Comparison of Results between Topical Estrogen Treatment for Postmenopausal Vaginal Atrophy and Platelet-Rich Plasma Treatment

Comparison of Results between Topical Estrogen Treatment for Postmenopausal Vaginal Atrophy and Platelet-Rich Plasma Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Results between Topical Estrogen Treatment for Postmenopausal Vaginal Atrophy and Platelet-Rich Plasma Treatment Ufuk Atlıhan, Can Ata, Huseyin Aytug Avsar, Onur Yavuz, Selcuk erkilinc, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4360464/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: With the increasing life expectancy, postmenopausal vulvovaginal atrophy has become more prominent in current medical practice, given its impact on quality of life, sexual function, and pelvic floor health. PRP is considered safe and is a low-cost, simple, natural, and minimally invasive method for vaginal rejuvenation. We aim to compare the effects of hormonal treatment options and PRP application for postmenopausal vulvovaginal atrophy. Materials and Methods From a total of 66 patients, topical estrogen treatment was administered to 36 patients, while PRP treatment was performed for 30 patients who had previously received topical estrogen treatment without obtaining a response. To assess the impact of vulvovaginal atrophy and associated symptoms on the quality of life of patients, three different questionnaires, namely vaginal health index, female sexual function index, and vulvovaginal symptoms questionnaire, along with the visual analog scale, were administered at 4 weeks interval. Results In the assessment at the 12th week, the results obtained from the use of female sexual function index and vulvovaginal symptoms questionnaire in patients treated with PRP showed a significant difference compared to the results obtained from patients treated with topical estrogen (p: 0.004, p: 0.000). Conclusion Autologous platelet-rich plasma injection is a safe and effective minimal invasive monotherapy for postmenopausal VVA and, consequently, vulvovaginal rejuvenation. PRP injection has been regarded as a promising method for the treatment of VVA in postmenopausal patients with contraindications to hormone therapy and to improve hydration of the vaginal mucosa. Platelet Rich Plasma Topical Estrogen Atrophic Vaginitis Introduction Menopause is known to be a gradual and physiological event associated with ovarian insufficiency, leading to significant effects on the lower genital tract due to hypoestrogenism. In European countries, the average age of menopause is approximately between 46 and 50 years ( 1 ). With the increasing life expectancy, postmenopausal vulvovaginal atrophy (VVA) has become more prominent in current medical practice, given its impact on quality of life, sexual function, and pelvic floor health ( 2 , 3 ). Under hypoestrogenic conditions, the vaginal epithelium undergoes thinning, the barrier function is lost, vaginal folds decrease, tissue elasticity diminishes, and the secretion activity of Bartholin glands decreases. This results in vaginal mucosal traumatization and painful sensations ( 4 ). Symptoms accompanying vaginal dryness due to hypoestrogenism may include itching, burning, discharge, and dyspareunia. The frequency of VVA, the severity of pathological changes, and the clinical course of the disease are dependent on the lenght of postmenopausal period.( 5 ) The main therapeutic goal in postmenopausal vaginal atrophy is the alleviation of symptoms. Low-dose vaginal Estrogen Therapy (ET) is the most widely used pharmacological treatment for VVA and is also the most effective and safe option. They facilitate the renewal of the epithelium and vaginal flora, leading to the improvement of urogenital and sexual complaints ( 5 ). During the use of low-dose vaginal ET, systemic estrogen absorption is minimal, and serum estradiol levels remain at postmenopausal levels ( 6 – 8 ). In recent years, opinions and data on the use of Platelet-Rich Plasma (PRP) application in the treatment of postmenopausal vaginal atrophy have come into focus, becoming an actively discussed topic. PRP is considered safe and is a low-cost, simple, natural, and minimally invasive method for vaginal rejuvenation. Autologous growth factors which are the essentials for PRP include molecules such as Vascular Endothelial Growth Factor, Epidermal Growth Factor, and Platelet-Derived Growth Factor (PDGF), which stimulate cell proliferation and cell differentiation. These molecules play a crucial role in reducing inflammation, stimulating collagen III synthesis, promoting angiogenesis, and ultimately contributing to tissue regeneration. PDGF has been reported to stimulate cell proliferation and participate in wound healing ( 9 , 10 ). Studies on PRP application in vulvovaginal atrophy are limited in the literature ( 11 , 12 ). Our study aims to compare the effects of ET and PRP application for postmenopausal vulvovaginal atrophy. Materials and Methods A total of 66 patients diagnosed with postmenopausal atrophic vaginitis who presented to our gynecology clinic between January 2019 and February 2022 were included in our study. The patients were divided into two groups based on the use of topical estrogen and PRP. Topical ET