Postmenopausal Vaginal Atrophy: Non-hormonal therapy with a moisturizing bioadhesive vaginal gel

Introduction Vaginal atrophy (VA) is an irreversible involution of the mucous membranes and tissues of the vagina following the drop in estrogen that commonly occurs in women during menopause (1). Due to a lengthening of the average lifespan and longer life expectancy after menopause, vaginal atrophy is destined to become a clinical problem with an increasingly greater epidemiological significance. It is a known fact that the urogenital epithelium is sensitive to the action of estrogens. The reduction in the circulating levels of these hormones brings about the onset of atrophy and a thinning of the vaginal and urethral mucous membrane (2). Vaginal atrophy has substantial repercussions of a genuinely pathological nature because it facilitates urogenital infections and, at the same time, impacts a woman’s quality of life during menopause by altering relations with her partner due to dyspareunia (3). Vaginal atrophy generally occurs with a sensation of dryness and burning, often also accompanied by itching, and urogenital infections are not uncommon (4). About 40% of menopausal women present with vaginal atrophy (1) and this incidence rises as the period of menopause grows longer. The physiopathological condition of vaginal atrophy is sustained by a thinning of the mucous membrane epithelium, with a reduction in secretions of the glandular epithelia in turn due to reduced hydration and loss of vaginal texture and elasticity. Typically, the vaginal pH during menopause tends toward values considerably higher than those observed during fertility (5). This increased pH in combination with an estrogen deficiency can in turn promote profound modifications of the vaginal bacterial flora, making bacterial forms of vaginal infections more frequent.