12 Uses of PRP (Platelet-Rich Plasma) in various Gynaecological Problems

This article reviews the uses of PRP (platelet rich plasma) in various gynaecological problems and the scientific evidence behind it to help you make an informed decision.

What is PRP?

Platelets are a naturally occurring component of your own blood and play an important role in wound healing and tissue regeneration. Platelet Rich Plasma [PRP] therapy is the process of isolating platelets from the blood and concentrating these platelets to much higher concentration levels than normal, through the process of centrifugation. The result is Platelet Rich Plasma [PRP].

PRP is currently considered a new and promising treatment for some gynaecological disorders especially disorders that are not very effective with conventional treatments.

PRP in Gynaecology Practice Studies and Research Update

Here, we have listed and compiled all significant scientific publications related to PRP in the field of gynaecology. The list was complied by running various searches on PubMed, Google Scholar, Clinical Key and Medline. Each study and is hyperlinked to the abstract in the U.S. National Library of Medicine or the full text article.

Here is the list by category.

1) PRP in skin lesions and wound healing

Due to the ability of PRP to promote wound healing, it is widely used in dermatology for purposes including the treatment of ulcers, scars, and alopecia. With this in mind, PRP was tested by a study by Tehranian et al. in wound healing in high-risk women undergoing cesarean sections. They applied PRP in 70 patients and compared them to 71 control cases without PRP application. They found a significant greater reduction in the redness, edema, ecchymosis, discharge, approximation score than in the control group (85.5% reduction in the PRP group vs. 72% in the control group). They concluded that PRP was an effective therapeutic approach for wound healing, and faster wound healing can be expected when PRP is used due to the presence of more platelets and growth factors.

2) PRP in cervical ectopy

Cervical ectropion, or cervical ectopy, is when the soft cells (glandular cells) that line the inside of the cervical canal spread to the outer surface of your cervix. Cervical ectopy can cause pain and bleeding during or after sexual intercourse.

A study by Hua et al., a randomized clinical study to compare the effectiveness of autologous PRP application to that of laser treatment for benign cervical ectopy. They applied PRP twice on the area of cervical erosion with a 1-week interval in 60 patients, while laser treatment was used in the other 60 patients. They found that the complete cure rate was 93.7% in the PRP group and 92.4% in the laser group. The mean time to re-epithelialization was significantly shorter in the PRP group. The rate of adverse treatment effects (i.e., vaginal discharge or vaginal bleeding) was much lower in the PRP group than in the laser group (p< 0.01). They concluded that autologous PRP application appeared promising for the treatment of cervical ectopy in symptomatic women, as it yielded a shorter tissue healing time and milder adverse effects than laser treatment.

3) PRP in vulvar dystrophy

PRP has been tried in many dermatological and autoimmune conditions non-responsive to corticosteroids, such as lichen sclerosus (LS) and eczema. LS affects the vulva and causes extensive scarring, with progressive loss of the labia minora, sealing of the clitoral hood, and burying of the clitoris. LS also causes progressive pruritus, dyspareunia, and genital bleeding. It has a considerable impact on the quality of life of affected patients by disturbing physical activity, sexual pleasure, and causing emotional and psychological problems. This condition is treated by topical and systemic corticosteroids. Application of PRP in cases of LS resistant to steroid therapy was tried in a study by Behnia-Willison et al. in 28 patients with LS. They injected PRP into the vulva in a fanning pattern. Patients received three PRP treatments 4 to 6 weeks apart and again at 12 months. Nearly all patients exhibited clinical improvements in the size of their lesions, and in 28.6% of the patients, the lesions disappeared completely after PRP treatment. Minimal pain and no complications were reported. They concluded that PRP injections could therefore be considered an effective therapy for LS.

4) PRP in reconstructive surgery for vulvar cancer

Morelli et al. conducted a retrospective study of patients who underwent surgery for vulvar cancer (radical vulvectomy). The aim of their study was to evaluate the efficacy of platelet gel application in women after radical surgery. They divided patients into two groups: group A (n = 10), who had platelet gel placed on the vaginal breach during reconstructive surgery, and group B (n = 15), who underwent only surgical treatment. They found significantly lower rates of wound infection, necrosis of vaginal wounds and wound breakdown in group A than in group B. They also found a reduction in the postoperative fever rate, a shorter hospital stay, and faster wound healing in group A, which received PRP gel treatment. They concluded that platelet gel application before vulvar reconstruction represented an effective strategy for preventing wound breakdown after surgery to treat locally advanced vulvar cancer.

5) PRP in Vaginal Fistula

Genital fistulae are treated by many modalities, as listed by Bodner-Adler et al. in a systemic review that assessed conservative and surgical treatments. They found that small fistulae could be treated conservatively with various therapies, including PRP, with success rates ranging from 67% to 100%. PRP has been tried in the treatment of vesicovaginal fistulae as a novel, minimally invasive approach for the closure of genital fistulae.

6) PRP in genital prolapse and urinary incontinence

Both absorbable and non-absorbable vaginal implants used in pelvic floor reconstructive procedures have numerous serious adverse effects. PRF is a mixture of platelets, leukocytes, cytokines, and circulating stem cells that is optimal for stimulating fibroblast migration and proliferation. This mixture causes rapid remodeling and connective tissue growth after vaginal surgery. Gorlero et al. conducted a prospective observational study of 10 consecutive women requiring surgery for prolapse recurrence (stage II or higher). They operated on the cases and performed PRF injections. The success rate was 80% with complete symptom relief. Sexual activity increased by 20% without dyspareunia. They concluded that the use of PRF for site-specific prolapse repair was associated with good functional outcomes.