was administered to 36 patients, while PRP treatment was performed for 30 patients who had previously received topical ET without obtaining a response. Patients receiving ET were given a vaginal cream containing 0.625 mg per dose Conjugated Estrogen for 14 nights, followed by applying one dose every other night for the following 10 weeks. Initially, venous blood samples were centrifuged at 2000 rpm for 10 minutes. The collected plasma was then subjected to centrifugation again in a plain tube at the same parameters. Platelet pellets and plasma samples were subsequently combined in a third tube. A 4 ml PRP treatment was administered using 30-G needles, with 1 ml injected separately into each of the four vaginal walls. This procedure was preceded by the application of topical anesthetic cream. Sessions were repeated every 4 weeks for a total of 3 sessions. To assess the impact of VVA and associated symptoms on the quality of life of patients, three different questionnaires, namely Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and Vulvovaginal Symptoms Questionnaire (VSQ), along with the Visual Analog Scale (VAS), were administered at weeks 0, 4, 8, and 12. The VHI utilized a scale from 1 to 5 to analyze five components, namely elasticity, fluid volume, pH, epithelial integrity, and moisture. The minimum total score of 5 points indicates severe VVA, while the maximum total score of 25 points indicates the absence of clinical symptoms of VVA. The VAS scale ranges from 0 (complete absence of symptoms) at the left end to 10 (worst possible symptom) at the right end. Participants rated VVA symptoms (dyspareunia, dryness, or burning) on a scale from 0 to 10. The FSFI questionnaire, assessing six different domains—desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort—used a scale from 0 (no sexual activity in the last 4 weeks) or 1 (very dissatisfied) to 5 (very satisfied) at weeks 0, 4, 8, and 12. Throughout the study, a full-scale score ranging from 2.0 (severe dysfunction) to 36.0 (no dysfunction) was employed to evaluate sexual function, considering increased FSFI scores associated with symptom improvement. An optimal cutoff score of 26, reported by Wiegel and colleagues, is used to distinguish women with and without current sexual dysfunction. The VSQ consists of 21 questions, utilizing a scoring scale ranging from 0 to 21 for evaluation ( 13 ). The study included postmenopausal women aged between 45 and 70 years, diagnosed with VVA, not currently on any systemic estrogen therapy for any reason. Women with a history of breast or endometrial cancer, abnormal uterine bleeding, acute thrombophlebitis, or previous thromboembolic disorders related to estrogen use in the past 6 months before the study, and those with any contraindications to estrogen therapy were excluded from the study. The study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical approval was obtained before the commencement of the research. The Levene test was employed to assess whether the study group exhibited equal variance and to test the homogeneity of variance. Skewness and kurtosis in the statistical data were found to be within the range of -1.5 to + 1.5, indicating that the data conformed to a normal distribution. Therefore, paired sample t-tests were conducted for dependent groups. As the age data did not exhibit a normal distribution, the Kruskal-Wallis analysis was performed to assess the significance of differences between group means. Statistical analysis of the research data was carried out using SPSS version 20 (IBM SPSS Statistics, IBM Corporation, Armonk, NY, USA). The results were evaluated at a significance level of p < 0.05 with a confidence interval of 95%. Results The mean ages of the volunteers participating in the study, categorized into those using topical estrogen and those undergoing PRP treatment, were 57.17 ± 8.02 and 57.20 ± 7.75, respectively (range 45–70) (p = 0.986). When considering the initial assessment data for all the tests used in the evaluation, a difference was observed only in the VSQ test between the two groups. In terms of other assessments during the baseline period, the groups are similar. In the assessment at the 12th week, the results obtained from the use of FSFI and VSQ in patients treated with PRP showed a significant difference compared to the results obtained from patients treated with topical estrogen (p: 0.004, p: 0.000). This assessment is shown in Table 1 . Table 1 Comparison of baseline and endpoint data between groups. Topical Estrogen Group n: 36 PRP Group n: 30 Signficance (p) Age 57.17 ± 8.02 57.20 ± 7.75 .986 VAS Scoring Innitial (Dyspareunia) 6.97 ± 1.23 6.67 ± 1.37 .344 VAS Scoring Innitial (Dryness) 6.17 ± 1.25 6.27 ± 1.08 .733 VAS Scoring Innitial (Burning) 6.11 ± 1.09 6.17 ± 0.87 .823 FSFI Scoring Innitial 22.47 ± 1.03 22.77 ± 0.94 .232 VHI Scoring Innitial 12.58 ± 3.38 12.80 ± 3.43 .798 VSQ Scoring Innitial 13.86 ± 1.13 15.07 ± 0.91 .000 VAS Scoring 12th week (Dyspareunia) 6.67 ± 0.89 6.27 ± 0.83 .066 VAS Scoring 12th week (Dryness) 5.97 ± 0.94 6.13 ± 0.82 .466 VAS Scoring 12th week (Burning) 5.75 ± 0.84 5.97 ± 0.61 .245 FSFI Scoring 12th week 23.50 ± 0.85 24.13 ± 0.86 .004 VHI Scoring 12th week 14.78 ± 2.43 15.67 ± 1.86 .107 VSQ Scoring 