Histologic and Cytologic Effects of Vaginal Estrogen in Women With Pelvic Organ Prolapse

Abstract

Preoperative vaginal estrogen application for 2 to 12 weeks restores vaginal cytology to premenopausal levels, but does not increase vaginal epithelial thickness in women with prolapse.

Randomised controlled trial to investigate the effectiveness of local oestrogen treatment in postmenopausal women undergoing pelvic organ prolapse surgery (LOTUS): a pilot study to assess feasibility of a large multicentre trial

“…Among women planning to undergo surgical repair for prolapse, three studies have reported on preoperative vaginal oestrogen by various methods, compared with placebo or no treatment, with a total of 111 participants. [10][11][12] Follow-up varied from 12 weeks to 3 years of postoperative surveillance. No vaginal oestrogen was given following surgery.…”

“…10 They suggested that if vaginal oestrogen does improve tissue integrity then therapy may need to be continued postoperatively until the time of complete scar maturation. 12 There is no clear evidence to state how long when a women would have adequate scar maturation after a prolapse surgery as this could be dependent on various factors of wound healing. In the current study, women in the intervention group continued oestrogen up to 20 weeks postsurgery.…”

“…Surgical failures requiring repeat POP repairs on an average occur within 2 years after primary surgery. 12 The PROSPECT study reported that 2% (6/395 standard repair) repeat surgeries were required as early as 1 year after primary surgery and 5% (16/348 standard repair) repeat surgery within 2 years. 15 The authors concluded that follow-up of patients for a minimum of 5 years would be required to assess recurrence of symptoms following POP surgery.…”

“…Flow of participants through the trial. *Reasons for ineligibility N=168 (%): no prolapse surgery required 38 (22), recurrence of prolapse in the same compartment 32 (19), has had previous breast or uterine malignancy 20(12), undergoing hormone replacement therapy (HRT) treatment 17 (10), unable to understand English 16 (9), genital bleeding of unknown origin 15(9), Has had previous hormone-dependent neoplasms 13 (8), Previous pelvic organ prolapse (POP) surgery involving mesh 6…”

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

“…Furthermore, in an RCT by Karp et al, using an estradiol-releasing ring 2 weeks (for 12 weeks) after pelvic floor repair resulted in improved markers of tissue quality including slightly reduced urinary tract infections compared with placebo [ 27 ]. In a study evaluating the role of 2–12 weeks’ preoperative local estrogen in increasing vaginal wall thickness prior to POP surgery, there was no statistically significant increase in the thickness of the vagina in the treatment group compared with the group with no intervention [ 28 ]. Similar, Rahn et al summarized in an SR that it is uncertain whether preoperative vaginal estrogen is beneficial before prolapse repair as no increased vaginal subepithelial or muscularis thickness could be observed (low quality) [ 16 ].…”