Effects of estroprogestins containing natural estrogen on vaginal flora

Abstract

Estroprogestins with “natural oestrogen” has represented a new option in terms of combined hormonal contraception. So, the aim of this study is to investigate how estroprogestins with natural estrogen may modify the vaginal niche. In literature, very few studies focused on the interaction between hormonal contraception and vaginal milieu. This is a prospective comparative study. We enrolled 60 women from January 2013 to September 2013, 30 of them were administered estradiol valerate dienogest (E2V+DNG – Klaira®) in a quadriphasic regimen, while the other 30 women were administered 17-β estradiol with nomestrol acetate (EV+NOMAC – Zoely®) in a monophasic regimen. After a baseline study of vaginal milieu at recruitment of patients (Gram stain with Nugent score, vaginal pH, vaginal wet mount for the quantification of leukocytes, Lactobacilli and/or presence of Candida), we performed the same follow-up after six months of estroprogestin therapy. Our results showed that the women treated with E2V+DNG had a trend of an improvement of vaginal health in terms of increase of lactobacillar flora and reduction of vaginal pH in place of women treated with EV+NOMAC that showed a reduction of cervical mucus. Finally, our data about the effects on vaginal flora exerted by two estroprogestin pills (EPs) containing a natural estrogen suggest slight, but interesting differences in terms of vaginal ecology. These differences could be related to the type of estrogen, type of progestin, regimen of administration and, after all, to the net balance between estrogenic and progestin component of the EPs.

Chinese abstract

含有天然雌激素的避孕药是复合激素避孕药的一种新选择。本研究的目的在于了解含有天然雌激素的避孕药可能对阴道微环境改变的程度。现有的文献很少研究激素避孕药和阴道环境的相互作用。这是一项前瞻性的对照研究。2013年1月至2013年9月我们募集了60名女性，其中30名女性口服四相的戊酸雌二醇地诺孕素复合制剂（E2V+DNG-Klaira），另外30名女性口服单相的17-β雌二醇和醋酸诺美孕酮复合制剂（EV+NOMAC –Zoely）。对研究对象的阴道环境（革兰染色Nugent评分，阴道PH值，阴道湿涂片行白细胞及乳酸杆菌计数，是否合并念珠菌）做基线研究，口服避孕药6个月后对上述指标再次进行测量。我们的结果显示：口服E2V+DNG的女性通过增加乳酸杆菌、降低阴道PH值有改善阴道健康的趋势，而口服EV+NOMAC的女性宫颈粘液减少。最终，我们的资料显示：两种含有天然雌激素的避孕药对阴道菌群的影响在阴道生态方面有细小的、有趣的差别。这些差别可能与雌、孕激素的种类、时相相关，归根到底和避孕药中雌孕激素的组分有关。

• Lactobacilli
• leukocytes
• oral contraceptive
• vaginal flora