12th week 12.64 ± 0.76 13.70 ± 0.47 .000 Assestment made with one-way ANOVA test for groups comparison. Significant values are bolded. In participants receiving topical estrogen, statistically significant differences were observed between measurements during 0–4 weeks, 0–8 weeks and 0–12 weeks for VAS for dyspareunia (p: 0.044, p: 0.044, p: 0.010); also a statistically significant difference was found between measurements during 0–8 weeks and 0–12 weeks for VAS for burning sensation. (p: 0.010, p: 0.002). No statistically significant difference was observed in measurements of VAS for dryness sensation within participants undergoing topical estrogen (p > 0.05). For participants undergoing PRP, statistically significant differences were observed between measurements during 0–8 weeks and 0–12 weeks for VAS for dyspareunia. (p: 0.010, p: 0.005) No statistically significant difference was observed in measurements of VAS for dryness sensation within participants undergoing PRP (p > 0.05). A significant difference was found between measurements during 0–12 weeks for VAS for burning sensation in participants undergoing PRP (p: 0.031). The detailed results regarding other evaluation methods are presented in Table 2 . Table 2 Week to week analysis of differences compared to innitial results among two groups. Topical Estrogen Mean Difference n: 36 Significance (p) PRP Mean Difference n: 30 Significance (p) VHI Scoring 4th week 1.25 ± 0.65 .000 1.37 ± 0.72 .000 8th week 2.08 ± 0.97 .000 2.37 ± 1.45 .000 12th week 2.19 ± 1.28 .000 2.87 ± 1.98 .000 FSFI Scoring 4th week 0.78 ± 1.05 .000 0.77 ± 0.97 .000 8th week 0.94 ± 1.09 .000 1.20 ± 1.10 .000 12th week 1.03 ± 1.08 .000 1.37 ± 1.13 .000 VSQ Scoring 4th week -0.78 ± 0.76 .000 -0.70 ± 0.75 .000 8th week -1.06 ± 0.95 .000 -1.20 ± 0.96 .000 12th week -1.22 ± 0.96 .000 -1.37 ± 1.07 .000 VAS Scoring (Dyspareunia) 4th week -0.11 ± 0.32 .044 -0.20 ± 0.61 .083 8th week -0.22 ± 0.64 .044 -0.33 ± 0.66 .010 12th week -0.31 ± 0.67 .010 -0.40 ± 0.72 .005 VAS Scoring (Dryness) 4th week -0.56 ± 0.33 .324 -0.10 ± 0.40 .184 8th week -0.19 ± 0.58 .051 -0.13 ± 0.43 .103 12th week -0.19 ± 0.58 .051 -0.13 ± 0.43 .103 VAS Scoring (Burning) 4th week -0.08 ± 0.28 .083 -0.07 ± 0.25 .161 8th week -0.28 ± 0.62 .010 -0.17 ± 0.46 .057 12th week -0.36 ± 0.64 .002 -0.20 ± 0.48 .031 The assessment involved comparing the initial questionnaire scoring results for each successive week of the study, stratified by the administration of either topical estrogen or PRP. The analysis was done with paired samples test. Significant values are bolded. Discussion In our study, we evaluated the mean differences in responses to questionnaires administered at 0, 4th, 8th, and 12th weeks following topical estrogen and PRP applications to monitor outcomes. Previously, in the REVIVE study, reported symptoms of vaginal atrophy in postmenopausal women included vaginal dryness (55%), dyspareunia (44%), vaginal irritation (37%), vaginal sensitivity (17%), bleeding during sexual intercourse (8%), and pain during exercise (2%) ( 14 ). In a separate study, vaginal dryness and dyspareunia emerged as the most prevalent symptoms, whereas itching, burning, vaginal discharge, a sensation of fullness, and coital bleeding may manifest as the condition progresses ( 15 ). In a study involving postmenopausal women aged 50–79, it is observed that 52% continue their sexual life, whereas in studies with women aged 70–79, this rate decreases to 22%.( 16 ) Looking at the frequency of sexual symptoms experienced by postmenopausal women in the literature, Liu and Eden's 2007 study found it to be 41%, while Chen et al.'s 2007 study reported 49.3%.( 17 , 18 ) In our study, we employed a variety of questionnaires to address the different types of symptoms mentioned earlier in patients with VVA. There was noted improvement in the VAS scores for dyspareunia between the 0-4th, 0-8th, and 0-12th weeks, as well as in the VAS scores for burning sensation between the 0-8th and 0-12th weeks, among the group using topical ET. In two similar studies the use of low-dose vaginal estrogen tablets was shown to be effective in reducing postmenopausal urogenital symptoms and reducing postmenopausal dyspareunia ( 19 , 20 ). FSFI scores and VHI scores consistently demonstrated symptom alleviation across all weeks of measurement, similar to findings from two other studies that also employed FSFI and VHI. These studies both indicated significant improvement in the respective scores following a 12-week topical estrogen therapy ( 21 , 22 ). Two separate studies utilizing VHI, VSQ, and FSFI, significant improvement in scores was achieved in patients treated with PRP during their one month follow-up assessments ( 23 , 24 ) In our study, participants who received PRP exhibited significant improvement in FSFI, VSQ, and VHI measurements throughout all weeks of the study, including the assessments conducted from week 0 to week 12. Hersant et al. observed improvement in clinical symptoms such as vaginal dryness and dyspareunia in all participants in their study.