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ceptor expression, resulted in significant improvement
of symptoms after treatment in the Treated Group com-
pared with the Placebo Group, with increased vaginal
epithelial thickness and percentage of immunopositive
cells to estrogen receptors.
11
As for the vaginal microbiota, we know that resident
bacteria of the genital tract obtain the glycogen used in
their nutrition from the local epithelium and, by produc-
ing lactic acid, they constitute a protective factor against
the proliferation of pathological bacteria. The concentration
of glycogen available for this microbiota depends on the
developmental conditions of the urogenital epithelium,
including the presence of estrogenic hormones, among
other factors. Therefore, the hypoestrogenism typical of
the climacteric phase allows a pathological microbiota to
develop. The analysis of the vaginal microbiota is thus a
tool for understanding the health condition of the uro-
genital tract. There are unsatisfactory attempts to improve
urogenital health with hormone therapy and oral thera-
py with phytoestrogens, but these approaches are associ-
ated with the presence of adverse reactions and uncon-
firmed therapeutic outcomes, respectively. On the other
hand, the application of phytoestrogens vaginally appears
to be satisfactory due to the possibility of local action
with little systemic interaction and a pharmacodynamics
typical of phytomedicines. We highlight a pioneering study
that evaluated the vaginal flora of women treated with
isoflavones derived from
Glycine max
(L.) Merr, for the pur-
pose of alternative (vaginal) route of phytoestrogens.
A study was conducted on the effects of isoflavones
derived from
Glycine max
(L.) Merr on the vaginal micro-
biota of postmenopausal women who did not present
systemic symptoms, had the exclusive complaint of vag-
inal atrophy, and applied topically a gel with the active
product for 90 days, compared with a placebo. Vaginal
pH, serum concentration of estradiol and symptoms of
genital atrophy were also analyzed.
The microbiota found in both groups was similar at
T0, T30 and T90 days, with the prevalence of acidophilic
species, namely coagulase-negative
Staphylococcus, Entero-
coccus
sp
, Escherichia coli
and
Bacillus
sp, with variation in
the isoflavones group. Regarding vaginal pH, there was a
statistically significant reduction in T30 and T90 in the
isoflavones group, which did not occur in the placebo
group. As for FSH, there was no significant difference in
the times studied. With respect to the Questionnaire on
Symptoms of Urogenital Atrophy, it was observed that in
the isoflavones group there was improvement in all symp-
toms while in the placebo group only dryness and pruritus
improved after 90 days of treatment. Thus, vaginal isofla-
vones appear to be an important alternative for the treat-
ment of symptoms of genital atrophy in postmenopausal
women, including those with contraindications to hor-
monal therapy, resulting in vaginal pH close to that of
women of reproductive age, an increase in acidophilic
species, including those potentially pathogenic – without
causing infection – and improved urogenital health.
12
Isoflavones administered vaginally present as an
important alternative for the treatment of the symptom
of genital atrophy thus constituting a new frontier with-
in gynecology.
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