NN, Goldstein I, Traish A. Effects of Ovariectomy and Estrogen and Androgen Treatment on Sildenafil-Mediated Changes in Female Genital Blood Flow and Vaginal Lubrication in the Animal Model. American Journal of Obstetrics and Gynecology. 2002;187(5): 1370-6. doi: 10.1067/mob.2002.126641

Chae HD, Choi SY, Cho EJ, Cho YM, Lee SR, Lee ES, et al. Awareness and Experience of Menopausal Symptom and Hormone Therapy in Korean Postmenopausal Women. Journal of Menopausal Medicine. 2014; 20(1):7-13. doi: 10.6118/jmm.2014.20.1.7

Farrell Am E. Genitourinary Syndrome of Menopause. Australian Family Physician. 2017;46(7): 481-4.

Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey. The Journal of Sexual Medicine. 2013;10(7): 1790-9. doi: 10.1111/jsm.12190

Krychman M, Graham S, Bernick B, Mirkin S, Kingsberg SA. The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. The Journal of Sexual Medicine. 2017; 14(3): 425-33. doi: 10.1016/j.jsxm.2017.01.011

Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina (Kaunas). 2019;55(9): 1-18. doi: 10.3390/medicina55090559

Naumova I, Castelo-Branco C. Current Treatment Options for Postmenopausal Vaginal Atrophy. International Journal of Women's Health. 2018;10(387-95. doi: 10.2147/IJWH.S158913

Wurz GT, Kao CJ, DeGregorio MW. Safety and Efficacy of Ospemifene for the Treatment of Dyspareunia Associated with Vulvar and Vaginal Atrophy due to Menopause. Clinical Interventions in Aging. 2014; 9(1939-50. doi: 10.2147/CIA.S73753

Rahn DD, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV, et al. Vaginal Estrogen for Genitourinary Syndrome of Menopause: a Systematic Review. Obstetrics and Gynecology. 2014;124(6): 1147-56. doi: 10.1097/AOG.0000000000000526

Archer DF, Kimble TD, Lin FDY, Battucci S, Sniukiene V, Liu JH. A Randomized, Multicenter, Double-Blind, Study to Evaluate the Safety and Efficacy of Estradiol Vaginal Cream 0.003% in Postmenopausal Women with Vaginal Dryness as the Most Bothersome Symptom. J Womens Health (Larchmt). 2018;27(3): 231-7. doi: 10.1089/jwh.2017.6515

Diem SJ, Guthrie KA, Mitchell CM, Reed SD, Larson JC, Ensrud KE, et al. Effects of Vaginal Estradiol Tablets and Moisturizer on Menopause-Specific Quality of Life and Mood in Healthy Postmenopausal Women with Vaginal Symptoms: a Randomized Clinical Trial. Menopause. 2018; 25(10): 1086-93. doi: 10.1097/GME.0000000000001131

Mitchell CM, Guthrie KA, Larson J, Diem S, LaCroix AZ, Caan B, et al. Sexual Frequency and Pain in a Randomized Clinical Trial of Vaginal Estradiol Tablets, Moisturizer, and Placebo in Postmenopausal Women. Menopause. 2019; 26(8): 816-22. doi: 10.1097/GME.0000000000001341

Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L, et al. Efficacy of Intravaginal Dehydroepiandrosterone (DHEA) on Moderate to Severe Dyspareunia and Vaginal Dryness, Symptoms of Vulvovaginal Atrophy, and of the Genitourinary Syndrome of Menopause. Menopause. 2016; 23(3):243-56. doi: 10.1097/GME.0000000000000571

Edwards D, Panay N. Treating Vulvovaginal Atrophy/Genitourinary Syndrome of Menopause: How Important is Vaginal Lubricant and Moisturizer Composition? Climacteric : the Journal of the International Menopause Society. 2016;19(2):151-61. doi: 10.3109/13697137.2015.1124259

Brown JM, Hess KL, Brown S, Murphy C, Waldman AL, Hezareh M. Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection among a Cohort of Women in the United States. Obstetrics and Gynecology. 2013;121(4): 773-80. doi: 10.1097/AOG.0b013e31828786f8

Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the Efficacy and Safety of Hyaluronic Acid Vaginal Gel to Ease Vaginal Dryness: a Multicenter, Randomized, Controlled, Open-Label, Parallel-Group, Clinical Trial. The Journal of Sexual Medicine. 2013;10(6):1575-84. doi: 10.1111/jsm.12125

Jokar A, Davari T, Asadi N, Ahmadi F, Foruhari S. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. International Journal of Community Based Nursing and Midwifery. 2016; 4(1): 69-78. doi:

Serati M, Bogani G, Di Dedda MC, Braghiroli A, Uccella S, Cromi A, et al. A Comparison Between Vaginal Estrogen and Vaginal Hyaluronic for the Treatment of Dyspareunia in Women using Hormonal Contraceptive. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2015;191(48-50. doi: 10.1016/j.ejogrb.2015.05.026

Munblit D, Abrol P, Sheth S, Chow LY, Khaleva E, Asmanov A, et al. Levels of Growth Factors and IgA in the Colostrum of Women from Burundi and Italy. Nutrients. 2018;10(9). doi: 10.3390/nu10091216

Vailati S, Melloni E, Riscassi E, Behr Roussel D, Sardina M. Evaluation of the Effects of a New Intravaginal Gel, Containing Purified Bovine Colostrum, on Vaginal Blood Flow and Vaginal Atrophy in Ovariectomized Rat. Sexual Medicine. 2013;1(2): 35-43. doi: 10.1002/sm2.8

Le Donne M, Caruso C, Mancuso A, Costa G, Iemmo R, Pizzimenti G, et al. The Effect of Vaginally Administered Genistein in Comparison with Hyaluronic Acid on Atrophic Epithelium in Postmenopause. Archives of Gynecology and Obstetrics. 2011; 283(6):1319-23. doi: 10.1007/s00404-010-1545-7

Lima SM, Bernardo BF, Yamada SS, Reis BF, da Silva GM, Galvao MA. Effects of Glycine max (L.) Merr. Soy Isoflavone Vaginal Gel on Epithelium Morphology and Estrogen Receptor Expression in Postmenopausal Women: a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial. Maturitas. 2014;78(3): 205-11. doi: 10.1016/j.maturitas.2014.04.007

Yaralizadeh M, Abedi P, Najar S, Namjoyan F, Saki A. Effect of Foeniculum Vulgare (fennel) Vaginal Cream on Vaginal Atrophy in Postmenopausal Women: A Double-Blind Randomized Placebo-Controlled Trial. Maturitas. 2016; 84(75-80. doi: 10.1016/j.maturitas.2015.11.005

Suwanvesh N, Manonai J, Sophonsritsuk A, Cherdshewasart W. Comparison of Pueraria mirifica Gel and Conjugated Equine Estrogen Cream Effects on Vaginal Health in Postmenopausal Women. Menopause. 2017; 24(2): 210-5. doi: 10.1097/GME.0000000000000742

Golmakani N, Parnan Emamverdikhan A, Zarifian A, Sajadi Tabassi SA, Hassanzadeh M. Vitamin E as Alternative Local Treatment in Genitourinary Syndrome of Menopause: a Randomized Controlled Trial. International Urogynecology Journal. 2019;30(5): 831-7. doi: 10.1007/s00192-018-3698-z

Hutchinson-Colas J, Segal S. Genitourinary Syndrome of Menopause and the Use of Laser Therapy. Maturitas. 2015; 82(4): 342-5. doi: 10.1016/j.maturitas.2015.08.001

Salvatore S, Athanasiou S, Candiani M. The Use of Pulsed CO2 Lasers for the Treatment of Vulvovaginal Atrophy. Current Opinion in Obstetrics & Gynecology. 2015; 27(6): 504-8. doi: 10.1097/GCO.0000000000000230

Published

28-05-2024

How to Cite

Sugiritama, I. W., Linawati, N. M., Wiryawan, I. G. N. S., Wahyuniari, I. A. I., Ratnayanti, G. A. D., & Arijana, I. G. K. N. (2024). Tinjauan Literatur: PATOGENESIS DAN TERAPI ATROFI VAGINA. Majalah Kesehatan, (00). Retrieved from https://majalahfk.ub.ac.id/index.php/mkfkub/article/view/672

Issue

Section

Literature Review