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Effects and safety of Pueraria mirifica gel on vaginal health and lower urinary tract in postmenopausal women
IUGA Academy. Manonai J. Jun 30, 2018; 212979; 333
Jittima Manonai
Jittima Manonai

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333

Effects and safety of Pueraria mirifica gel on vaginal health and lower urinary tract in postmenopausal women

Manonai, J1

1: Faculty of Medicine Ramathibodi Hospital, Mahidol University

Introduction Due to estrogen depletion in postmenopausal period, the epithelium of genital and lower urinary tract would be dry and thin. Moreover, those organs would have declined in cell proliferation, had lower acidity and decreased in blood supply. As a results, postmenopausal women have higher chance to experience genitourinary syndrome of menopause such as, vaginal dryness, abnormal discharge, and urinary incontinence. Vaginal estrogens are effective in treating genital symptoms in postmenopausal women. Focusing on female continence, estrogens are known to affect most components that contribute to urethral closure and bladder function.

Pueraria mirifica (PM) is a kind of herb mainly consisted of miroestrol, deoxymiroestrol, which exhibit similar effects to estrogens. Pueraria mirifica demonstrated an estrogen-like effect on the urethral epithelium and increased leak point pressure according to urodynamic study in ovariectomized rats. There is no evidence on estrogenic effects of PM on urethral epithelium and vascular component of urethra in postmenopausal women.

Objective To compare the effects of Pueraria mirifica gel and placebo gel on vaginal and urethral cytology, vaginal pH, and periurethral blood flow in postmenopausal women.

Methods In a randomized, double blinded, placebo-controlled study, 20 postmenopausal women were randomly assigned into two groups for treatment with either 0.5 g of 5% Pueraria mirifica gel or identical placebo gel intravaginally daily for 2 weeks. Vaginal maturation index, urethral maturation index and urethral vascularity were evaluated at the beginning and 2-weeks after treatment. The endovaginal ultrasound (EVUS) scan was performed to examine the anterior compartment focusing on the urethra with the use of a biplane transducer (type 8848) with a frequency of 12 MHz. Color Doppler mode was applied for assessment of the vascularity pattern; the analyzed parameters were the pulsatility index (PI) and resistance index (RI).

Results A total of 20 participants were enrolled; 10 were assigned to the Pueraria mirifica gel group and the other 10 to the placebo gel group. The mean age was 58.05 + 4.91 years and years since menopause was 9.95 + 6.31 years. The vaginal pH decreased from 7.3 + 0.89 to 6.75 + 0.95 after 2 weeks of PM treatment while there were no changes in the placebo group. The vaginal maturation index increased significantly in the PM group, from 14.25 + 24.61 to 40.00 + 26.35 (p<0.05) and it was significantly different from the placebo group (p<0.05). The urethral maturation index did not increased significantly in both groups at week 2 (p>0.05). The PI and RI remained unchanged in both groups (p>0.05).

Table 1 Mean values of Doppler velocimetric parameters before and after treatment

Parameters

Pueraria mirifica group

Placebo group

p value

Before

After

Before

After

Pulsatility index

5.99 + 1.81

5.97 + 1.35

5.65 + 1.60

5.79 + 1.82

0.364

Resistance index

1.02 + 0.09

1.07 + 0.11

0.99 + 0.02

1.04 + 0.07

0.855

Conclusion Two-week treatment of 5% Pueraria mirifica vaginal gel was efficient in improving vaginal health compared to placebo gel. The PM vaginal gel did not demonstrate estrogenic effects on urethral epithelium and periurethral vascularization.

Disclosure:

Work supported by industry: no.

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