The following is a summary of “Effects of preoperative intravaginal estrogen on pelvic floor disorder symptoms in postmenopausal women with pelvic organ prolapse,” published in the SEPTEMBER 2023 issue of Obstetrics and Gynecology by Rahn, et al.

Pelvic floor disorders, such as prolapse, urinary incontinence, and other related symptoms, frequently manifest in postmenopausal women due to decreased systemic estrogen. Prior research suggested that preoperative intravaginal estrogen may benefit postmenopausal women with symptomatic prolapse; however, its impact on other pelvic floor symptoms remains uncertain. For a study, researchers sought to assess the effects of intravaginal estrogen (compared to a placebo) on various pelvic floor symptoms in postmenopausal women with symptomatic prolapse, including stress and urgency urinary incontinence, urinary frequency, sexual function, dyspareunia, and vaginal atrophy symptoms and signs.

The analysis was part of a planned ancillary study conducted within a randomized, double-blind trial called “Investigation to Minimize Prolapse Recurrence Of the Vagina using Estrogen.” The trial enrolled participants with stage 2 or higher apical and/or anterior prolapse who were scheduled for transvaginal native tissue apical repair at three US sites. The intervention involved 1 g of intravaginal conjugated estrogen cream (0.625 mg/g) or an identical placebo, administered nightly for two weeks, followed by twice-weekly use for at least five weeks before surgery, and continued twice weekly for one year postoperatively. The analysis compared participants’ responses to questions regarding lower urinary tract symptoms (Urogenital Distress Inventory-6 Questionnaire), sexual health (Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire—IUGA-Revised), and atrophy-related symptoms (including dryness, soreness, dyspareunia, discharge, and itching, each scored 1–4, 4 being quite bothersome), as well as examiner assessments of vaginal characteristics, including vaginal color, dryness, and petechiae (each scored 1–3).

Among 199 randomized participants with baseline data, 191 provided preoperative data. The Urogenital Distress Inventory-6 Questionnaire scores demonstrated minimal changes during the median 7-week interval between baseline and preoperative visits. For participants experiencing moderately bothersome baseline stress urinary incontinence (32 in the estrogen group and 21 in the placebo group), 50% in the estrogen group and 43% in the placebo group showed improvement (P=.78). Similarly, 43% of participants in the estrogen group and 31% in the placebo group experienced improvements in urgency urinary incontinence (P=.41), while 41% in the estrogen group and 26% in the placebo group showed improved urinary frequency (P=.18). Minimal changes were observed in sexual function scores for sexually active women; rates of dyspareunia did not significantly differ between the intravaginal estrogen and placebo groups during the preoperative assessment (42% and 48%, respectively) (P=.49). Although the improvement in the most bothersome atrophy symptom (among adherent participants with baseline symptoms) was slightly greater with intravaginal estrogen (adjusted mean difference, -0.33 points; 95% CI, -0.98 to 0.31), it did not reach statistical significance (P=.19). However, objective signs of atrophy improved more with intravaginal estrogen treatment in adherent participants (+1.54 vs. +0.69; mean difference, 0.85; 95% CI, 0.05–1.65 P=.01).

The study results did not provide clear evidence regarding the impact of 7 weeks of preoperative intravaginal estrogen cream in postmenopausal women with symptomatic pelvic organ prolapse on urinary function, sexual function, dyspareunia, and other atrophy-related symptoms. While objective changes in the vaginal epithelium were observed in adherent participants, further research was required better to understand the effects of intravaginal estrogen in the population.

Source: ajog.org/article/S0002-9378(23)00352-6/fulltext