7) PRP in premature ovarian failure

Premature ovarian failure (POF) refers to loss of normal function of the ovaries before age 40, accompanied by the loss of fertility. PRP therapy is investigated in women with POF, infertile women more than 35 years of age, and women with low ovarian reserve. Treatment with PRP is referred to as ovarian rejuvenation; in this procedure, PRP is injected into the ovary under ultrasound guidance, similarly to ovum retrieval in in vitro fertilization (IVF). A case report by Sfakianoudis et al., published in 2019, presented the case of a woman aged 40 who has experienced premature menopause from the age of 35. Having rejected oocyte donation, she opted for intra-ovarian injection of autologous platelet-rich plasma with the aim to rejuvenate the ovarian tissue and enable the employment of her own gametes through in-vitro fertilization. Six weeks following the autologous platelet-rich plasma treatment, a significant reduction in the patient’s follicle-stimulating hormone (FSH) levels were noted. A natural in-vitro fertilization cycle led to a biochemical pregnancy, resulting in a spontaneous abortion at the 5th week of pregnancy. This is the first report of a successful autologous platelet-rich plasma application leading to pregnancy in menopause.

8) PRP in refractory endometrium

Endometrial thinness is a common cause of infertility that is often refractory to hormonal therapy, a condition referred to as refractory endometrium, and it frequently leads to repeated implantation failure.

The endometrium plays an important role in achieving optimal outcomes of assisted reproductive technologies. Endometrial growth following inadequate ovarian stimulation may be insufficient, leading to poor results of IVF/ICSI cycles. Various strategies been suggested to improve endometrial thickness, especially in resistant cases. PRP is a new and promising therapy that has been tried in such patients. Zadehmodarres et al., in their pilot study, included 10 patients who had a history of cancelled cycles due to inadequate endometrial growth ( < 7 mm). They found that endometrial thickness increased at 48 hours after the first PRP application and reached more than 7 mm after the second PRP application in all patients. Embryo transfer was then carried out in all patients. Five patients became pregnant (50%), and in four of them the pregnancy progressed normally. They concluded that PRP was effective for endometrial growth in patients with a thin endometrium.

9) PRP in repeated implantation failure

Repeated implantation failure (RIF) is defined as failure to conceive following several embryo transfers in IVF cycles. Numerous factors are involved in the implantation process, including embryo quality, endometrial receptivity, and immunological factors. Several methods have been suggested for RIF management, but little consensus exists on which is most effective. These methods include blastocyst transfer, assisted hatching, hysteroscopy, endometrial scratching, and immune therapy. Recently, the intrauterine infusion of PRP has been described as a way to promote endometrial growth and receptivity. Nazari et al. enrolled 20 participants with a history of RIF to evaluate the effectiveness of PRP in improving the pregnancy rate in RIF patients. The inclusion criteria were being younger than 40 years and having a BMI below 30 kg/m2 . They reported that 18 of the 20 participants (90%) became pregnant. Sixteen clinical pregnancies were recorded, and their pregnancies were ongoing at the time of the study. They concluded that PRP was effective in improving pregnancy outcomes in RIF patients.

10) PRP in breast reconstruction

Many studies of PRP have been conducted in the field of aesthetic and plastic surgery, but all were pilot studies, had small samples, or used animal models. PRP together with adipose tissue has been used in breast reconstruction. Gentile et al. enrolled 100 patients aged between 19 and 60 years affected by breast soft-tissue defects. They divided the patients into two equally-sized groups. The study group was treated with fat grafting and PRP, while the control group was treated with fat grafting injections only. They found that the patients treated with PRP added to the autologous fat grafts showed a 69% maintenance rate of the restored contour and of three-dimensional volume after 1 year, whereas the patients in the control group showed a 39% maintenance rate. They concluded that PRP mixed with fat grafts led to improvements in the maintenance of breast volume in patients affected by breast soft-tissue defects.

11) PRP in sexual dysfunction (O-Shot therapy)

PRP use in sexual dysfunction is considered to be a revolutionary new nonsurgical outpatient treatment that helps improve both urinary incontinence and sexual dysfunction through using a woman’s own growth factors. The PRP is injected into specific areas of the vagina with the aid of local anesthetic cream. This modality of treatment is called the “O-shot.” PRP immediately activates tissue regeneration, and the enhancement in sexual response is dramatic. The desired response includes improved arousal, stronger orgasm, decreased dyspareunia, and increased natural lubrication. Runels et al. [46] enrolled 11 women who presented with dyspareunia. They injected PRP into the clitoris and vagina, and found that intravaginal and intraclitoral PRP injections could be an effective method to treat certain types of female sexual dysfunction, especially in the areas of desire, arousal, lubrication, and orgasm.

12) PRP in Vaginal rejuvenation and Urinary Incontinence

Aesthetic practitioners have used PRP for the regeneration of vaginal mucosa, muscles, and skin. After PRP injection, vaginal vascularity is increased, with a subsequent dramatic increase in sensitivity. In addition, the skin becomes thicker and firmer, making the vagina look much more youthful. Moreover, the ligaments and muscles supporting the urethra become stronger, alleviating urinary incontinence. Kim et al. reported the use of PRP in a case of vaginal rejuvenation. They concluded that the application of autologous lipofilling mixed with PRP in a patient with vaginal atrophy produced relief of symptoms and contour restoration. The rejuvenated appearance of the external genitalia provided a pleasing cosmetic outcome to the patient.

References:

Each study reference is hyperlinked to the abstract in the U.S. National Library of Medicine or the full text article.