A Review on Therapeutic Effects of Labisia pumila on Female Reproductive Diseases.

The Labisia pumila (LP) is a traditional plant that is locally known as Kacip Fatimah, Selusuh Fatimah, or Pokok Ringgang by the Malaysian indigenous people. It is believed to facilitate their childbirth, treating their postchild birth and menstrual irregularities. The water extract of LP has shown to contain bioactive compounds such as flavonoids, ascorbic acid, ß-carotene, anthocyanin, and phenolic acid, which contribute extensive antioxidant, anti-inflammatory, antimicrobial, and antifungal. The LP ethanolic extract exhibits significant estrogenic effects on human endomentrial adenocarcinoma cell in estrogen-free basal medium and promoting an increase in secretion of alkaline phosphate. Water based has been used for many generations, and studies had reported that it could displace in binding the antibodies and increase the estradiol production making it similar to esterone and estradiol hormone. LP extract poses a potential and beneficial aspect in medical and cosmeceutical applications. This is mainly due to its phytoestrogen properties of the LP. However, there is a specific functionality in the application of LP extract, due to specific functional group in phytoconstituent of LP. Apart from that, the extraction solvent is important in preparing the LP extract as it poses some significant and mild side effects towards consuming the LP extracts. The current situation of women reproductive disease such as postmenopausal syndrome and polycystic ovary syndrome is increasing. Thus, it is important to find ways in alternative treatment for women reproductive disease that is less costly and low side effects. In conclusion, these studies proven that LP has the potential to be an alternative way in treating female reproductive related diseases such as in postmenopausal and polysystic ovarian syndrome women.

At-Home Transvaginal Device Following Fractional Carbon Dioxide Laser Treatment for Genitourinary Syndrome of Menopause.

BACKGROUND: Device-based therapeutic approaches have been developed to treat women’s genitourinary post-menopausal symptoms. Fractional carbon dioxide laser resurfacing (FxCO2) has been demonstrated to be safe and effective in the treatment of GSM symptoms, however the results begin to wane by 12-months post-treatment. OBJECTIVE: This study aims at assessing the application of an at-home transvaginal red and infrared light device as a maintenance treatment commencing 12 months following FxCO2 laser treatment for genitourinary syndrome of menopause (GSM). STUDY DESIGN: Subjects completing 12-month follow-up after three fractional CO2 laser vulvovaginal treatments received an at-home device and monitored for GSM symptoms with long-term follow-up to 12 months (2 years post-laser). METHODS: 10 post-menopausal subjects completing 12-months follow-up after three FxCO2 vulvovaginal treatments for GSM were treated with an at-home red and infrared LED device. Treatment consisted of intravaginal application three times per week, and subjects were followed to 1, 3, 6, and 12 months. Subjects completed the vaginal assessment scale subject satisfaction, and QUID to assess for vulvovaginal and stress urinary incontinence (SUI) symptoms. RESULTS: Vulvovaginal symptoms measured by VAS were mean 89% improved at 12-month follow-up after FxCO2 and maintained at 73% improved over baseline (2 years post-laser) following an additional 12 months of at-home transvaginal light therapy (P<0.05). VAS symptoms gradually increased over the 12 months maintenance period by a mean of 17% (P<0.05). Mean subject satisfaction was 0 at baseline, 1.86 at 1 year following FxCO2, and 1.00 after an additional 1 year of at-home light therapy. SUI symptoms as measured by QUID were mean 81% improved at 12-month follow-up after FxCO2and maintained at 38% improved over baseline (2 years post-laser) following an additional 12-months of at-home light therapy (P<0.05). SUI symptoms gradually increased by a mean of 43% over the 12-month maintenance period (P<0.05). CONCLUSIONS: At-home transvaginal red and near infrared light therapy commencing at 12 months post-FxCO2 vulvovaginal treatment in a post-menopausal population maintained statistically significant improvements in vulvovaginal and SUI symptoms over the additional12-month period (2 years post-laser); however, a gradual return of symptoms suggests that laser re-treatment or combination withhormone therapy may be necessary to maintain optimal outcomes.J Drugs Dermatol. 2020;19(11):1076-1079. doi:10.36849/JDD.2020.1012.

