rehabРеабилитологияJournal of Medical Rehabilitation2949-58732949-5881IRBIS LLC10.17749/2949-5873/rehabil.2023.5rehab-14Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESРеабилитация пациенток с вульвовагинальной атрофиейRehabilitation of patients with vulvovaginal atrophyХазанП. Л.KhazanP. L.

Хазан Петр Леонидович - к.м.н.

3-я Парковая ул., д. 51, стр. 1, Москва 105425

Petr L. Khazan - PhD.

51, bldg 1 3rd Parkovaya Str., Moscow 105425

p_hasan2000@mail.ruМнацаканьянА. Н.MnatsakanyanA. N.

Мнацаканьян Анна Никитична - к.ф.н., доцент.

Ул. 2-я Бауманская, д. 5, стр. 4, Москва 105005

Anna N. Mnatsakanyan - PhD, Assoc. Prof.

5, bldg 4 2nd Baumanskaya Str., Moscow 105005

https://orcid.org/0000-0002-0459-0488КорабельниковД. И.KorabelnikovD. I.

Корабельников Даниил Иванович - к.м.н., доцент. Scopus Author ID: 7801382184.

Ул. 2-я Брестская, д. 5, Москва 123056

Daniil I. Korabelnikov - PhD, Assoc. Prof. Scopus Author ID: 7801382184.

5 Brestskaya Str., Moscow 123056

https://orcid.org/0000-0002-3509-9501АмпилоговаД. М.AmpilogovaD. M.

Ампилогова Диана Михайловна

Ул. Пехотная, д. 3, Москва 123182

Diana M. Ampilogova

3 Pekhotnaya Str., Moscow 123182

https://orcid.org/0000-0001-5849-5585ПетренкоД. А.PetrenkoD. A.

Петренко Дарья Андреевна

Ул. Трубецкая, д. 8/2, Москва 119048

Daria А. Petrenko

8/2 Trubetskaya Str., Moscow 119048

Научно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал Федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияLopatkin Research Institute of Urology and Interventional Radiology – branch of National Medical Research Radiological CentreRussian FederationФедеральное государственное бюджетное учреждение высшего образования «Московский государственный технический университет им. Н.Э. Баумана (национальный исследовательский университет)»РоссияBauman Moscow State Technical UniversityRussian FederationАвтономная некоммерческая организация дополнительного профессионального образования «Московский медико-социальный институт им. Ф.П. Гааза»РоссияHaass Moscow Medical Social InstituteRussian FederationГосударственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница № 52 Департамента здравоохранения города Москвы»РоссияCity Clinical Hospital No. 52Russian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian Federation202306092024116068Copyright © Хазан П.Л., Мнацаканьян А.Н., Корабельников Д.И., Ампилогова Д.М., Петренко Д.А., 20242024Хазан П.Л., Мнацаканьян А.Н., Корабельников Д.И., Ампилогова Д.М., Петренко Д.А.Khazan P.L., Mnatsakanyan A.N., Korabelnikov D.I., Ampilogova D.M., Petrenko D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rehabilitology.com/jour/article/view/14Актуальность

Актуальность. Генитоуринарный менопаузальный синдром (ГУМС) характеризуется широким спектром патологических изменений, в частности урологическими расстройствами, вульвовагинальной атрофией (ВВА) и сексуальной дисфункцией. Они обычно сопровождаются существенным падением качества жизни (КЖ) женщин и зачастую требуют медицинского вмешательства. При этом применяемых мер, позволяющих эффективно решить данную проблему, недостаточно. Таким образом, актуальным представляется поиск средств реабилитации пациенток с ВВА.

Цель

Цель: определить эффективность современных средств реабилитации пациенток с ВВА.

Материал и методы

Материал и методы. Поиск публикаций в международных научных базах PubMed/MEDLINE, ScienceDirect, поисковых системах и научной электронной библиотеке eLibrary позволил выявить 4330 публикаций. После процедуры отсева с учетом рекомендаций PRISMA в анализ отобрано 44 источника.