( 25 ) In our study, participants who received PRP showed significant improvement in VAS for dyspareunia and VAS for burning sensation measurements from week 0 to week 12, while no significant improvement was observed in VAS for dryness sensation measurements. To date including our study, no adverse effects have been reported in the literature regarding vaginal PRP applications. This is explained by the fact that PRP content is obtained from the patient's own plasma. To our knowledge, there are no other studies comparing the two methods for treating VVA. Therefore, when comparing the effectiveness of topical estrogen and PRP applications, it is noteworthy that although there was no significant difference in initial FSFI and VHI scores, a significant difference was observed in favor of PRP at the end of the 12th week. Conclusion We believe that our study contributes to the literature by comparing the efficacy of these two aforementioned applications. The strength of our study lies in the frequency of application and the duration of treatment, which surpasses that of other studies in the literature, many of which have shorter treatment durations. However, limitations of our study include a relatively small sample size and the lack of investigation into the partner's sexual dysfunction as a potential cause of female sexual dysfunction. PRP application by injection is a safe and effective minimal invasive monotherapy for postmenopausal VVA. PRP injection has been regarded as a promising method for the treatment of VVA in postmenopausal patients with contraindications to hormone therapy and to improve hydration of the vaginal mucosa. The authors believe that larger randomized studies are necessary to comprehensively address the outcomes of primary PRP treatment for VVA. Declarations Ethical approval: Ethical approval for this study was obtained from the ‘Buca Seyfi Demirsoy Training and Research Hospital’ on September 27, 2023, with the protocol number 2023/168. Consent for publication: Not applicable Consent to participate: All participiants were consented with informed consents approved by local ethical board. Availability of data and materials: The datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request. Funding: The authors received no fnancial support for the research, authorship, and/or publication of this article. Acknowledgements: Not applicable Competing interests: The authors declare that they have no competing interests. Authors’ information: 1 Private Karataş Hospital, Izmir, Turkey 2 Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey 3 Dokuz Eylul University School of Medicine, Izmir, Turkey All authors reviewed and approved the final version and no other person made a substantial contribution to the paper. References Cuadros J, Llaneza P, Mateu S. Demografía y epidemiología del climaterio en España. Menopausia, EMISA: Madrid, Spain.: Libro Blanco de la Menopausia en España; 2000. pp. 15–23. Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, 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. 10.1016/j.ajog.2016.07.045 . Epub 20160726. Pérez-López FR, Vieira-Baptista P, Phillips N, Cohen-Sacher B, Fialho S, Stockdale CK. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4360464","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299621585,"identity":"d666d6e6-785f-47c0-aa3e-b5da34fa82ab","order_by":0,"name":"Ufuk Atlıhan","email":"","orcid":"","institution":"Private Karatas Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Atlıhan","suffix":""},{"id":299621587,"identity":"ff08fe7d-085c-44ca-b9c0-9457158ef229","order_by":1,"name":"Can Ata","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCA1Can4GBjSQtBgySDSRrMThArBa+24cffi6o+SNvfCP52YMPFQzy/GIH8GuRPJdmLD3jmIHhthtp5oYzzjAYzpydgF+LwRkeBmkeNgPGbTcSzKR52xgSDG4T1sL8m+efgf3mGenfiNbCBlRpkLhBIodIWyTPsJlZ8/YZJ88486ZMcsYZCcJ+4TvD/Pg2zzc52/729G0SHyps5PmlCWhBAAGwSglilYMA/wFSVI+CUTAKRsFIAgAgkT+4O35KXAAAAABJRU5ErkJggg==","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":true,"prefix":"","firstName":"Can","middleName":"","lastName":"Ata","suffix":""},{"id":299621589,"identity":"0d248803-fe55-4c36-a9fb-b762f0d4630d","order_by":2,"name":"Huseyin Aytug Avsar","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"Aytug","lastName":"Avsar","suffix":""},{"id":299621591,"identity":"07e7eb86-efff-40a5-839f-9d8f6ebfd17a","order_by":3,"name":"Onur Yavuz","email":"","orcid":"","institution":"Dokuz Eylül University","correspondingAuthor":false,"prefix":"","firstName":"Onur","middleName":"","lastName":"Yavuz","suffix":""},{"id":299621593,"identity":"2f8d2d6a-0b03-448b-9843-f0abd0e48327","order_by":4,"name":"Selcuk erkilinc","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"Selcuk","middleName":"","lastName":"erkilinc","suffix":""},{"id":299621596,"identity":"3e1db829-b59d-46f6-ac95-61879e4a01be","order_by":5,"name":"Tevfik Berk Bildaci","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"Tevfik","middleName":"Berk","lastName":"Bildaci","suffix":""}],"badges":[],"createdAt":"2024-05-02 17:24:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4360464/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4360464/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60306031,"identity":"1318bca6-1db2-4e1d-825f-7d23531a5b1a","added_by":"auto","created_at":"2024-07-15 11:52:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":477851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4360464/v1/d096f58f-57b0-4125-8dcd-afdda35d0c01.