| Objective Through the experimental study of fenmanto,estradiol gel,propestrene vaginal softgel capsule and Lactobacillus progenus capsule for the treatment of GSM,the effects on GSM symptoms,vaginal health index,vaginal microbiome,vaginal immune molecules,vaginal glycogen and lactate content,endometrial thickness and hormone levels were observed,and the regulatory mechanism of estrogen drugs with different dosage forms and routes of administration on vaginal microbiome recovery and immunity in GSM patients was discussed,and their safety was evaluated,so as to provide a basis for clinical use.Methods A total of 120 GSM patients who visited the Gynecology Clinic of the General Hospital of Ning Xia and the Gynecology Clinic of Cardiovascular between September 2021 and September 2022 were randomly divided into 4 groups,with a total of 3 groups in the observation group,respectively treated with fenmanto,propestrene vaginal softgel,and estradiol gel,30 cases in each group,and 30 cases in the control group.The GSM symptom score,vaginal health index score,number of lactobacillus in vaginal secretions,glycogen,lactic acid and SIg A contents of the four groups before and after drug treatment were compared,and the changes of ALT,AST,creatinine,urea,estrogen(E2),follicle-stimulating hormone(FSH)levels,endometrial thickness and the incidence of adverse events before and after treatment were observed.Results(1)The three estrogen drugs in the observation group significantly improved the symptom score and vaginal health index score(P<0.05)of GSM.The symptom score and vaginal health index score of the control group improved significantly after treatment(P<0.05),but the symptom improvement was not as good as that of the observation group,and there was a statistically significant difference in symptom score after treatment(P<0.05).(2)The content of lactic acid in vaginal secretions in the observation group and the control group after treatment increased significantly compared with before treatment(P<0.05),the p H value in the vagina was significantly lower than before treatment(P<0.05),and the lactobacillus count in the observation group after treatment was significantly increased compared with before treatment(P<0.05)and there was no significant difference between the three groups,but the increase in the estradiol gel group was not obvious,and there was no significant difference with the difference before treatment.After treatment,the lactobacillus count in the control group was statistically significant compared with the estradiol gel group(P<0.008),and the p H value was significantly reduced(P<0.05).The glycogen content in the observation group after treatment increased significantly(P<0.05),among which the content of proestrene vaginal softgel group was higher than that in the fenmotong group and estradiol gel group,but there was no significant significance,while the glycogen content in the control group after treatment was not statistically significant compared with before treatment.(3)The content of SIg A in vaginal discharge in the observation group increased significantly after treatment(P<0.05),and there was no significant significance between the three groups after treatment,while the SIg A content in the control group before and after treatment was not statistically significant,and there was a significant statistical difference between the control group and the observation group after treatment(P<0.05).(4)There were no significant differences between ALT,AST,creatinine and urea levels in the four groups after treatment and before treatment,and the endometrial thickness and E2 levels in the observation group were significantly increased(P<0.05)and FSH levels decreased(P<0.05)after treatment in the observation group,but still within the normal range,there was no significant difference in endometrial thickness,E2 and FSH levels in the observation group and the control group compared with before treatment.There was no significant difference in the incidence of adverse reactions between the four groups after treatment,but the incidence of adverse reactions in the observation group was lower than in the proestrone vaginal softgel group and the control group than in the other two observation groups.Conclusion(1)Oral,percutaneous and vaginal local estrogen therapy can significantly improve GSM symptoms,vaginal health index score,and improve vaginal local immunity,and the effect is better than that of vaginal lactobacillus live bacteria capsules;(2)Transvaginal administration of estrogen has a certain effect on the recovery of vaginal microecology in GSM patients,has a better effect on the improvement of vaginal immune microenvironment,and shows better safety than systemic MHT;(3)Lactobacillus live bacteria capsules for vaginal use have better advantages than estrogen in increasing the amount of vaginal lactobacillus and lactic acid and reducing vaginal PH. |
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