위축성 질염의 좌훈 치료 연구에 관한 체계적 문헌 고찰

백선은 ( Seon Eun Baek ),장새별 ( Sae Byul Jang ),최경희 ( Kyung Hee Choi ),유정은 ( Jeong Eun Yoo ) 대한한방부인과학회 2016 大韓韓方婦人科學會誌 Vol.29 No.1

Objectives: The purpose of this systematic review was to overview and evaluate the effectiveness of fumigation treatment for women with atrophic vaginitis. Methods: We searched articles from Pubmed, Chinese Academic Journals (CAJ) and Oasis online databases. Searching keywords were ‘fumigation’, ‘atrophic vaginitis’, ‘vaginitis’, ‘陰道炎’, ‘膣炎’, ‘老年性 陰道炎’, ‘坐熏’, ‘熏洗’, ‘熏浴’, ‘좌훈요법’, ‘질염’, ‘위축성질염’. After searching the articles, we performed quality assessment using Cochrane risk of bias (RoB) tool. Results: Among the 142 articles were searched, 5 randomized controlled clinical trials (RCTs) were finally selected. All of 5 studies showed that fumigation treatment has significant effect on atrophic vaginitis in terms of the effectiveness rate, but 3 studies were not statistically significant. Conclusions: Our systematic review found encouraging but limited evidence of fumigation therapy for atrophic vaginitis. We recommend clinical trials which obtain stronger evidence without the demerits of trial design.

위축성 질염의 한약 치료 임상 연구에 관한 체계적 문헌 고찰

남은영 대한한방부인과학회 2019 大韓韓方婦人科學會誌 Vol.32 No.3

Objectives: The purpose of this study is to review clinical studies of traditional Korean medicine treatment (herb medicine) on vaginal atrophy. Methods: Key words “Vaginal atrophy”, “Vulvovaginal atrophy”, “Vaginal dryness”, “Atrophic vaginitis”, “Herb medicine”, “Acupuncture”, “Moxibustion”, “Catgut embedding” were searched on 11 database systems (PMC, CENTRAL, EMBASE, CNKI, KTKP, KISS, NDSL, OASIS, DBpia, KMBASE, RISS) on May 31th 2019. In all searches, limits were set for MeSH (human) and language (English, Chinese or Korean). Results: 18 controlled clinical trials were collected in accordance with the selection and exclusion criteria. The types of intervention were herbal medicine, and types of herbal medicine were decoction, cream, suppository, oil, ect. The study results and methods of intervention were analyzed. Conclusions: Among the 18 trials, 5 studies showed that herbal medicine with hormone or antiprotozoal therapy was more effective than hormone or antiprotozoal therapy alone. And 2 studies showed that herbal medicine treatment was more effective than oil treatment of topical use. There was no abnormal vaginal bleeding, breast swelling and pain in TCM group.

위축성 질염을 호소하는 여성의 HRV 특성 연구

김민영 ( Min Young Kim ),유은실 ( Eun Sil Yoo ),황덕상 ( Deok Sang Hwang ),이진무 ( Jin Moo Lee ),장준복 ( Jun Bock Jang ),이경섭 ( Kyung Sub Lee ),이창훈 ( Chang Hoon Lee ) 대한한방부인과학회 2015 大韓韓方婦人科學會誌 Vol.28 No.3

Objectives: This study is performed to recognize the relationship between atrophic vaginitis and stress that have an affect on autonomic nervous system. Methods: We studied 47 patients who visited Kangnam Kyunghee Korean Hospital Medical Examination Center from November, 2013 to June, 2014. They were devided into two groups, atrophic vaginitis group (AV, n=18) and non-atrophic vaginitis group (NAV, n=29). We compared the result of HRV between the two groups. Results: The mean of The standard deviation of NN intervals (SDNN), the square root of the mean squared difference of successive NNs (RMSSD) in AV group was lower than NAV group, but there was no significant difference between the two groups. Total power (TP), low frequency (LF) and very low frequency (VLF) of AV group was significantly lower than NAV group. There was no significant difference in high frequency (HF). Conclusions: Women with atrophic vaginitis is expected to have low adaptive capacity against stress.

위축성 질염으로 진단받은 폐경 여성 환자에 대한 한방치료 치험 2례

강나훈 ( Na-hoon Kang ),김준호 ( Joon-ho Kim ),박남춘 ( Nam-chun Park ),유은실 ( Eun-sil Yoo ),이진무 ( Jin-moo Lee ),이창훈 ( Chang-hoon Lee ),장준복 ( Jun-bok Jang ),황덕상 ( Deok-sang Hwang ) 대한한방부인과학회 2016 大韓韓方婦人科學會誌 Vol.29 No.4

Objectives: Atrophic vaginitis is common disease in menopausal women. There are some studies about effective of the Korean medicine therapies to treat this disease, but cases are still deficiency. This study aims to report the effects of Korean medicine therapies on atrophic vaginitis in menopausal women. Methods: 2 menopausal women patients, who are suffered from atrophic vaginitis, were enrolled in this study. They received Korean medicine therapies such as herbal medicine, moxibustion, and acupuncture. Results: After Korean medicine therapies, severity of symptoms of atropic vaginitis were reduced. Conclusions: The present study suggests that Korean medicine therapies have a effect on atrophic vaginitis in menopausal women.

Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials

( Arum Lee ),( Tae-hee Kim ),( Hae-hyeog Lee ),( Yeon-suk Kim ),( Temuulee Enkhbold ),( Bora Lee ),( Yoo Jin Park ),( Kisung Song ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.1

Objectives: Atrophic vaginitis (AV), which is common in postmenopausal women, is characterized by vaginal dryness, dyspareunia, and discomfort. There are a variety of therapeutic agents for the treatment of AV, besides hormone replacement therapy. We performed this systematic review to compare the effectiveness of various therapies for symptom improvement in AV patients. Methods: We searched the Cochrane Library, EMBASE, MEDLINE, and other literature (Google Scholar, Web of Science, and hand search) for studies published between January 2010 and March 2015. AV was evaluated by the following outcomes: vaginal pH, dyspareunia, vaginal dryness, or cytological change (endometrial thickness, percentages of superficial cells and parabasal cells). They measured treatment efficacy with various outcomes pertaining to AV symptoms. Results: Meta-analysis suggested that ospemifene was effective against dyspareunia, vaginal dryness, endometrial thickness, and percentage changes in superficial and parabasal cells. Vaginal pH was most affected by soy isoflavone vaginal gel. Ospemifene was effective for AV symptoms. Conclusions: This systematic review compared the effects of several therapeutic agents on symptoms of AV through a network meta-analysis. This study provides objective evidence for clinical treatment and efficacy management in AV. (J Menopausal Med 2018;24:1-10)