Результаты

Результаты. В основе развития ВВА лежит снижение сывороточного эстрогена и эстрогенных рецепторов. Эстроген является вазоактивным гормоном, способствует кровенаполнению половых органов и участвует в поддержании нормальной микрофлоры мочеполовых путей. У женщин данный процесс может развиться как по возрастным причинам, так и вследствие проводимой терапии или радикального хирургического вмешательства. При этом зачастую происходит формирование ГУМС, одним из ключевых элементов которого является ВВА. Данные изменения сопровождаются сексуальной дисфункцией, дистрессом и падением общего КЖ женщин. Пациенткам такого профиля целесообразно проводить комплексную персонифицированную реабилитацию и мониторинг КЖ. Показана эффективность эстрогенсодержащих препаратов при местном использовании, а также вспомогательной терапии негормональными лубрикантами и увлажняющими гелями или кремами у женщин с ВВА.

Заключение

Заключение. Определено, что симптомы ВВА в целом существенно влияют на КЖ пациенток вне зависимости от возраста. Отмечена необходимость разработки специализированных реабилитационных программ, проводимых специалистами различного профиля. Эффективность данных программ будет выше при своевременной диагностике, которая тоже требует существенного внимания.

Background

Background. Genitourinary syndrome of menopause (GSM) is characterized by a number of pathological changes, in particular urological disorders, vulvovaginal atrophy (VVA) and sexual dysfunction. They are commonly accompanied by decreased quality of life (QoL) and often require medical intervention. At the same time, the steps taken to effectively solve this problem are not enough. Thus, it seems relevant to search for rehabilitation methods for VVA patients.

Objective

Objective: to determine the effectiveness of current rehabilitation methods for VVA patients.

Material and methods

Material and methods. The search of publications in international scientific databases PubMed/MEDLINE, ScienceDirect, search engines and eLibrary revealed 4,330 publications, of them 44 sources were selected for the analysis after the screening procedure according to PRISMA scheme.

Results

Results. VVA is based on decreased serum estrogen level and estrogen receptors quantity. Estrogen is a vasoactive hormone that promotes blood supply to the genitals and is involved in maintaining the normal genitourinary microflora. This may occur in women for age-related reasons or as a result of ongoing therapy or radical surgical intervention. At the same time, GSM is often formed, where VVA is one of the key elements. These changes are accompanied by sexual dysfunction, distress and decreased overall QoL in women. It is advisable to carry out complex personalized rehabilitation and QoL monitoring for such patients. The effectiveness of estrogen-containing therapy for topical use as well as adjunctive therapy with non-hormonal lubricants and moisturizing gels or creams was shown for VVA patients.

Conclusion

Conclusion. It was determined that VVA symptoms, in general, significantly affect the patients’ QoL, regardless of age. The necessity of developing specialized rehabilitation programs conducted by specialists of various profiles was noted. The effectiveness of these programs will be higher with timely diagnosis, which also requires significant attention.