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Results between Topical Estrogen Treatment for Postmenopausal Vaginal Atrophy and Platelet-Rich Plasma Treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMenopause is known to be a gradual and physiological event associated with ovarian insufficiency, leading to significant effects on the lower genital tract due to hypoestrogenism. In European countries, the average age of menopause is approximately between 46 and 50 years (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). With the increasing life expectancy, postmenopausal vulvovaginal atrophy (VVA) has become more prominent in current medical practice, given its impact on quality of life, sexual function, and pelvic floor health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Under hypoestrogenic conditions, the vaginal epithelium undergoes thinning, the barrier function is lost, vaginal folds decrease, tissue elasticity diminishes, and the secretion activity of Bartholin glands decreases. This results in vaginal mucosal traumatization and painful sensations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Symptoms accompanying vaginal dryness due to hypoestrogenism may include itching, burning, discharge, and dyspareunia. The frequency of VVA, the severity of pathological changes, and the clinical course of the disease are dependent on the lenght of postmenopausal period.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe main therapeutic goal in postmenopausal vaginal atrophy is the alleviation of symptoms. Low-dose vaginal Estrogen Therapy (ET) is the most widely used pharmacological treatment for VVA and is also the most effective and safe option. They facilitate the renewal of the epithelium and vaginal flora, leading to the improvement of urogenital and sexual complaints (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). During the use of low-dose vaginal ET, systemic estrogen absorption is minimal, and serum estradiol levels remain at postmenopausal levels (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, opinions and data on the use of Platelet-Rich Plasma (PRP) application in the treatment of postmenopausal vaginal atrophy have come into focus, becoming an actively discussed topic. PRP is considered safe and is a low-cost, simple, natural, and minimally invasive method for vaginal rejuvenation. Autologous growth factors which are the essentials for PRP include molecules such as Vascular Endothelial Growth Factor, Epidermal Growth Factor, and Platelet-Derived Growth Factor (PDGF), which stimulate cell proliferation and cell differentiation. These molecules play a crucial role in reducing inflammation, stimulating collagen III synthesis, promoting angiogenesis, and ultimately contributing to tissue regeneration. PDGF has been reported to stimulate cell proliferation and participate in wound healing (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Studies on PRP application in vulvovaginal atrophy are limited in the literature (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study aims to compare the effects of ET and PRP application for postmenopausal vulvovaginal atrophy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA total of 66 patients diagnosed with postmenopausal atrophic vaginitis who presented to our gynecology clinic between January 2019 and February 2022 were included in our study. The patients were divided into two groups based on the use of topical estrogen and PRP. Topical ET was administered to 36 patients, while PRP treatment was performed for 30 patients who had previously received topical ET without obtaining a response. Patients receiving ET were given a vaginal cream containing 0.625 mg per dose Conjugated Estrogen for 14 nights, followed by applying one dose every other night for the following 10 weeks.\u003c/p\u003e \u003cp\u003eInitially, venous blood samples were centrifuged at 2000 rpm for 10 minutes. The collected plasma was then subjected to centrifugation again in a plain tube at the same parameters. Platelet pellets and plasma samples were subsequently combined in a third tube. A 4 ml PRP treatment was administered using 30-G needles, with 1 ml injected separately into each of the four vaginal walls. This procedure was preceded by the application of topical anesthetic cream. Sessions were repeated every 4 weeks for a total of 3 sessions.\u003c/p\u003e \u003cp\u003eTo assess the impact of VVA and associated symptoms on the quality of life of patients, three different questionnaires, namely Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and Vulvovaginal Symptoms Questionnaire (VSQ), along with the Visual Analog Scale (VAS), were administered at weeks 0, 4, 8, and 12. The VHI utilized a scale from 1 to 5 to analyze five components, namely elasticity, fluid volume, pH, epithelial integrity, and moisture. The minimum total score of 5 points indicates severe VVA, while the maximum total score of 25 points indicates the absence of clinical symptoms of VVA. The VAS scale ranges from 0 (complete absence of symptoms) at the left end to 10 (worst possible symptom) at the right end. Participants rated VVA symptoms (dyspareunia, dryness, or burning) on a scale from 0 to 10. The FSFI