Does preoperative locally applied estrogen treatment facilitate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse? A randomised controlled double-masked, placebo-controlled, multicentre study

Objective To evaluate whether locally applied vaginal estrogen affects prolapse-associated complaints compared with placebo treatment in postmenopausal women prior to surgical prolapse repair. Design Randomised, double-masked, placebo-controlled, multicentre study. Setting Urogynaecology unit at the Medical University of Vienna and University Hospital of Tulln. Population Postmenopausal women with symptomatic pelvic organ prolapse and planned surgical prolapse repair. Methods Women were randomly assigned local estrogen cream or placebo cream 6 weeks preoperatively. Main outcome measures The primary outcome was differences in subjective prolapse-associated complaints after 6 weeks of treatment prior to surgery, assessed with the comprehensive German pelvic floor questionnaire. Secondary outcomes included differences in other pelvic floor-associated complaints (bladder, bowel or sexual function). Results Out of 120 women randomised, 103 (86%) remained for the final analysis. After 6 weeks of treatment the prolapse domain score did not differ between the estrogen and the placebo groups (4.4 +/- 0.19 versus 4.6 +/- 0.19; mean difference, -0.21; 95% CI -0.74 to 0.33; P = 0.445). Multivariate analysis, including only women receiving the intervention, showed that none of the confounding factors modified the response to estradiol. Conclusions These results demonstrate that preoperative locally applied estrogen does not ameliorate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse. Tweetable abstract Preoperative local estrogen does not ameliorate prolapse-associated symptoms in postmenopausal women with pelvic organ prolapse.

Automated summary

The study aimed to evaluate the effects of preoperative locally applied vaginal estrogen on prolapse-associated complaints in postmenopausal women prior to surgical repair. The results showed that preoperative local estrogen did not ameliorate symptoms in postmenopausal women with symptomatic pelvic organ prolapse.