Estradiol 1mg and micronized natural progesterone 200mg 14 days a month (oral)

Percutaneous estradiol gel 1.5mg and micronized progesterone 200mg vaginal 14 days a month (non-oral)

Menopause

Hormone Replacement Therapy

Oral hormone therapy - estradiol 1mg every day and micronized natural progesterone 200mg only 14 days a month

Oral hormone therapy (estradiol and micronized natural progesterone)

Percutaneous estradiol gel 1.5mg every day and micronized progesterone 200mg vaginal only 14 days a month

Non-oral hormone therapy (estradiol and micronized natural progesterone)

Hospital de Clínicas de Porto Alegre

Effects of Hormone Replacement Therapy on Cardiovascular Risk and Body Composition Parameters

Effects of Oral and Non-oral Hormonal Therapy on Cardiovascular Risk and Body Composition Parameters in Postmenopausal Women

Lean mass (kilograms) evaluated by dual energy X-ray absorptiometry (DXA)

Fat mass (kilograms) evaluated by dual energy X-ray absorptiometry (DXA)

HDL, LDL, triglycerides (evaluated by blood sample)

Evaluated by dual energy X-ray absorptiometry (DXA)

Calcium, phosphorus, PTH, albumin, 25 OH vitamin D (evaluated by blood sample)

Hospital de Clinicas de Porto Alegre

With decreasing estrogen levels occurring following menopause, changes of the vaginal mucosa appear: it becomes thin and pale and loses its elasticity. The blood supply decreases, normal secretion is reduced, the epithelial cells do not undergo the normal differentiation process, the bacterial population changes with loss of lactobacilli and pH increases. These changes are associated with morphological and histological changes, manifested, among other findings, by alterations in the collagen composition, loss of the trabecular organization of collagen and reduced amount of elastic fibers. Women with reduced vaginal estrogen content may report dryness, itching, discomfort, burning sensation during micturition, pain and dyspareunia. These changes are reversible: topical or systemic estrogen change the vaginal mucosa's characteristics and may also alleviate complaints arising from estrogen deficiency.
The intervention is 3 treatments with fractional / Pixel CO2 Laser

Lichen sclerosus is a chronic cutaneous disease involving the vulvar and peri-anal skin. The involved skin becomes thin and white, with frequently present bruises or petechiae and anatomic changes.
Lichen sclerosus is thought to be an auto-immune disorder and its most frequent signs are itching, irritation or burning. The discoloration may involve the entire vulvar and peri-anal area (sometimes having the form of an "8" or a "keyhole" surrounding the vulva and anus) or appear as separated spots of various sizes occupying only part of the skin. At advanced stages of lichen sclerosus, scarring may appear, with loss of the labia minor and adhesions which may entirely cover the clitoris.
The treatment is of topical steroid. Lichen sclerosus is a chronic disorder, and even with good treatment, in a certain proportion of cases the skin does not return to its original appearance.
The intervention is 3 treatments with fractional / Pixel CO2 Laser

Vaginal Atrophy

Lichen Sclerosus

The laser energy is transferred in a fractioned manner: the laser beam splits while passing through a lens to 81 dots (9 x 9 pixels) onto approximately 1 cm2, so the laser rays hit the tissue in small spots.
For gynecological applications, the treatment is performed by a transducer, which was specifically designed for vaginal application.

Fractional / Pixel CO2 Laser

Hadassah Medical Organization

Fractional / Pixel CO2 Laser Treatment of Vulvar Atrophy and Lichen Sclerosus

Score of 1-15, which includes the following parameters: elasticity, fluid volume, pH, epithelial integrity, moisture.

Ratio of parabasal cells, intermediate cells and mature squamous cells

Visual analogue scale of symptoms (dryness, itch, irritation, pain, dysuria and dyspareunia)

Ahinoam Lev-Sagie

In the experimental arm, the participants will be randomized (1:1 allocation) to receive a vaginal progesterone suppository (100mg) as the intervention.
Participants will be instructed to insert the vaginal suppository into the vagina, as high as is comfortable for the patient. They are to insert the drug three days per week, on Monday, Wednesday and Fridays, preferably at bedtime. Patients will record the use of their medications. This will be done for the study period of 12 weeks.

In the placebo arm, the participants will be randomized (1:1 allocation) to receive a vaginal suppository (100mg) containing hard fat without any active hormonal ingredient as the intervention.
Participants will be instructed to insert the vaginal suppository into the vagina, as high as is comfortable for the patient. They are to insert the placebo three days per week, on Monday, Wednesday and Fridays, preferably at bedtime. Patients will record the use of their medications. This will be done for the study period of 12 weeks.

Atrophic Vaginitis

Vulvovaginal Atrophy

Micronized vaginal progesterone 100mg inserted vaginally

Vaginal progesterone

Placebo

Mount Sinai Hospital

Vaginal Progesterone Versus Placebo for the Treatment of Vaginal Atrophy

Vaginal Progesterone Versus Placebo for the Treatment of Vaginal Atrophy - a Double Blind Randomized Control Trial

Improvement in patient-identified most bothersome symptom (vaginal dryness, itching, soreness, pain with sexual activity)

Wendy Wolfman

Professor, Obstetrics and Gynaecology, University of Toronto

Mount Sinai Hospital, Canada

Patients will receive daily doses of 150 mg of concentrated extract of soy per os

Patients will receive daily placebo pills

150 mg of concentrated extract of soy containing 60 mg of isoflavone comprising 40 mg of genistein, 14,55 mg of daidizein, 3,02 mg of daidzine, 1,14 mg of glicitine, 0,91 mg genistine and 0,38 mg of glicetein.

Isoflavone

Universidade Federal de Sao Paulo's web page

atrophic vaginitis/progesterone

Effects of Hormone Replacement Therapy on Cardiovascular Risk and Body Composition Parameters

Fractional / Pixel CO2 Laser Treatment of Vulvar Atrophy and Lichen Sclerosus

Vaginal Progesterone Versus Placebo for the Treatment of Vaginal Atrophy

Effects of the Concentrated Extract of Soy on Coagulation Factors After Menopause

Effects of Tibolone Treatment on the Endometrium

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