Randomized clinical trial of vaginal microbiota in menopausal genitourinary syndrome using radiofrequency and topical estriol.

Objective: To analyze the vaginal microbiota before and after the treatment with vaginal microablative fractional radiofrequency (FRAXX) and compare it with topical estriol treatment in women with GMS. Methods: Pilot clinical trial, double-blind, randomized, and placebo-controlled. Thirty women diagnosed with SGM were evaluated regarding the vaginal microbiota before and one month after the end of the treatment protocol, through culture, bacterioscopy by Gram and pHmetry. Then, they were randomized into two groups: one with application of topical estriol for 21 days of attack and then 3 times a week until completing 3 months, together with placebo radiofrequency (RF) pulses, and the other group, with monthly radiofrequency pulses for 3 months, together with placebo vaginal cream. Results: The average age of participants was 56.33 ± 7.10 (minimum 42 and maximum 69 years of age), average age at onset of menopause 44.70 ± 5.74. In the estriol group, the participants showed no significant difference after treatment in relation to the number of basal and parabasal cells (p = 1.000), type of vaginal microbiota (p = 0.544), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Coccobacillus (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000), except for the presence of Candida (p = 0.025) and decrease in vaginal hydrogen potential (pH) (p = 0.006). In the group treated with FRAXX, it was observed that the participants showed no significant difference after treatment regarding the number of basal and parabasal cells (p = 0.500), type of vaginal microbiota (p = 0.637), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Cocobacilli (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000) and presence (or absence) of Candida (p = 1.000), except for pH variation (p = 0.037). Comparing the groups, women treated with FRAXX had a higher proportion of Lactobacillus (type I) than women treated with estriol (66.7% and 26.7%, respectively; p = 0.057). On the other hand, the proportional presence of other bacteria, but with a predominance of Lactobacillus (type II a) was higher in the group treated with estriol, when compared to the FRAXX group (46.6% and 6.7%, respectively; p = 0.057). And the application of estriol significantly increased the Candida concentration when compared to FRAXX (p = 0.042). Conclusion: There was improvement in the parameters analyzed regarding the vaginal microbiota in the intervention with FRAXX with a higher proportion of Lactobacillus and a decrease in pH. And there was no superiority of FRAXX in relation to the use of topical estriol.