questionnaire, assessing six different domains\u0026mdash;desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort\u0026mdash;used a scale from 0 (no sexual activity in the last 4 weeks) or 1 (very dissatisfied) to 5 (very satisfied) at weeks 0, 4, 8, and 12. Throughout the study, a full-scale score ranging from 2.0 (severe dysfunction) to 36.0 (no dysfunction) was employed to evaluate sexual function, considering increased FSFI scores associated with symptom improvement. An optimal cutoff score of 26, reported by Wiegel and colleagues, is used to distinguish women with and without current sexual dysfunction. The VSQ consists of 21 questions, utilizing a scoring scale ranging from 0 to 21 for evaluation (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study included postmenopausal women aged between 45 and 70 years, diagnosed with VVA, not currently on any systemic estrogen therapy for any reason. Women with a history of breast or endometrial cancer, abnormal uterine bleeding, acute thrombophlebitis, or previous thromboembolic disorders related to estrogen use in the past 6 months before the study, and those with any contraindications to estrogen therapy were excluded from the study.\u003c/p\u003e \u003cp\u003e The study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical approval was obtained before the commencement of the research. The Levene test was employed to assess whether the study group exhibited equal variance and to test the homogeneity of variance. Skewness and kurtosis in the statistical data were found to be within the range of -1.5 to +\u0026thinsp;1.5, indicating that the data conformed to a normal distribution. Therefore, paired sample t-tests were conducted for dependent groups. As the age data did not exhibit a normal distribution, the Kruskal-Wallis analysis was performed to assess the significance of differences between group means. Statistical analysis of the research data was carried out using SPSS version 20 (IBM SPSS Statistics, IBM Corporation, Armonk, NY, USA). The results were evaluated at a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 with a confidence interval of 95%.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean ages of the volunteers participating in the study, categorized into those using topical estrogen and those undergoing PRP treatment, were 57.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02 and 57.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75, respectively (range 45\u0026ndash;70) (p\u0026thinsp;=\u0026thinsp;0.986). When considering the initial assessment data for all the tests used in the evaluation, a difference was observed only in the VSQ test between the two groups. In terms of other assessments during the baseline period, the groups are similar. In the assessment at the 12th week, the results obtained from the use of FSFI and VSQ in patients treated with PRP showed a significant difference compared to the results obtained from patients treated with topical estrogen (p: 0.004, p: 0.000). This assessment is shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline and endpoint data between groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTopical Estrogen Group\u003c/p\u003e \u003cp\u003en: 36\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePRP Group\u003c/p\u003e \u003cp\u003en: 30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignficance (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e57.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.986\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring Innitial (Dyspareunia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring Innitial (Dryness)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring Innitial (Burning)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.823\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSFI Scoring Innitial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVHI Scoring Innitial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVSQ Scoring Innitial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring 12th week (Dyspareunia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring 12th week (Dryness)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Scoring 12th week (Burning)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSFI Scoring 12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e23.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVHI Scoring 12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVSQ Scoring 12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAssestment made with one-way ANOVA test for groups comparison. Significant values are bolded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn participants receiving topical estrogen, statistically significant differences were observed between measurements during 0\u0026ndash;4 weeks, 0\u0026ndash;8 weeks and 0\u0026ndash;12 weeks for VAS for dyspareunia (p: 0.044, p: 0.044, p: 0.010); also a statistically significant difference was found between measurements during 0\u0026ndash;8 weeks and 0\u0026ndash;12 weeks for VAS for burning sensation. (p: 0.010, p: 0.002). No statistically significant difference was observed in measurements of VAS for dryness sensation within participants undergoing