1Department of Midwifery, Yasuj College of Medical Sciences, Yasuj, Iran
2Department of Midwifery, College of Nursing and Midwifery, Ahvaz Jundishapur College of Medical Sciences, Ahvaz, Iran
3Department of Pharmacology, Nanotechnology Analysis Heart and Faculty of Pharmacy, Ahvaz Jundishapur College of Medical Sciences, Ahvaz, Iran
4Department of Public Well being, College of Public Well being, Ahvaz Jundishapur College of Medical Sciences, Ahvaz, Iran
5Department of Pathology, Jundishapour College of Medical Sciences, Ahvaz, Iran
6Department of Anatomy, Yasouj College of Medical Sciences, Yasuj, Iran
Summary
INTRODUCTION
Menopause is the stage of a girl’s reproductive life that’s accompanied by estrogen deficiency which has many damaging results on the vaginal mucosa, resembling dryness, irritation, and vaginal atrophy.[1,2] There may be proof that vulvovaginal atrophy is a standard situation in postmenopausal girls.[3,4] In a traditional situation, the vaginal epithelium is rugated, moist, and thick, whereas in estrogen deficiency, it turns into dry and skinny.[5] Subsequently, estrogen hormone is crucial to take care of the conventional construction and performance of the vaginal tract. So, exterior intervention is required to scale back the widespread signs together with postcoital bleeding, dyspareunia, pruritus, and soreness in postmenopausal girls.[6] Varied therapies resembling hormonal remedy and vaginal moisturizers have been thought of and evaluated for vaginal atrophy.[7,8] Though vaginal estrogens are an efficient remedy for vulvovaginal atrophy, there are issues in some girls with a historical past of breast or endometrial hyperplasia.[9] Additionally, a report says that the systemic estrogen can enhance the thrombosis and breast most cancers danger.[10] So, non-hormonal different remedy is critical to eliminate the antagonistic results of exogenous estrogen. Vitamin D [1,25-dihydroxyvitamin D3 (1,25(OH) 2D3] is a promoter of keratinocyte differentiation and proliferation within the dermis.[11] It has been documented that the vaginal epithelium turns into atrophic within the absence of estradiol.[12] One other research confirmed that using calcitriol has a helpful impact on vaginal atrophy in postmenopausal girls and it could possibly be an alternative choice to estrogen remedy.[13] Additionally, 1,25(OH) 2D3 can utilized in totally different illnesses together with diabetes, most cancers, and psoriasis.[14] Moreover, in an experimental research, remedy with exogenous vitamin D3 in ovariectomized rats led to expression of vitamin D receptor within the superficial layers of the vaginal epithelium.[12] Conflicting stories recommend that calcium with Vitamin D remedy following discontinuation of postmenopausal hormone remedy in osteoporotic girls trigger the worsening of vaginal atrophy signs.[15] This contrasting proof created some questions in regards to the helpful results of 1,25(OH) 2 D3 on vaginal atrophy which haven’t been answered. Thus, this medical trial was performed to judge whether or not vitamin D vaginal suppository might enhance the sexual ache, maturation index, and vaginal atrophy in postmenopausal girls.
MATERIALS AND METHODS
This research was a double-blind medical trial that was authorized by the institutional ethics committee of medical sciences and was registered within the Iranian registry of medical trials (http://irct.ir) with IRCT No.: IRCT201111185109N1. A follicle-stimulating hormone (FSH) check have been used to confirmed whether or not the ladies has gone via menopause. postmenopausal girls have been enrolled on this medical trial who menopause occurred for at the least 1 yr as much as 4 years. These girls who had an irregular Papanicolaou smear or have had hormonal remedy or existence of vaginal an infection within the earlier yr have been excluded from the research. Forty-four girls who discovered eligible have been randomized into two equal teams, the remedy and management teams, which obtained vitamin D and placebo vaginal suppository every day for 8 weeks, respectively.
RESULTS
As proven in Desk 1, the outcomes indicated no vital relation in age, physique mass, the age at menopause, and parturition between the 2 teams [Table 1].
As proven in Desk 2, impartial samples t-test confirmed no vital relation in imply ache throughout intercourse earlier than remedy and from the primary to the fourth week of the research. Outcomes confirmed that the distinction within the imply ache scores between the 2 teams elevated from the 2nd week towards the eighth week [Table 2]. The imply ache scores decreased within the remedy group considerably in comparison with the management group after 56 days. Outcomes additionally confirmed the imply values of dryness and paleness have been the identical earlier than remedy and till 14 days of the research [Table 2], whereas dryness and paleness decreased considerably within the remedy group in comparison with the management group at 56 days [Table 2].