Генитоуринарный менопаузальный синдромГУМСвульвовагинальная атрофияВВАсексуальная дисфункцияреабилитацияGenitourinary syndrome of menopauseGSMvulvovaginal atrophyVVAsexual dysfunctionrehabilitationReferencesMac Bride M.B., Rhodes D.J., Shuster L.T. Vulvovaginal atrophy. Mayo Clin Proc. 2010; 85 (1): 87–94. https://doi.org/10.4065/mcp.2009.0413.Mac Bride M.B., Rhodes D.J., Shuster L.T. Vulvovaginal atrophy. Mayo Clin Proc. 2010; 85 (1): 87–94. https://doi.org/10.4065/mcp.2009.0413.Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015; 58 (3): 476–91. https://doi.org/10.1097/GRF.0000000000000126.Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015; 58 (3): 476–91. https://doi.org/10.1097/GRF.0000000000000126.Portman D.J., Gass M.L.S., Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014; 21 (10): 1063–8. https://doi.org/10.1097/GME.0000000000000329.Portman D.J., Gass M.L.S., Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014; 21 (10): 1063–8. https://doi.org/10.1097/GME.0000000000000329.Макацария А.Д., Блинов Д.В., Бицадзе В.О., Хизроева Д.Х. Лечение эстриолом вульвовагинальной атрофии в постменопаузе: обновление научных данных 2014–2018 гг. Акушерство, гинекология и репродукция. 2019; 13 (3): 227–38. https://doi.org/10.17749/2313-7347.2019.13.3.227-238.Makatsariya A.D., Blinov D.V., Bitsadze V.O., Khizroeva J.Kh. Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018. Obstetrics, Gynecology and Reproduction. 2019; 13 (3): 227–38 (in Russ.). https://doi.org/10.17749/2313-7347.2019.13.3.227-238.Nappi R.E., Martini E., Cucinella L., et al. Addressing vulvovaginal atrophy (VVA) / genitourinary syndrome of menopause (GSM) for healthy aging in women. Front Endocrinol. 2019; 10: 561. https://doi.org/10.3389/fendo.2019.00561.Nappi R.E., Martini E., Cucinella L., et al. Addressing vulvovaginal atrophy (VVA) / genitourinary syndrome of menopause (GSM) for healthy aging in women. Front Endocrinol. 2019; 10: 561. https://doi.org/10.3389/fendo.2019.00561.Власина А.Ю., Идрисова Л.Э., Солопова А.Г. и др. Реабилитация онкогинекологических больных после противоопухолевой терапии: пути решения. Акушерство, гинекология и репродукция. 2020; 14 (1): 55. https://doi.org/10.17749/2313-7347.2020.14.1.44-55.Vlasina A.V., Idrisova L.E., Solopova A.G., et al. Rehabilitation of oncogynecological patients after antitumor therapy: ways of solution. Obstetrics, Gynecology and Reproduction. 2020; 14 (1): 55 (in Russ.). https://doi.org/10.17749/2313-7347.2020.14.1.44-55.Cox P., Panay N. Vulvovaginal atrophy in women after cancer. Climacteric. 2019; 22 (6): 565–71. https://doi.org/10.1080/13697137.2019.1643180.Cox P., Panay N. Vulvovaginal atrophy in women after cancer. Climacteric. 2019; 22 (6): 565–71. https://doi.org/10.1080/13697137.2019.1643180.Gandhi J., Chen A., Dagur G., et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016; 215 (6): 704–11. https://doi.org/10.1016/j.ajog.2016.07.045.Gandhi J., Chen A., Dagur G., et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016; 215 (6): 704–11. https://doi.org/10.1016/j.ajog.2016.07.045.DiBonaventura M., Luo X., Moffatt M., et al. The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe. J Womens Health. 2015; 24 (9): 713–22. https://doi.org/10.1089/jwh.2014.5177.DiBonaventura M., Luo X., Moffatt M., et al. The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe. J Womens Health. 2015; 24 (9): 713–22. https://doi.org/10.1089/jwh.2014.5177.Palacios S. Managing urogenital atrophy. Maturitas. 2009; 63 (4): 315–8. https://doi.org/10.1016/j.maturitas.2009.04.009.Palacios S. Managing urogenital atrophy. Maturitas. 2009; 63 (4): 315–8. https://doi.org/10.1016/j.maturitas.2009.04.009.Peters K.J. What is genitourinary syndrome of menopause and why should we care? Perm J. 2021; 25: 20.248. https://doi.org/10.7812/TPP/20.248.Peters K.J. What is genitourinary syndrome of menopause and why should we care? Perm J. 2021; 25: 20.248. https://doi.org/10.7812/TPP/20.248.Солопова А.Г., Табакман Ю.Ю., Идрисова Л.Э., Сдвижков А.М. Реабилитация онкогинекологических больных. Взгляд на проблему. Акушерство, гинекология и репродукция. 