비뇨생식기 위축 증상을 동반한 폐경 여성에서 에스트로겐 질정 투여 후 국소 증상, 질 내 산도 및 질 성숙 지표의 변화

김명환 ( Myoung Hwan Kim ),최훈 ( Hoon Choi ) 대한폐경학회 2010 대한폐경학회지 Vol.16 No.3

연구목적: 비뇨생식기 위축 증상을 호소하는 폐경 여성에게 에스트로겐 국소 요법은 효과적이라고 알려져 있다. 그러나 그 효과를 조기에 판정할 수 있는 방법은 명확하게 알려져 있지 않다. 본 연구는 폐경 여성에서 에스트로겐 질 정 투여 전후 위축 증상, 질 성숙 지표, 질 내 산도 (pH)를 측정하여 가장 먼저 좋아지는 지표를 알아보고자 하였다. 연구재료 및 방법: 2007년 11월 1일부터 2009년 4월 30일까지 상계백병원 폐경기 클리닉에 방문한 환자를 대상으로 1주 치료군과 2주 치료군으로 무작위 배정하여 처음 방문 시 질 내 산도 (pH), 질 성숙 지표 (vaginal maturation index, VMI) 검사, 가장 불편한 증상을 측정하였고 주 3회 에스트리올 질 정 (500μg) 투여 후 질 내 산도, 질 성숙 지표, 위축 증상 호전 유무를 측정하는 전향적 연구를 시행하였다. 각 치료 군의 치료 전후 위축 증상 호전 유무, 질 내 산도(pH), 질 성숙 지표를 비교 평가하였고 각 군 간에도 차이가 있는지 비교하였다. 1주 치료군은 40명, 2주 치료군은 27명이 실험을 완료하였다. 각 군 환자들의 투여 전후 질 내 산도, 질 성숙 지표는 Paired T-test, 국소 폐경 증상 호전유무는 McNemar test를 사용하여 비교하였다. 두 치료군 간의 질 내 산도, 질 성숙 지표는 Independent T-test, 위축 증상 호전 빈도는 Chi-square test를 사용하여 비교하였고 maturation value (MV)와 질 내 산도의 상관관계는 Pearson`s correlation coefficient를 사용하여 비교하였다. 결 과: 1주 치료군과 2주 치료군 모두에서 치료 전후 평균 질 성숙 지표의 세포분율에 유의한 변화가 있었고, 평균MV는 1주 치료군에서는 치료 전 23.1 ± 21.6 (SD)에서 치료 후 38.2 ± 23.9 (SD), 2주 치료군에서는 치료 전 23.6 ± 26.1 (SD)에서 치료 후 46.1 ± 15.0 (SD)로 유의한 증가가 있었다 (각각 P=0.000, P=0.000). 두 군 간 MV를 치료전과 후에 비교하였을 때 유의한 차이는 없었다 (P=0.933, P=0.931). 1주 치료 군의 평균 질 내 산도는 치료 전 6.2 ± 0.5 (SD)에서 치료 후 5.0 ± 1.0 (SD)로 유의한 감소가 있었고, 2주 치료 군의 평균 질 내 산도도 치료 전 6.2 ± 0.6 (SD)에서 치료 후 4.8 ± 0.8 (SD)로 유의한 감소가 있었다 (각각 P=0.002, P=0.000). 두 군 간 질 내 산도 (pH)를 치료 전과 후에 비교하였을 때 유의한 차이는 없었다 (각각 P=0.756, P=0.261). 가장 불편해 하는 증상 (most bothersome symptom)은 두 군 모두에서 유의한 증상 개선을 보였다 (1주 치료군: P=0.000, 2주: P=0.000). 두 군간 위축 증상의 치료 후 개선 빈도의 차이는 없었다 (P=0.777). MV와 질 내 산도의 상관관계는 치료 전 상관계수 r = -0.518, 1주 치료 후 상관계수 r= -0.736, 2주 치료 후 상관계수 r= -0.481로 뚜렷한 음적 선형관계를 보였다. (각각 P=0.000, P=0.000, P=0.011). 결론: 비뇨생식기 위축 증상을 호소하는 폐경 여성에게 주 3회 에스트리올 질 정을 투여한 후 위축 증상, 질 내 산도, 질 성숙지표의 유의한 변화가 1주부터 관찰되며, 이들 세 가지 지표는 어느 한 지표의 선행함이 없이 동시에 호전된다고 생각된다. Objectives: The aim of this study was to assess atrophic symptoms, the vaginal maturation index (VMI), and vaginal pH in postmenopausal women after use of estriol vaginal tablets for the treatment of vaginal atrophy. Methods: In a randomized prospective study, 67 postmenopausal women were treated with 500μg estriol tablets 3 times a week for 1 week in the 1-week treatment group (n=40) and for 2 weeks in the 2-week treatment group (n=27). The primary endpoints were changes in the VMI, vaginal pH, and improvement in participant-reported most bothersome symptom (MBS; vaginal dryness, irritation/itching, or dyspareunia). We compared three endpoints before and after treatment in each group and between the two treatment groups. The correlation between the vaginal pH and maturation value (MV) was assessed. Results: A statistically significant increase in the MV, decrease in pH, and improvement in the MBS occurred for women treated with estriol vaginal tablets in the 1- (P=0.000, P=0.002, and P=0.000, respectively) and 2-week treatment groups (P=0.000, P=0.000, and P=0.000, respectively). There were no significant differences between the 1- and 2-week treatment groups with respect to improvement in the VMI, vaginal pH, or MBS. The correlation between the vaginal pH and MV showed a negative linear correlation at 0, 1, and 2 weeks (P=0.000, P=0.000, and P=0.011, respectively). Conclusion: Treatment with 500μg estriol vaginal tablets thrice-weekly for 1 week was effective in improving. It is thought that the three primary endpoints (VMI, vaginal pH, and MBS) improved at the same time during treatment. (J Korean Soc Menopause 2010;16:162-169)

위축성 질염에 대한 한약 투약의 효과 : 체계적 문헌 고찰

박어진,조희근 대한한방부인과학회 2019 大韓韓方婦人科學會誌 Vol.32 No.3

Objectives: To evaluate the effectiveness and safety of application of Traditional East Asian Herbal Medicine (TEAM) in the treatment of Atrophic Vaginitis (AV). Methods: Randomized Controlled Trials (RCTs) were obtained from PubMed, Cochrane Library, Embase, CNKI, RISS, NDSL, and KISS. The risk of bias was assessed by using Cochrane’s risk of bias tool, and RevMan 5.3 software was used. Results: 26 RCTs with 3,162 patients were identified and reviewed. Among them, 21 RCTs observe the effect of integrated traditional Chinese and Western medicine. 23 RCTs reported treatment groups was statistically effective than control groups in the study. Also, the recurrence rate was estimated in 10 RCTs and was lower than control groups. 12 studies observed adverse events (AEs) and severe AEs were not reported. Conclusions: This review suggested that TEAM was safe and effective in the treatment of AV. TEAM may also decrease the recurrence rate. However, this could not be proven conclusively. To ensure evidence-based clinical practice, well-designed trials with larger sample sizes are needed.

Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements

( Suhyun Shim ),( Kyung-min Park ),( Youn-jee Chung ),( Mee-ran Kim ) 대한폐경학회 2021 대한폐경학회지 Vol.27 No.1

Postmenopausal atrophic vaginitis, along with vasomotor symptoms and sleep disorders, is one of the most troublesome symptoms of menopause. However, many women do not manage this symptom properly due to insufficient knowledge of the symptoms or sexual embarrassment. With appropriate treatment, many postmenopausal women can experience relief from discomforts, including burning sensation or dryness of the vagina and dyspareunia. Topical lubricants and moisturizers, systemic and local estrogens, testosterones, intravaginal dehydroepiandrosterones (DHEAs), selective estrogen receptor modulators, and energy-based therapies are possible treatment modalities. Systemic and local estrogen therapies effectively treat genitourinary syndrome of menopause (GSM), but they are contraindicated in patients with breast cancer, for whom lubricants and moisturizers must be considered as the primary treatment. Intravaginal DHEA and ospemifene can be recommended for moderate to severe GSM; however, there is insufficient data on the use of intravaginal DHEA or ospemifene in patients with breast cancer, and further studies are needed. Energy-based devices such as vaginal laser therapy reportedly alleviate GSM symptoms; however, the U.S. Food and Drug Administration warning has recently been issued because of complications such as chronic pain and burning sensations of the vagina. To summarize, clinicians should provide appropriate individualized treatment options depending on women’s past history, symptom severity, and chief complaints.

Vaginal Vitamin E for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review of Randomized Controlled Trials

( Laura Porterfield ),( Nyajuok Wur ),( Zuleica Santiago Delgado ),( Farha Syed ),( Amanda Song ),( Susan C. Weller ) 대한폐경학회 2022 대한폐경학회지 Vol.28 No.1

Genitourinary syndrome of menopause significantly affects the quality of life in postmenopausal women with few evidence-based alternatives to vaginal estrogen for women with contraindications. This systematic review evaluates the evidence for vaginal vitamin E efficacy in reducing patient-reported genitourinary symptoms in healthy postmenopausal women compared to placebo or vaginal control therapy. This systematic review evaluated randomized controlled trials before October 2020 that assessed the efficacy of vitamin E vaginal suppositories in reducing genitourinary symptoms in postmenopausal women compared with a control group of healthy postmenopausal women. Outcomes included patient-perceived genitourinary symptoms. Of the 31 studies, four met the inclusion criteria. One 8-week trial (n = 42) found a significant reduction in vaginal symptoms in the 1 mg vitamin E group than the placebo group (difference in means, 5.3; 95% confidence interval [CI], 4.4 to 6.2). Another 8-week trial (n = 40) found 5 mg vaginal hyaluronic acid superior to 1 mg vitamin E (difference in means -0.50, 95% CI, -0.95 to -0.05). Two 12-week trials (n = 52 in each) found no difference between 0.5 g vaginal estrogen and 100 IU vaginal vitamin E in healthy postmenopausal women (difference in means: -0.19, 95% CI, -4.4 to 4.0, and -3.47, 95% CI, -13.8 to 6.8). Evidence from small, limited studies suggests that vaginal vitamin E may be effective in alleviating symptoms of genitourinary syndrome of menopause; however, additional high-quality studies are needed to determine efficacy, ideal dosing, and long-term safety.

Gold Thread Implantation for Female Sexual Dysfunction and Vaginal Laxity: A Preliminary Investigation

Su Mi Kim,Young Seok Won,Seul Ki Kim 대한폐경학회 2020 대한폐경학회지 Vol.26 No.2

Objectives: We evaluated the efficacy of gold thread implantation (GTI) in the vulva and vagina to improve female sexual dysfunction (FSD) and vaginal laxity. Methods: A retrospective chart review was conducted on 46 women who underwent GTI between 2017 and 2018 at our institution. Physicians interviewed patients using questionnaires at baseline and 1–3 months post-treatment. The questionnaires consisted of eight questions: vaginal laxity, vaginal dryness, pain during intercourse, sexual satisfaction during intercourse, sexual arousal confidence, sexual satisfaction of partner, frequency, and maintaining lubrication. Results: Overall, participants experienced significant improvement after GTI treatment (P < 0.0001). The median score of vaginal laxity was 3 (slightly loose) at baseline and 5 (slightly tight) at post-treatment. Vaginal dryness also improved from 4 (moderate) at baseline to 2 (little) at post-treatment. The degree of pain during intercourse decreased from 3 to 1. The sexual satisfaction score was 3 (moderately dissatisfied) at baseline and 4 (about equally satisfied and dissatisfied) at post-treatment. Sexual confidence of arousal increased from a score of 3 (low confidence) at baseline to 4 (moderate confidence) at post-treatment. They perceived greater partner sexual satisfaction, moving from a score of 2 to 4. Participants reported lubrication was more frequent during sexual activity, which was maintained until completion of sexual activity. Both scores regarding lubrication increased from 3.5 at baseline to 5 at post-treatment. Conclusions: GTI may be an option for FSD and vaginal laxity.