N.V. Shperling (1, 2), E.V. Romanova (3), I.A. Sperling (2)

1 Medical University “Reaviz”, St. Petersburg, Russia; 2 State Scientific Research Test Institute of Military Medicine, St. Petersburg, Russia; 3 Siberian State Medical University, Tomsk, Russia
Background. The problem of atrophic vaginitis (AV) in postmenopause is widespread; it is considered as a natural aging process and is not currently solved. To ensure the proliferation of stratified squamous epithelium for the formation of vaginal resistance to infection in postmenopause, topical therapy with estrogens is performed. Before restoration of vaginal functions using estrogen preparations, pre-treatment sanitation is reasonable. The appearance of combined preparations with antimicrobial and fungicidal action on the market of requires the development of schemes for their effective application. Objective: to evaluate the clinical efficacy of complex therapy of AV in postmenopausal women, including the use of vaginal cream containing 2% butoconazole, clindamycin 2%, for vaginal use, followed by the use of suppositories with estriol. Methods. The main group (I) consisted of 54 women who were prescribed cream butoconazole+clindamycin 5 g daily intravaginally with an applicator for 6 days and then vaginal suppositories with estriol containing 0.5 mg of estriol, one suppository once a day before bed for 15 days. The comparison group (II) comprised 20 women who received only suppositories with estriol. The evaluation of the effectiveness of the treatment was carried out 2 weeks and 1 month after the treatment according to the results of the clinical and laboratory examination, including evaluation of smears of vaginal secretion from the cervix, and real-time polymerase chain reaction (Femoflor test). Results. Two weeks after the course of the medications, the most significant efficacy of the combined treatment of AV was noted: the acidity of the vaginal contents was restored to the average statistical value (pH 4.5); the white blood cell count in the vaginal secretion decreased more than by 10 times; the number of small rods increased by 2, 3 times; and 9-fold decrease in the representation of cocco-bacillary flora was observed. A month after the end of the combined treatment, the patients were clinically healthy. After monotherapy, 8 (40%) patients had a burning sensation in the vagina, all patients had low acidity of the vaginal contents (within the pH range of 6.1), a small number of lactobacilli (within 35.0±3.7%); representation of microflora remained at a high level due to coccobacillary flora (up to 50%). Conclusion. Pre-treatment application of the drug with a wide range of antimicrobial and fungicidal action allows to prevent the appearance of dysbiotic disorders in restoring the function of the cells of the vaginal mucosa during the treatment of AV in postmenopause. Complex therapy with combined cream for intravaginal use containing butoconazole+clindamycin (Clindacin B Prolong) and suppositories containing therapeutic doses of estriol (Ovipol Klio) serves as a simple and safe therapeutic strategy for AV in the
postmenopausal period.

About the Autors

Corresponding author: N.V. Shperling – MD, Prof. at the Department of Clinical Medicine of the Medical University «Reaviz», Senior Scientist at the State Scientific Research Test Institute of Military Medicine, St. Petersburg, Russia; e-mail:,

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