The imply of pH in girls with vitamin D vaginal suppository was considerably decrease than in girls with placebo suppositories (P < 0.001) at 56 days after remedy [Table 3]. The numbers of parabasal, intermediate, and superficial cells from the smear have been counted earlier than remedy and at 56 days of the research in each the teams. Unbiased samples t-test confirmed there was not any vital distinction between the 2 teams earlier than remedy [Table 3]. Eight weeks after the research, the imply of superficial cells (Imply ± SD: 69.76 ± 12.4) within the remedy group elevated considerably compared to the management group (54.66 ± 18.38) [Table 3]. Epithelial parabasal cells elevated in girls with placebo vaginal suppository in comparison with the quantity within the girls of remedy group [Figure 1].
DISCUSSION – “vitamin d vaginal suppository”
This medical trial confirmed that vitamin D vaginal suppositories have protecting results that lower the imply ache throughout intercourse, vaginal pH, dryness, and paleness and assist enhance the vaginal maturation worth in comparison with the placebo suppositories. These findings are in settlement with the research of Yildirim and colleagues who reported that the organic impact of vitamin D on vaginal epithelium is mediated by its receptors.[17] The findings of the research confirmed the imply of the superficial cells within the remedy group elevated from almost 10 to 68 cells throughout the research. These findings are supported by the results of Abban and colleagues that the intracellular receptors of vitamin D are within the basal and suprabasal layers of the vaginal epithelium.[12,18] Additional, these receptors not solely exist in stratified squamous epithelium, but in addition are discovered on vascular clean muscle, endothelium, and cardiomyocytes.[19] Within the current research, vitamin D vaginal suppositories protected the vaginal squamous epithelium and brought on a rise of superficial cells [Figure 1].
Our information demonstrated that dryness decreased by 26% in girls with vitamin D vaginal suppositories. This result’s in settlement with Checa et al.’s report that vitamin D is efficient in treating vaginal dryness with its receptors.[15] Importantly, our information confirmed the lower in vaginal pH which improves the microenvironment of the epithelial layers of the mucous membrane, and in addition hydration and elasticity of the vaginal mucosa. The acidic situations of the vagina point out a wholesome vaginal ecology and is a possible to stop development of pathogens resembling Gardnerella vaginalis, Mycoplasma hominis and anaerobes, that are elevated in diseased vagina.[20] Though estrogen remedy is the primary method to deal with vaginal atrophy and has quite a few protecting results on the urogenital tissue,[21] it’s contraindicated in many ladies with a historical past of breast most cancers, stroke, dementia, or venous thromboembolism.[22] So, hormone substitute remedy is useful for postmenopausal girls to scale back the danger of heart problems, endometrial hyperplasia, and colon most cancers.[23] Thus, vaginal moisturizers and lubricants are the choice selections for vaginal atrophy. Moreover, it has been discovered that there is no such thing as a report concerning the facet impact of vitamin D.[13] Subsequently, vitamin D vaginal suppository is accessible with out prescription and is used as a lubricant and vaginal moisturizer. Thus, it may be a brand new technique to deal with vaginal atrophy.[13] Vitamin D was additionally discovered to have antiapoptotic and antifibrotic results and acts as a pleiotropic hormone with proliferative and differentiation results on quite a few cell sorts.[24] Different non-hormonal different remedy, resembling Replens, has been proven to be efficient in relieving menopausal atrophic vaginitis, nevertheless it wants a carbomer-polycarbophil system.[25] Though vitamin D reduces friction and vaginal dryness, contrasting proof signifies that lubricants and moisturizers are ineffective to deal with vaginal atrophy signs.[24] However within the current research, discount of vaginal pH and enhance of superficial cells within the vaginal epithelium demonstrated that vitamin D is efficient to restore the histology and alleviate current signs. The doable mechanism by which vitamin D brings in regards to the restoration of vaginal epithelium could possibly be defined by its regulatory motion on calcium and phosphate metabolism in stratified squamous epithelium.[26] Though low-dose vaginal estrogen might restore the thickness and suppleness of the vaginal tissue, some antagonistic results, resembling vaginal bleeding and breast ache, have been related to conjugated equine estrogen cream remedy.[27] Thus, some hormone substitute remedy could possibly be simpler for vaginal maturation and to revive the morphology of vaginal atrophy in post-menopausal girls than an estrogen cream.[28] In accordance with an earlier report, our consequence additionally confirmed vitamin D supplementations enhance vaginal maturation.[13]
CONCLUSION
The outcomes of this research confirmed vitamin D have protecting results for vaginal atrophy in postmenopausal girls, and particularly this strategies is pricey, sensible and simple to achieve. It’s a new secure therapeutically agent, with none response and have results in enhancing the VMV. Subsequently, the applying of vitamin D in vaginal atrophy remedy ought to be pursued.
ACKNOWLEDGMENT
“vitamin d vaginal suppository”