topical estrogen (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eFor participants undergoing PRP, statistically significant differences were observed between measurements during 0\u0026ndash;8 weeks and 0\u0026ndash;12 weeks for VAS for dyspareunia. (p: 0.010, p: 0.005) No statistically significant difference was observed in measurements of VAS for dryness sensation within participants undergoing PRP (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A significant difference was found between measurements during 0\u0026ndash;12 weeks for VAS for burning sensation in participants undergoing PRP (p: 0.031). The detailed results regarding other evaluation methods are presented in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeek to week analysis of differences compared to innitial results among two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTopical Estrogen\u003c/p\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003cp\u003en: 36\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePRP\u003c/p\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003eDifference\u003c/p\u003e \u003cp\u003en: 30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSignificance (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVHI Scoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFSFI Scoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVSQ Scoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVAS Scoring\u003c/p\u003e \u003cp\u003e(Dyspareunia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVAS Scoring\u003c/p\u003e \u003cp\u003e(Dryness)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVAS Scoring\u003c/p\u003e \u003cp\u003e(Burning)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eThe assessment involved comparing the initial questionnaire scoring results for each successive week of the study, stratified by the administration of either topical estrogen or PRP. The analysis was done with paired samples test. Significant values are bolded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we evaluated the mean differences in responses to questionnaires administered at 0, 4th, 8th, and 12th weeks following topical estrogen and PRP applications to monitor outcomes. Previously, in the REVIVE study, reported symptoms of vaginal atrophy in postmenopausal women included vaginal dryness (55%), dyspareunia (44%), vaginal irritation (37%), vaginal sensitivity (17%), bleeding during sexual intercourse (8%), and pain during exercise (2%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In a separate study, vaginal dryness and dyspareunia emerged as the most prevalent symptoms, whereas itching, burning, vaginal discharge, a sensation of fullness, and coital bleeding may manifest as the condition progresses (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In a study involving postmenopausal women aged 50\u0026ndash;79, it is observed that 52% continue their sexual life, whereas in studies with women aged 70\u0026ndash;79, this rate decreases to 22%.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Looking at the frequency of sexual symptoms experienced by postmenopausal women in the literature, Liu and Eden's 2007 study found it to be 41%, while Chen et al.'s 2007 study reported 49.3%.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) In our study, we employed a variety of questionnaires to address the different types of symptoms mentioned earlier in patients with VVA.\u003c/p\u003e \u003cp\u003eThere was noted improvement in the VAS scores for dyspareunia between the 0-4th, 0-8th, and 0-12th weeks, as well as in the VAS scores for burning sensation between the 0-8th and 0-12th weeks, among the group using topical ET. In two similar studies the use of low-dose vaginal estrogen tablets was shown to be effective in reducing postmenopausal urogenital symptoms and reducing postmenopausal dyspareunia (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). FSFI scores and VHI scores consistently demonstrated symptom alleviation across all weeks of measurement, similar to findings from two other studies that also employed FSFI and VHI. These studies both indicated significant improvement in the respective scores following a 12-week topical estrogen therapy (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTwo separate studies utilizing VHI, VSQ, and FSFI, significant improvement in scores was achieved in patients treated with PRP during their one month follow-up assessments (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) In our study, participants who received PRP exhibited significant improvement in FSFI, VSQ, and VHI measurements throughout all weeks of the study, including the assessments conducted from week 0 to week 12. Hersant et al. observed improvement in clinical symptoms such as vaginal dryness and dyspareunia in all participants in their study.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) In our study, participants who received PRP showed significant improvement in VAS for dyspareunia and VAS for burning sensation measurements from week 0 to week 12, while no significant improvement was observed in VAS for dryness sensation measurements. To date including our study, no adverse effects have been reported in the literature regarding vaginal PRP applications. This is explained by the fact that PRP content is obtained from the patient's own plasma.