Current insight flavonoid quercetin in epithelial maturation vagina for menopause treatment: a narrative review

Background: Menopause affects all parts of the women’s body system, especially in the genitourinary area. The impact on the genitourinary system causes post-menopausal women to complain of menopause-related genitourinary syndrome due to vaginal atrophy, sexual dysfunction, and pelvic organ prolapse in the long term. Various research has been conducted to find alternative therapy, especially flavonoid quercetin, due to its phytoestrogen characteristic. Methods: This review article assembles much literature to highlight the menopause effect on the vagina and the phytoestrogen effect of flavonoid quercetin as a potential alternative therapy. This study aims to develop future experimental studies of quercetin’s effect on the vagina. Results: Hypoestrogenic condition affects all vaginal layers. This is due to estrogen receptors distributed in the epithelial lining, lamina propria, and muscular layer of the vagina. In vitro studies showed quercetin induces cell proliferation by activating signal pathway b-catenin/c-Myc/cyclin A2, mediated by estrogen receptor. The signal pathway increases the cell cycle transition to the G1 phase. It also increases keratinocyte proliferation and migration, proliferating cell nuclear antigen, and positive a6 and b1 integrin cells in the basal layer of the epidermis, which causes thickening of the epidermis. Conclusion: Flavonoid quercetin is a promising alternative for menopause therapy in the vagina. Further, in vivo studies are needed to confirm the result of in vitro study and as basic data for comparison with other potent phytoestrogen.