Fisiopatología y tratamiento de la atrofia genitourinaria en mujeres / Pathophysiology and therapy of urogenital atrophy in women

La involución del tracto genital femenino refleja su integración con los cambios que sufre el eje hipotálamo-hipofisario-ovárico. El descenso de los niveles de estradiol conlleva una serie de efectos adversos, incluidos los relativos a las vías urinarias inferiores. El cambio más importante es la atrofia vaginal: la mucosa vaginal se vuelve más fina y seca, lo cual puede producir incomodidad vaginal, sequedad, quemazón, prurito y dispareunia. El epitelio vaginal puede presentar cambios inflamatorios y ser un factor que contribuya a los síntomas urinarios, tales como frecuencia, urgencia, disuria, incontinencia, e infecciones recurrentes. Por otra parte, se ha sugerido que los niveles bajos de estrógenos pueden afectar los tejidos periuretrales y contribuir a la laxitud de la pelvis y la incontinencia de esfuerzo. Relacionados con el hipoestrogenismo, los cambios en el pH y la flora vaginal pueden predisponer a las mujeres posmenopáusicas a las infecciones del tracto urinario. La terapia hormonal local en forma de cremas, comprimidos o supositorios es la base del tratamiento de la atrofia genital. Además, otras vías de administración de hormonas, tanto local como sistémica, también han demostrado ser válidas. Sin embargo, a pesar de que los beneficios del reemplazo con estrógenos en la prevención de la atrofia vaginal y la reducción de la incidencia de los síntomas están bien establecidos, este tipo de tratamiento está contraindicado en algunas mujeres y no es una opción aceptable para otras. Pero además, la ruta óptima de administración del tratamiento hormonal, el régimen, las dosis, y las alternativas no hormonales para mejorar los síntomas y la calidad de vida de la población posmenopáusica no han sido completamente estudiados. Esta revisión se centra en los cambios del envejecimiento vaginal e intenta presentar una sinopsis de la fisiopatología y el tratamiento de la atrofia vaginal y la vaginitis atrófica.

Fisiopatología y tratamiento de la atrofia genitourinaria en mujeres / Pathophysiology and therapy of urogenital atrophy in women

La involución del tracto genital femenino refleja su integración con los cambios que sufre el eje hipotálamo-hipofisario-ovárico. El descenso de los niveles de estradiol conlleva una serie de efectos adversos, incluidos los relativos a las vías urinarias inferiores. El cambio más importante es la atrofia vaginal: la mucosa vaginal se vuelve más fina y seca, lo cual puede producir incomodidad vaginal, sequedad, quemazón, prurito y dispareunia. El epitelio vaginal puede presentar cambios inflamatorios y ser un factor que contribuya a los síntomas urinarios, tales como frecuencia, urgencia, disuria, incontinencia, e infecciones recurrentes. Por otra parte, se ha sugerido que los niveles bajos de estrógenos pueden afectar los tejidos periuretrales y contribuir a la laxitud de la pelvis y la incontinencia de esfuerzo. Relacionados con el hipoestrogenismo, los cambios en el pH y la flora vaginal pueden predisponer a las mujeres posmenopáusicas a las infecciones del tracto urinario. La terapia hormonal local en forma de cremas, comprimidos o supositorios es la base del tratamiento de la atrofia genital. Además, otras vías de administración de hormonas, tanto local como sistémica, también han demostrado ser válidas. Sin embargo, a pesar de que los beneficios del reemplazo con estrógenos en la prevención de la atrofia vaginal y la reducción de la incidencia de los síntomas están bien establecidos, este tipo de tratamiento está contraindicado en algunas mujeres y no es una opción aceptable para otras. Pero además, la ruta óptima de administración del tratamiento hormonal, el régimen, las dosis, y las alternativas no hormonales para mejorar los síntomas y la calidad de vida de la población posmenopáusica no han sido completamente estudiados. Esta revisión se centra en los cambios del envejecimiento vaginal e intenta presentar una sinopsis de la fisiopatología y el tratamiento de la atrofia vaginal y la vaginitis atrófica. (AU)

Dolor de origen urogenital / Pain of urogenital origin

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Urogenital atrophy: prevention and treatment.

Fifteen percent of premenopausal women, 10-40% of postmenopausal women, and 10-25% of women receiving systemic hormone therapy experience urogenital atrophy. The most common symptoms are dryness, burning, pruritus, irritation, and dyspareunia. Estrogen loss, drugs, and chemical sensitivities are causes. Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women. Dosages prescribed for menopause symptoms or to prevent osteoporosis (and, potentially, other conditions) can restore the vagina to premenopausal physiology and relieve symptoms. Concomitant progestins are necessary for women with an intact uterus to minimize or eliminate estrogen-induced endometrial cancer. Low-dosage oral and vaginal ERT can relieve urogenital atrophy but might not produce systemic effects. Progestins are not necessary with vaginal rings and vaginal tablets. If ERT is given only to treat urogenital atrophy, estrogen creams 1 or 2 times/week may prevent recurrence after symptoms are resolved. Progestins are not required for occasional estrogen cream use. Vaginal moisturizers provide longer relief by changing the fluid content of endothelium and lowering vaginal pH. Vaginal lubricants provide short-term relief. Women with contraindications to ERT-HRT could use lubricants for intercourse-related dryness or moisturizers for more continuous relief. The lay press promotes agrimony, black cohosh, chaste tree, dong quai, witch hazel, and phytoestrogens for vaginal dryness and dyspareunia; however, no evidence exists to support these specific claims. Pharmacists should be actively involved in identifying, preventing, and treating urogenital atrophy.