\u003c/p\u003e \u003cp\u003eTo our knowledge, there are no other studies comparing the two methods for treating VVA. Therefore, when comparing the effectiveness of topical estrogen and PRP applications, it is noteworthy that although there was no significant difference in initial FSFI and VHI scores, a significant difference was observed in favor of PRP at the end of the 12th week.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe believe that our study contributes to the literature by comparing the efficacy of these two aforementioned applications. The strength of our study lies in the frequency of application and the duration of treatment, which surpasses that of other studies in the literature, many of which have shorter treatment durations. However, limitations of our study include a relatively small sample size and the lack of investigation into the partner's sexual dysfunction as a potential cause of female sexual dysfunction.\u003c/p\u003e \u003cp\u003ePRP application by injection is a safe and effective minimal invasive monotherapy for postmenopausal VVA. PRP injection has been regarded as a promising method for the treatment of VVA in postmenopausal patients with contraindications to hormone therapy and to improve hydration of the vaginal mucosa. The authors believe that larger randomized studies are necessary to comprehensively address the outcomes of primary PRP treatment for VVA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e Ethical approval for this study was obtained from the \u0026lsquo;Buca Seyfi Demirsoy Training and Research Hospital\u0026rsquo; on September 27, 2023, with the protocol number 2023/168.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAll participiants were consented with informed consents approved by local ethical board. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors received no fnancial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003ePrivate Karataş Hospital, Izmir, Turkey \u003csup\u003e2\u003c/sup\u003eDemokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Dokuz Eylul University School of Medicine, Izmir, Turkey\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version and no other person made a substantial contribution to the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCuadros J, Llaneza P, Mateu S. 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PubMed PMID: 29738415.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Platelet Rich Plasma, Topical Estrogen, Atrophic Vaginitis","lastPublishedDoi":"10.21203/rs.3.rs-4360464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4360464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eWith the increasing life expectancy, postmenopausal vulvovaginal atrophy has become more prominent in current medical practice, given its impact on quality of life, sexual function, and pelvic floor health. PRP is considered safe and is a low-cost, simple, natural, and minimally invasive method for vaginal rejuvenation. We aim to compare the effects of hormonal treatment options and PRP application for postmenopausal vulvovaginal atrophy.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eFrom a total of 66 patients, topical estrogen treatment was administered to 36 patients, while PRP treatment was performed for 30 patients who had previously received topical estrogen treatment without obtaining a response. To assess the impact of vulvovaginal atrophy and associated symptoms on the quality of life of patients, three different questionnaires, namely vaginal health index, female sexual function index, and vulvovaginal symptoms questionnaire, along with the visual analog scale, were administered at 4 weeks interval.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the assessment at the 12th week, the results obtained from the use of female sexual function index and vulvovaginal symptoms questionnaire in patients treated with PRP showed a significant difference compared to the results obtained from patients treated with topical estrogen (p: 0.004, p: 0.000).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAutologous platelet-rich plasma injection is a safe and effective minimal invasive monotherapy for postmenopausal VVA and, consequently, vulvovaginal rejuvenation. PRP injection has been regarded as a promising method for the treatment of VVA in postmenopausal patients with contraindications to hormone therapy and to improve hydration of the vaginal mucosa.\u003c/p\u003e","manuscriptTitle":"Comparison of Results between Topical Estrogen Treatment for Postmenopausal Vaginal Atrophy and Platelet-Rich Plasma Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-13 08:56:45","doi":"10.21203/rs.3.rs-4360464/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb8e0895-d752-4326-a955-059a4cd3c167","owner":[],"postedDate":"May 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-15T11:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-13 08:56:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4360464","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4360464","identity":"rs-4360464","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}