2016; 9 (4): 46–54. https://doi.org/10.17749/2070-4968.2015.9.4.046-054.Solopova A.G., Tabakman Yu.Yu., Idrisova L.E., Sdvizhkov A.M. Rehabilitation of onсogyneсologic patients. View of a problem. Obstetrics, Gynecology and Reproduction. 2016; 9 (4): 46–54 (in Russ.). https://doi.org/10.17749/2070-4968.2015.9.4.046-054.Блинов Д.В., Акарачкова Е.С., Ампилогова Д.М. и др. Депрессия у женщин в менопаузе: организация междисциплинарного подхода в лечении и перспективы реабилитации. Акушерство, гинекология и репродукция. 2021; 15 (6): 738–54. https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.280.Blinov D.V., Akarachkova E.S., Ampilogova D.M., et al. Depression in postmenopause: interdisciplinary approach in management and perspectives for rehabilitation. Obstetrics, Gynecology and Reproduction. 2021; 15 (6): 738–54 (in Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.280.Particco M., Djumaeva S., Nappi R.E., et al. The European Vulvovaginal Epidemiological Survey (EVES): impact on sexual function of vulvovaginal atrophy of menopause. Menopause. 2020; 27 (4): 423–9. https://doi.org/10.1097/GME.0000000000001496.Particco M., Djumaeva S., Nappi R.E., et al. The European Vulvovaginal Epidemiological Survey (EVES): impact on sexual function of vulvovaginal atrophy of menopause. Menopause. 2020; 27 (4): 423–9. https://doi.org/10.1097/GME.0000000000001496.PRISMA 2020 statement. URL: https://www.prisma-statement.org/ prisma-2020-statement (дата обращения 27.06.2023).PRISMA 2020 statement. Available at: https://www.prismastatement.org/prisma-2020-statement (accessed 27.06.2023).Angelou K., Grigoriadis T., Diakosavvas M., et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020; 12 (4): e7586. https://doi.org/10.7759/cureus.7586.Angelou K., Grigoriadis T., Diakosavvas M., et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020; 12 (4): e7586. https://doi.org/10.7759/cureus.7586.Musicki B., Liu T., Lagoda G.A., et al. Endothelial nitric oxide synthase regulation in female genital tract structures. J Sex Med. 2009; 6 (S3 Proceedings): 247–53. https://doi.org/10.1111/j.1743-6109.2008.01122.x.Musicki B., Liu T., Lagoda G.A., et al. Endothelial nitric oxide synthase regulation in female genital tract structures. J Sex Med. 2009; 6 (S3 Proceedings): 247–53. https://doi.org/10.1111/j.1743-6109.2008.01122.x.Briggs P. Genitourinary syndrome of menopause. Post Reprod Health. 2020; 26 (2): 111–4. https://doi.org/10.1177/2053369119884144.Briggs P. Genitourinary syndrome of menopause. Post Reprod Health. 2020; 26 (2): 111–4. https://doi.org/10.1177/2053369119884144.North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007; 14 (3 Pt. 1): 355–69. https://doi.org/10.1097/gme.0b013e31805170eb.North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007; 14 (3 Pt. 1): 355–69. https://doi.org/10.1097/gme.0b013e31805170eb.Palma F., Volpe A., Villa P., Cagnacci A. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas. 2016; 83: 40–4. https://doi.org/10.1016/j.maturitas.2015.09.001.Palma F., Volpe A., Villa P., Cagnacci A. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas. 2016; 83: 40–4. https://doi.org/10.1016/j.maturitas.2015.09.001.Wasnik V.B., Acharya N., Mohammad S. Genitourinary syndrome of menopause: a narrative review focusing on its effects on the sexual health and quality of life of women. Cureus. 2023; 15 (11): e48143. https://doi.org/10.7759/cureus.48143.Wasnik V.B., Acharya N., Mohammad S. Genitourinary syndrome of menopause: a narrative review focusing on its effects on the sexual health and quality of life of women. Cureus. 2023; 15 (11): e48143. https://doi.org/10.7759/cureus.48143.Kim H.K., Kang S.Y., Chung Y.J., et al. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015; 21 (2): 65–71. https://doi.org/10.6118/jmm.2015.21.2.65.Kim H.K., Kang S.Y., Chung Y.J., et al. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015; 21 (2): 65–71. https://doi.org/10.6118/jmm.2015.21.2.65.Nappi R.E., Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012; 15 (1): 36–44. https://doi.org/10.3109/13697137.2011.647840.Nappi R.E., Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012; 15 (1): 36–44. https://doi.org/10.3109/13697137.2011.647840.Levine K.B., Williams R.E., Hartmann K.E. