Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial

Vaginal Histological Changes Of The Baboon During The Normal Menstrual Cycle And Pregnancy

“…We also demonstrated in this current study that there was an increased level of glycogen rich cells during the ovulation stage as compared to other stages ( Table 1). The results are comparable to the ones in women, where, topical vaginal oestrogen treatment in women, improved the thin atrophic vaginal mucosa to a thick one making the epithelium cornified and increasing its glycogen content (13).…”

Vaginal Estrogen Preparations: A Review of Safety and Efficacy for Vaginal Atrophy

“…for bleeding Vaginal ulceration or irritation Ayton et al, 1996 6 No ulceration with either estradiol ring or CEE cream; some irritation in both groups (10 ring, 3 cream users) Barentsen et al, 1997 8 No ulceration mentioned with estradiol ring and estriol cream Casper and Similar adverse effects with estradiol ring and estriol pessary, level of statistical Petri, 1999 10 significance not reported; a few patients in each group had vaginal irritation; no mention of ulceration Eriksen, 1999 14 A study end, irritation was seen only in control (no treatment) group, not with estradiol ring; ulceration was observed only in control, not ring, groups Henriksson et al, 1994 16 Estradiol ring and estriol pessary equivalent for irritation; no subject had ulceration; irritation in 3 of 112 ring users and 2 of 53 pessary users. Raz and Stamm, Irritation, burning, or itching in 10 of 50 estriol cream subjects vs. 4 of 43 placebo 1993 22 subjects, mild and self-limited but led to withdrawal; no serious AEs Vaginal discharge Eriksen, 1992 13 No difference between vaginal estradiol and placebo tablets Eriksen, 1999 14 8 of 53 subjects using estradiol ring; placebo values not reported Vaginal bleeding Ayton et al, 1996 6 No difference between estradiol ring and CEE cream Barentsen et al, 1997 8 No difference between estradiol ring and estriol cream Eriksen, 1999 14 No difference between estradiol ring and no-treatment control in incidence of atrophic bleeding by end of study Henriksson , 1995 9 no difference between doses Dugal et al, 2000 12 No change with either vaginal estradiol tablet or estriol vagitory Felding et al, No difference between estradiol tablet (Vagifem) and placebo in patients when 1992 15 applied prior to genital prolapse surgery Mettler and Olsen, Mean levels were higher in twice-weekly group vs. once-weekly vaginal tablet 1991 5 groups but were lower than baseline from week 2 onward; levels remained in postmenopausal range in both groups throughout Nilsson and Heimer, 1992 4 No effect of treatment with either 10 mg or 25 mg tablets, levels remained in postmenopausal range Serum lutinizing hormone levels Mettler No difference between estradiol tablet (Vagifem) and placebo in patients when 1992 15 applied prior to genital prolapse surgery Mettler and Olsen, No difference between once-weekly and twice-weekly vaginal estradiol tablet 1991 5 groups Nachtigall, 1995 20 No significant effect of estradiol ring on serum estradiol levels; no comment regarding CEE cream group Nilsson and Initial significant estradiol absorption with both 10-mg and 25-mg tablets, but Heimer, 1992 …”

“…Raz and Stamm, Irritation, burning, or itching in 10 of 50 estriol cream subjects vs. 4 of 43 placebo 1993 22 subjects, mild and self-limited but led to withdrawal; no serious AEs Vaginal discharge Eriksen, 1992 13 No difference between vaginal estradiol and placebo tablets Eriksen, 1999 14 8 of 53 subjects using estradiol ring; placebo values not reported Vaginal bleeding Ayton et al, 1996 6 No difference between estradiol ring and CEE cream Barentsen et al, 1997 8 No difference between estradiol ring and estriol cream Eriksen, 1999 14 No difference between estradiol ring and no-treatment control in incidence of atrophic bleeding by end of study Henriksson , 1995 9 no difference between doses Dugal et al, 2000 12 No change with either vaginal estradiol tablet or estriol vagitory Felding et al, No difference between estradiol tablet (Vagifem) and placebo in patients when 1992 15 applied prior to genital prolapse surgery Mettler and Olsen, Mean levels were higher in twice-weekly group vs. once-weekly vaginal tablet 1991 5 groups but were lower than baseline from week 2 onward; levels remained in postmenopausal range in both groups throughout Nilsson and Heimer, 1992 4 No effect of treatment with either 10 mg or 25 mg tablets, levels remained in postmenopausal range Serum lutinizing hormone levels Mettler No difference between estradiol tablet (Vagifem) and placebo in patients when 1992 15 applied prior to genital prolapse surgery Mettler and Olsen, No difference between once-weekly and twice-weekly vaginal estradiol tablet 1991 5 groups Nachtigall, 1995 20 No significant effect of estradiol ring on serum estradiol levels; no comment regarding CEE cream group Nilsson and Initial significant estradiol absorption with both 10-mg and 25-mg tablets, but Heimer, 1992 4 after 14 days absorption declined significantly with both doses; absorption was dose dependent and greater with 25-mg than 10-mg dose on day 1 and day 14; still slightly significant elevation in plasma estradiol day 14 vs. day 1 for both 10-mg and 25-mg doses without difference between doses Rioux et al, 2000 23 At each time point, there were fewer instances of increased estradiol levels above the postmenopausal range in the vaginal estradiol tablet compared with CEE cream groups, as expected by daily dosing regimen of CEE cream Acceptability/preference of one local therapy over another Ayton et al, 1996 6 Both parameters in favor of estradiol ring over CEE cream Barentsen et al, 1997 8 Both parameters in favor of estradiol ring over estriol cream Casper and Both parameters in favor of estradiol ring over estriol pessary Petri, 1999 …”

“…Decreased incidence of recurrent cystitis postoperatively in subjects using vaginal 1992 15 estradiol pessary (Vagifem) vs. placebo; some patients never proceeded with surgery due to positive effects of pelvic floor exercises with pessary treatment Mikkelsen, 1995 18 Preoperative estradiol pessary (Vagifem) decreased incidence of bacteriuria in immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse 3 years later; a few patients did not need surgery because they felt better with pessary and pelvic floor surgery Raz and Stamm, Incidence of infections lower with estriol cream than placebo. Cumulative propor-1993 22 tion of women staying free of infection was higher in estriol than placebo group; corresponding decrease in Enterobacteriaceae colonization in estriol vs. no change in placebo group a OCP, oral contraceptive pill used vaginally.…”

Pearls and Pitfalls of Mesh Surgery

“…It is desirable to employ strategies that reduce chronic pelvic floor stress like insuring weight loss, treating constipation and chronic cough [10,11]. It is appropriate to use preoperative vaginal estrogen and advise pelvic floor physiotherapy that ideally should continue post-operatively as well [12]. Richard Te Linde famously commented ''the patient should ask the gynecologist for relief; the gynecologist should not urge the patient to have corrective surgery if she does not feel sufficiently uncomfortable to request it'' [4].…”