Medical articles




V.E. Balan, E.V. Tikhomirova, T.V. Lovygina, Yu.P. Titchenko, M.A. Chechneva, N.V. Zarochentseva, L.K. Jijihia,

T.S. Budykina, P.V. Balan

For quotation:

Balan V.E., Tikhomirova E.V., Lovygina T.V. etc. Modern possibilities of combination therapy

overactive bladder in peri- and early postmenopause. Questions of practical colposcopy.

Genital infections. 2022; (3): 66–72.

DOI: 10.46393/27826392_2022_3_66


Genitourinary menopausal syndrome (GUMS) significantly reduces the quality of life of women in menopause, especially with the development of overactive bladder (OAB). The effectiveness and side effects of OAB therapy with M-anticholinergics have been well studied, but in recent years the β3-adrenergic agonist mirabegron has become the drug of choice, the side effects of which do not exceed placebo. In addition, the combination of all symptoms of GUMS (urinary and vaginal) is well known, which suggests a significant increase in the effectiveness of treatment when combining M-anticholinergics and menopausal hormone therapy (MHT). At the same time, there is no data yet on the effectiveness of the combination of MHT and β3-adrenergic agonists and on the possibility of using an innovative method of treating GUMS - quadripolar dynamic RF technology on the EVATM device.

Purpose of the study: to compare the effectiveness of combination therapy and monotherapy with β3-agonists of OAB in peri- and postmenopausal women.

Material and methods. 150 patients aged 45–55 years (average age 49.25 ± 5.4 years) were examined.

All patients were randomly divided into three groups (using fixed simple randomization, sealed envelope method). The first group consisted of 50 patients with symptoms of OAB who received monotherapy with a drug from the group of β3-adrenergic agonists mirabegron 50 mg daily for 6 months. The second group included 50 patients with symptoms of OAB taking a combination of drugs: mirabegron 50 mg per day and estriol in the form of a cream 0.5 mg, one dose intravaginally daily continuously for 3 months, then in a maintenance regimen 2 times a week continuously until 6 months months of therapy. The third group included 50 women with diagnosed OAB who were treated with mirabegron at a dose of 50 mg per day in combination with the use of quadripolar dynamic RF technology

on the EVATM device. Before inclusion in the study, none of the patients received MHT or treatment of OAB with M-anticholinergics for 6 months. The duration of the study was 6 months.

At visit zero, patients were randomized; at visits 1, 2, and 3, the severity of OAB symptoms and vulvovaginal atrophy were assessed using a visual analogue scale (dryness, burning/itching, dyspareunia, bleeding after intercourse, lymphorrhea).

Results. Both monotherapy with the β3-agonist mirabegron and the combination of mirabegron + MHT are effective against all symptoms of OAB. After 6 months of treatment, the frequency of pollakiuria decreased by 6 times, nocturia by 5.5 times, urgency by 5.4 times, and urgent urinary incontinence by 4 times. The results of the study allow us to conclude that an important advantage of combination therapy (β3-adrenomimetic mirabegron 50 mg per os + estriol 0.5 mg intravaginally) is a more pronounced reduction in the main symptom of OAB - urgency (2.3 times) and a decrease in the frequency of relapses 2.5 times.

In patients receiving therapy with mirabegron in combination with the method of dynamic quadripolar radiofrequency exposure, a 2-fold decrease in symptoms of urgency urinary incontinence was noted, which was almost no different from the results of monotherapy with mirabegron.

Conclusion. The results of this study allow us to conclude that the combination of the β3-agonist mirabegron with local hormonal therapy with estriol is significantly more effective in correcting the symptoms of OAB in peri- and postmenopausal women than monotherapy with the β3-agonist mirabegron (p < 0.05).

Journal “Issues of practical colposcopy. Genital infections" No. 3_2022
Made on