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause. 2008; 15 (4 Pt. 1): 661–6. https://doi.org/10.1097/gme.0b013e31815a5168.Levine K.B., Williams R.E., Hartmann K.E. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause. 2008; 15 (4 Pt. 1): 661–6. https://doi.org/10.1097/gme.0b013e31815a5168.Robinson D., Cardozo L.D. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003; 62 (4 Suppl. 1): 45–51. https://doi.org/10.1016/s0090-4295(03)00676-9.Robinson D., Cardozo L.D. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003; 62 (4 Suppl. 1): 45–51. https://doi.org/10.1016/s0090-4295(03)00676-9.Felippe M.R., Zambon J.P., Girotti M.E., et al. What is the real impact of urinary incontinence on female sexual dysfunction? A case control study. Sex Med. 2017; 5 (1): e54–60. https://doi.org/10.1016/j.esxm.2016.09.001.Felippe M.R., Zambon J.P., Girotti M.E., et al. What is the real impact of urinary incontinence on female sexual dysfunction? A case control study. Sex Med. 2017; 5 (1): e54–60. https://doi.org/10.1016/j.esxm.2016.09.001.Moral E., Delgado J.L., Carmona F., et al. Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Climacteric. 2018; 21 (2): 167–73. https://doi.org/10.1080/13697137.2017.1421921.Moral E., Delgado J.L., Carmona F., et al. Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Climacteric. 2018; 21 (2): 167–73. https://doi.org/10.1080/13697137.2017.1421921.Nappi R.E., Kingsberg S., Maamari R., Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013; 10 (9): 2232–41. https://doi.org/10.1111/jsm.12235.Nappi R.E., Kingsberg S., Maamari R., Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013; 10 (9): 2232–41. https://doi.org/10.1111/jsm.12235.Kingsberg S.A., Wysocki S., Magnus L., Krychman M.L. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013; 10 (7): 1790–9. https://doi.org/10.1111/jsm.12190.Kingsberg S.A., Wysocki S., Magnus L., Krychman M.L. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013; 10 (7): 1790–9. https://doi.org/10.1111/jsm.12190.Diyu I.A.N.P., Agustini N.K.T. The correlation between menopausal symptoms and sexual function in menopausal women. J Islam Nurs. 2021; 6 (1): 19–22. https://doi.org/10.24252/join.v6i1.17887.Diyu I.A.N.P., Agustini N.K.T. The correlation between menopausal symptoms and sexual function in menopausal women. J Islam Nurs. 2021; 6 (1): 19–22. https://doi.org/10.24252/join.v6i1.17887.Доскин В.А., Лаврентьева Н.А., Мирошников М.П., Шарай В.Б. Тест дифференцированной самооценки функционального состояния. Вопросы психологии. 1973; 6: 141–5.Doskin V.A., Lavrentyeva N.A., Miroshnikov M.P., Sharay V.B. Test of differentiated self-assessment of functional state. Voprosy Psychologii. 1973; 6: 141–5 (in Russ.).FACT-G. Functional Assessment of Cancer Therapy – General. URL: https://www.facit.org/measures/fact-g (дата обращения 27.06.2023).FACT-G. Functional Assessment of Cancer Therapy – General. Available at: https://www.facit.org/measures/fact-g (accessed 27.06.2023).EORTC Quality of Life. Quality of Life of Cancer Patients. URL: https://qol.eortc.org/questionnaire/eortc-qlq-c30/ (дата обращения 27.06.2023).EORTC Quality of Life. Quality of Life of Cancer Patients. Available at: https://qol.eortc.org/questionnaire/eortc-qlq-c30/ (accessed 27.06.2023).Reed S.D., Mitchell C.M., Joffe H., et al. Sexual function in women on estradiol or venlafaxine for hot flushes: a randomized controlled trial. Obstet Gynecol. 2014; 124 (2 Pt 1): 233–41. https://doi.org/10.1097/AOG.0000000000000386.Reed S.D., Mitchell C.M., Joffe H., et al. Sexual function in women on estradiol or venlafaxine for hot flushes: a randomized controlled trial. Obstet Gynecol. 2014; 124 (2 Pt 1): 233–41. https://doi.org/10.1097/AOG.0000000000000386.Pines A., Sturdee D.W. Personal opinion: treatment of vulvovaginal atrophy – are hidden interests and misinformation preventing better management? Climacteric. 2015; 18 (6): 802–4. https://doi.org/10.3109/13697137.2015.1090149.Pines A., Sturdee D.W. Personal opinion: treatment of vulvovaginal atrophy – are hidden interests and misinformation preventing better management? Climacteric. 