{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:13:55Z","timestamp":1784542435187,"version":"3.55.0"},"reference-count":76,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hormonal vaginal therapy is an effective treatment option for women who experience vaginal symptoms related to hormonal changes. Estrogen and prasterone are widely used as vaginal treatments, particularly for urogenital atrophy. These symptoms may include vaginal dryness, itching, burning, and pain during sexual intercourse, all of which can significantly affect a woman\u2019s quality of life. Previous studies have indicated that such treatment improves tissue elasticity, moisturizes the vagina, and can have a substantial impact on urine incontinence and vaginal microflora and decreases dyspareunia. Hormonal therapy is also useful and commonly used before vaginal surgical treatment. Prasterone is quite a new option for vaginal therapy in Poland and is mainly recommended for dyspareunia in menopausal women. The study related to prasterone therapy emphasizes its effectiveness and safety, making it advantageous to explore its beneficial impact. This paperwork aims to summarize the mechanism of action as well as the effects of both drugs and their beneficial action during vaginal treatment.<\/jats:p>","DOI":"10.3390\/jcm12144740","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T01:46:02Z","timestamp":1689644762000},"page":"4740","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["New Possibilities for Hormonal Vaginal Treatment in Menopausal Women"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7651-8250","authenticated-orcid":false,"given":"Katarzyna","family":"Tomczyk","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-8353","authenticated-orcid":false,"given":"Karolina","family":"Chmaj-Wierzchowska","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9336-7060","authenticated-orcid":false,"given":"Katarzyna","family":"Wszo\u0142ek","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wilczak","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/SPV.0b013e318278cc40","article-title":"Histologic and cytologic effects of vaginal estrogen in women with pelvic organ prolapse: A randomized controlled trial","volume":"19","author":"Vaccaro","year":"2013","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","article-title":"Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women\u2019s Sexual Health and the North American Menopause Society","volume":"21","author":"Portman","year":"2014","journal-title":"Menopause"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.maturitas.2015.09.001","article-title":"Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study","volume":"83","author":"Palma","year":"2016","journal-title":"Maturitas"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1089\/jwh.2018.7494","article-title":"Androgen Therapy in Women","volume":"29","author":"Vegunta","year":"2020","journal-title":"J. Womens Health (Larchmt)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s40266-019-00700-w","article-title":"Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause","volume":"36","author":"Kagan","year":"2019","journal-title":"Drugs Aging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/SPV.0b013e3181ab4804","article-title":"Local Effects of Vaginally Administered Estrogen Therapy: A Review","volume":"15","author":"Krause","year":"2009","journal-title":"J. Pelvic Med. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s40265-014-0259-8","article-title":"Dehydroepiandrosterone (DHEA): Hypes and hopes","volume":"74","author":"Rutkowski","year":"2014","journal-title":"Drugs"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/0378-5122(92)90208-L","article-title":"Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial","volume":"15","author":"Felding","year":"1992","journal-title":"Maturitas"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1159\/000292320","article-title":"Clinical effects of preoperative oestradiol treatment before vaginal repair operation. A double-blind, randomized trial","volume":"40","author":"Mikkelsen","year":"1995","journal-title":"Gynecol. Obs. Obstet. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Maher, C., Feiner, B., Baessler, K., and Glazener, C.M.A. (2010). Surgical management of pelvic organ prolapse in women. Cochrane Database Syst. Rev., 4.","DOI":"10.1002\/14651858.CD004014.pub4"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.maturitas.2012.06.009","article-title":"EMAS clinical guide: Low-dose vaginal estrogens for postmenopausal vaginal atrophy","volume":"73","author":"Rees","year":"2012","journal-title":"Maturitas"},{"key":"ref_12","first-page":"CD001500","article-title":"Local oestrogen for vaginal atrophy in postmenopausal women (Review)","volume":"31","author":"Lethaby","year":"2016","journal-title":"Cochrane Libr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/GME.0000000000000428","article-title":"Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone)","volume":"22","author":"Archer","year":"2015","journal-title":"Menopause"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/gme.0b013e31823b8983","article-title":"Systemic and topical hormone therapies reduce vaginal innervation density in postmenopausal women","volume":"19","author":"Griebling","year":"2012","journal-title":"Menopause"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00192-014-2554-z","article-title":"Vaginal estrogen use in postmenopausal women with pelvic floor disorders: Systematic review and practice guidelines","volume":"26","author":"Rahn","year":"2015","journal-title":"Int. Urogynecol. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3728","DOI":"10.1210\/jc.2014-1216","article-title":"Effects of preoperative local estrogen in postmenopausal women with prolapse: A randomized trial","volume":"99","author":"Rahn","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S0378-5122(03)00240-8","article-title":"Low-dose (0.3 mg) synthetic conjugated estrogens a is effective for managing atrophic vaginitis","volume":"47","author":"Marx","year":"2004","journal-title":"Maturitas"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"288","DOI":"10.5005\/jp-journals-10006-1950","article-title":"Association of Vaginal Maturation Index and Vaginal pH with the Most Bothersome Symptoms of Genitourinary Syndrome of Menopause","volume":"13","author":"Lumbanraja","year":"2021","journal-title":"J. South Asian Fed. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1097\/gme.0b013e3181a48c4e","article-title":"Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally","volume":"16","author":"Bahmann","year":"2009","journal-title":"Menopause J. N. Am. Menopause Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/gme.0b013e3182518e9a","article-title":"The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: Results from a pivotal phase III study","volume":"19","author":"Cano","year":"2012","journal-title":"Menopause"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/01.GME.0000077620.13164.62","article-title":"Efficacy of low-dose intravaginal estradiol on urogenital aging in postmenopausal women","volume":"11","author":"Dessole","year":"2004","journal-title":"Menopause"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.maturitas.2011.12.022","article-title":"Low dose estriol pessaries for the treatment of vaginal atrophy: A double-blind placebo-controlled trial investigating the efficacy of pessaries containing 0.2 mg and 0.03 mg estriol","volume":"71","author":"Griesser","year":"2012","journal-title":"Maturitas"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/SPV.0b013e31825e6401","article-title":"A randomized clinical trial of the impact of local estrogen on postoperative tissue quality afer vaginal reconstructive surgery","volume":"18","author":"Karp","year":"2012","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/j.1743-6109.2009.01667.x","article-title":"A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women","volume":"7","author":"Raghunandan","year":"2010","journal-title":"J. Sex. Med."},{"key":"ref_25","first-page":"12","article-title":"A comparative study of vaginal estrogen cream and sustained released estradiol vaginal tablet (Vagifem) in the treatment of atrophic vaginitis among postmenopausal women","volume":"12","author":"Daneshmand","year":"2014","journal-title":"Iran. J. Reprod. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1034\/j.1600-0412.2000.079004293.x","article-title":"Comparisons of usefulness of estradiol vaginal tablets and estriol vagitories for treatment of vaginal atrophy","volume":"79","author":"Dugal","year":"2000","journal-title":"Acta Obstet. Et Gynecol. Scand."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0301-2115(96)02612-7","article-title":"Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy","volume":"71","author":"Barentsen","year":"1997","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s001920050040","article-title":"Local treatment of urogenital atrophy with an estradiol-releasing vaginal ring: A comparative and placebo controlled multicenter study","volume":"10","author":"Casper","year":"1999","journal-title":"Int. Urogynecol. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/0002-9378(81)90710-9","article-title":"Estrogen receptors in the human female lower urinary tract","volume":"141","author":"Iosif","year":"1981","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/13697130802585576","article-title":"Topical estrogen therapy in the management of postmenopausal vaginal atrophy: An up-to-date overview","volume":"12","author":"Ewies","year":"2009","journal-title":"Climacteric"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ejogrb.2006.10.039","article-title":"Alterations of estrogen receptor-alpha and -beta in the anterior vaginal wall of women with urinary incontinence","volume":"134","author":"Xie","year":"2007","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_32","first-page":"722","article-title":"Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: Second report of the Hormones and Urogenital Therapy Committee","volume":"92","author":"Cardozo","year":"1998","journal-title":"Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1007\/s001920070042","article-title":"Power Doppler of the urethra in continent or incontinent, pre- and postmenopausal women","volume":"11","author":"Girao","year":"2000","journal-title":"Int. Urogynecol. J. Pelvic Floor. Dysfunct"},{"key":"ref_34","first-page":"343","article-title":"Factors maintaining the intraurethral pressure in women","volume":"17","author":"Rud","year":"1980","journal-title":"Investig. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/S0022-5347(17)54176-2","article-title":"Effect of hormonal deprivation on the bladder defense mechanism","volume":"127","author":"Mulholland","year":"1982","journal-title":"J. Urol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1055\/s-2005-869480","article-title":"Vaginal hormone therapy for urogenital and menopausal symptoms","volume":"23","author":"Ballagh","year":"2005","journal-title":"Semin. Reprod. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/00042192-200007030-00005","article-title":"17beta-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis","volume":"7","author":"Rioux","year":"2000","journal-title":"Menopause"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"405","DOI":"10.3109\/13697137.2010.500748","article-title":"Topical vaginal estrogen therapy in managing postmenopausal urinary symptoms: A reality or a gimmick?","volume":"13","author":"Ewies","year":"2010","journal-title":"Climacteric"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/0378-5122(94)00898-H","article-title":"Testosterone enhances estradiol\u2019s effects on postmenopausal bone density and sexuality","volume":"21","author":"Davis","year":"1995","journal-title":"Maturitas"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1016\/S0015-0282(02)02984-9","article-title":"Aromatization of androgens in women: Current concepts and findings","volume":"77","author":"Simpson","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/03602530600569877","article-title":"The biological actions of dehydroepiandrosterone involves multiple receptors","volume":"38","author":"Webb","year":"2006","journal-title":"Drug Metab. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.yfrne.2008.11.002","article-title":"Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS)","volume":"30","author":"Maninger","year":"2009","journal-title":"Front. Neuroendocrinol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S0960-0760(03)00204-8","article-title":"Androgens in women","volume":"85","author":"Davison","year":"2003","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"524","DOI":"10.3109\/09513590903511547","article-title":"High internal consistency and efficacy of intravaginal DHEA for vaginal atrophy","volume":"26","author":"Labrie","year":"2010","journal-title":"Gynecol. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.maturitas.2011.06.005","article-title":"Vaginal DHEA to treat menopause related atrophy: A review of the evidence","volume":"70","author":"Panjari","year":"2011","journal-title":"Maturita"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.maturitas.2015.02.005","article-title":"Prasterone has parallel beneficial effects on the main symptoms of vulvovaginal atrophy: 52-week open-label study","volume":"81","author":"Labrie","year":"2015","journal-title":"Maturitas"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jsbmb.2005.02.018","article-title":"Effects of dehydroepiandrosterone, premarin and acolbifene on histomorphology and sex steroid receptors in the rat vagina","volume":"96","author":"Berger","year":"2005","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1111\/jsm.12219","article-title":"Androgenic action of dehydroepiandrosterone (DHEA) on nerve density in the ovariectomized rat vagina","volume":"10","author":"Pelletier","year":"2013","journal-title":"J. Sex. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/GME.0000000000000571","article-title":"Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause","volume":"23","author":"Labrie","year":"2018","journal-title":"Menopause"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.maturitas.2009.01.012","article-title":"Safety of testosterone use in women","volume":"63","author":"Shufelt","year":"2009","journal-title":"Maturitas"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1210\/jc.2006-2171","article-title":"Effects of testosterone treatment on endometrial proliferation in postmenopausal women","volume":"92","author":"Zang","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Azziz, R., Nestler, J.E., and Dewailly, D. (2006). Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders, Humana Press Inc.. Contemporary Endocrinology.","DOI":"10.1007\/978-1-59745-179-6"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3489","DOI":"10.1210\/jc.2014-2260","article-title":"Androgen therapy in women: A reappraisal: An Endocrine Society clinical practice guideline","volume":"99","author":"Wierman","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_54","unstructured":"European Medicines Agency (2019, June 20). Intrarosa: Summary of Product Characteristics, Available online: http:\/\/www.ema.europa.eu\/."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/gme.0b013e31819e85c6","article-title":"Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women","volume":"16","author":"Labrie","year":"2009","journal-title":"Menopause"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12934-020-01464-4","article-title":"Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health","volume":"19","author":"Chee","year":"2020","journal-title":"Microb. Cell Factories"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1113\/JP271694","article-title":"The vaginal microbiota, host defence and reproductive physiology","volume":"595","author":"Smith","year":"2017","journal-title":"J. Physiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"132ra52","DOI":"10.1126\/scitranslmed.3003605","article-title":"Temporal dynamics of the human vaginal microbiota","volume":"4","author":"Gajer","year":"2012","journal-title":"Sci. Transl. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"103696","DOI":"10.1016\/j.micpath.2019.103696","article-title":"Crosstalk between vaginal microbiome and female health: A review","volume":"136","author":"Gupta","year":"2019","journal-title":"Microb. Pathog."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Torcia, M.G. (2019). Interplay among vaginal microbiome, immune response and sexually transmitted viral infections. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20020266"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3389\/fphys.2015.00164","article-title":"Antimicrobial and immune modulatory effects of lactic acid and short chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis","volume":"6","author":"Aldunate","year":"2015","journal-title":"Front. Physiol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Barrientos-Dur\u00e1n, A., Fuentes-L\u00f3pez, A., de Salazar, A., Plaza-D\u00edaz, J., and Garc\u00eda, F. (2020). Reviewing the Composition of Vaginal Microbiota: Inclusion of Nutrition and Probiotic Factors in the Maintenance of Eubiosis. Nutrients, 12.","DOI":"10.3390\/nu12020419"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"643422","DOI":"10.3389\/fmicb.2021.643422","article-title":"Role of Vaginal Microbiota Dysbiosis in Gynecological Diseases and the Potential Interventions","volume":"12","author":"Han","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/AOG.0000000000001932","article-title":"Vaginal microbiome and its relationship to behavior, sexual health, and sexually transmitted diseases","volume":"129","author":"Lewis","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2147\/IJWH.S158913","article-title":"Current treatment options for postmenopausal vaginal atrophy","volume":"10","author":"Naumova","year":"2018","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.maturitas.2016.05.015","article-title":"Menopause and the vaginal microbiome","volume":"91","author":"Muhleisen","year":"2016","journal-title":"Maturitas"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Leyva-G\u00f3mez, G., Del Prado-Audelo, M.L., Ortega-Pe\u00f1a, S., Mendoza-Mu\u00f1oz, N., Urb\u00e1n-Morl\u00e1n, Z., Gonz\u00e1lez-Torres, M., Gonz\u00e1lez-Del Carmen, M., Figueroa-Gonz\u00e1lez, G., Reyes-Hern\u00e1ndez, O.D., and Cort\u00e9s, H. (2019). Modifications in Vaginal Microbiota and Their Influence on Drug Release. Chall. Oppor. Pharm., 11.","DOI":"10.3390\/pharmaceutics11050217"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/GME.0000000000000904","article-title":"Vaginal microbiota and genitourinary menopausal symptoms: A cross sectional analysis","volume":"24","author":"Mitchell","year":"2017","journal-title":"Menopause"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3389\/fmed.2018.00181","article-title":"The Vaginal Microenvironment: The Physiologic Role of Lactobacilli","volume":"5","author":"Amabebe","year":"2018","journal-title":"Front. Med."},{"key":"ref_70","first-page":"191","article-title":"Treatment of vaginal atrophy","volume":"10","author":"Domoney","year":"2014","journal-title":"Women\u2019s Health"},{"key":"ref_71","first-page":"2200","article-title":"Does preoperative locally applied estrogen treatment facilitate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse? A randomised controlled double-masked, placebo-controlled, multicenter study","volume":"128","author":"Marschalek","year":"2021","journal-title":"Int. J. Obstet. Ang Gynecol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1097\/GME.0000000000000614","article-title":"Effects of preoperative vaginal estrogen therapy for the incidence of mesh complication after pelvic organ prolapse surgery in postmenopausal women: Is it helpful or a myth? A 1-year randomized controlled trial","volume":"23","author":"Zhixing","year":"2016","journal-title":"Menopause"},{"key":"ref_73","first-page":"1728","article-title":"Local Estrogen Therapy for Pelvic Organ Prolapse in Postmenopausal Women: A Systematic Review and Meta-Analysis","volume":"51","author":"Yu","year":"2022","journal-title":"Iran. J. Public Health"},{"key":"ref_74","first-page":"0808","article-title":"Stress incontinence","volume":"14","year":"2009","journal-title":"BMJ Clin. Evid."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/GME.0000000000002007","article-title":"Prasterone in the treatment of mild to moderate urge incontinence: An observational study","volume":"29","author":"Gabrielli","year":"2022","journal-title":"Menopause"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Hummelen, R., Macklaim, J.M., Bisanz, J.E., Hammond, J.A., McMillan, A., Vongsa, R., Koenig, D., Gloor, G.B., and Reid, G. (2011). Vaginal microbiome and epithelial gene array in postmenopausal women with moderate to severe dryness. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026602"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4740\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:13:46Z","timestamp":1760127226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,18]]},"references-count":76,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12144740"],"URL":"https:\/\/doi.org\/10.3390\/jcm12144740","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,18]]}}}