2015; 18 (6): 802–4. https://doi.org/10.3109/13697137.2015.1090149.Перепанова Т.С., Хазан П.Л. Современные подходы к терапии урогенитальных расстройств у женщин в постменопаузе. Акушерство, гинекология и репродукция. 2011; 5 (1): 10–3.Perepanova T.S., Khazan P.L. Modern approaches to therapy of urogenital disorders in post-menopausal females. Obstetrics, Gynecology and Reproduction. 2011; 5 (1): 10–3 (in Russ).Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005; 8 (Suppl. 1): 3–63. https://doi.org/10.1080/13697130500148875.Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005; 8 (Suppl. 1): 3–63. https://doi.org/10.1080/13697130500148875.Seland M., Skrede K., Lindemann K., et al. Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer. Acta Obstet Gynecol Scand. 2022; 101 (3): 313–22. https://doi.org/10.1111/aogs.14310.Seland M., Skrede K., Lindemann K., et al. Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer. Acta Obstet Gynecol Scand. 2022; 101 (3): 313–22. https://doi.org/10.1111/aogs.14310.Weare K. Rehabilitation after gynecological cancer treatment. Int J Gynaecol Obstet. 2015; 131 (Suppl. 2): S164–6. https://doi.org/10.1016/j.ijgo.2015.06.015.Weare K. Rehabilitation after gynecological cancer treatment. Int J Gynaecol Obstet. 2015; 131 (Suppl. 2): S164–6. https://doi.org/10.1016/j.ijgo.2015.06.015.Verrilli L., Esposito-Smith M., Williams M. Sexual health and function in menopause and beyond. In: Brown H.W., Williams M., Schrager S. (Eds.) Challenges in older women’s health: a guide for clinicians. Springer International Publishing; 2021: 185–99. https://doi.org/10.1007/978-3-030-59058-1_12.Verrilli L., Esposito-Smith M., Williams M. Sexual health and function in menopause and beyond. In: Brown H.W., Williams M., Schrager S. (Eds.) Challenges in older women’s health: a guide for clinicians. Springer International Publishing; 2021: 185–99. https://doi.org/10.1007/978-3-030-59058-1_12.Srisukho S., Pantasri T., Piyamongkol W., et al. The experience of genitourinary syndrome of menopause (GSM) among Thai postmenopausal women: the non-reporting issue. Int Urogynecol J. 2019; 30 (11): 1843–7. https://doi.org/10.1007/s00192-019-03991-0.Srisukho S., Pantasri T., Piyamongkol W., et al. The experience of genitourinary syndrome of menopause (GSM) among Thai postmenopausal women: the non-reporting issue. Int Urogynecol J. 2019; 30 (11): 1843–7. https://doi.org/10.1007/s00192-019-03991-0.Jensen S.E., Rosenbloom S.K., Beaumont J.L. A new index of priority symptoms in advanced ovarian cancer. Gynecol Oncol. 2011; 120 (2): 214–9.Jensen S.E., Rosenbloom S.K., Beaumont J.L. A new index of priority symptoms in advanced ovarian cancer. Gynecol Oncol. 2011; 120 (2): 214–9.Náfrádi L., Nakamoto K., Schulz P.J. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017; 12 (10): e0186458. https://doi.org/10.1371/journal.pone.0186458.Náfrádi L., Nakamoto K., Schulz P.J. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017; 12 (10): e0186458. https://doi.org/10.1371/journal.pone.0186458.Schofield P., Juraskova I., Bergin R., et al. A nurseand peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial. Trials. 2013; 14: 39. https://doi.org/10.1186/1745-6215-14-39.Schofield P., Juraskova I., Bergin R., et al. A nurseand peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial. Trials. 2013; 14: 39. https://doi.org/10.1186/1745-6215-14-39.Donnelly C.M., Lowe-Strong A., Rankin J.P., et al. A focus group study exploring gynecological cancer survivors’ experiences and perceptions of participating in a RCT testing the efficacy of a homebased physical activity intervention. Support Care Cancer. 2013; 21 (6): 1697–708. https://doi.org/10.1007/s00520-012-1716.Donnelly C.M., Lowe-Strong A., Rankin J.P., et al. A focus group study exploring gynecological cancer survivors’ experiences and perceptions of participating in a RCT testing the efficacy of a homebased physical activity intervention. Support Care Cancer. 2013; 21 (6): 1697–708. https://doi.org/10.1007/s00520-012-1716.

The authors declare that there are no conflicts of interest present.