Estrogen Cream Does not Enhance Prolapse Healing

According to the findings of a multinational clinical research performed by UT Southwestern Medical Center, vaginal estrogen cream, which is routinely recommended to aid women after surgery for pelvic organ prolapse (POP), did not prevent a recurrence of the illness. However, the drug did help to alleviate the symptoms of vaginal atrophy. According to the study authors, the findings, which were published in JAMA, could lead to novel techniques to enhance the outcomes of prolapse repairs.

“Our results would argue against routine prescription of vaginal estrogen to optimize vaginal tissue for prolapse repair, a practice that is recommended by some experts,” said study leader David Rahn, M.D., Professor of Obstetrics and Gynecology at UT Southwestern.

By the age of 80, almost one in every five women will have undergone surgery for POP (a condition in which pelvic muscles and tissues can no longer support organs such as the uterus, intestine, or bladder, causing them to bulge into the vagina) or urine incontinence. The lifetime chance of undergoing POP surgery is approximately 13%.

The most popular surgical approaches for correcting prolapse involve the utilization of native pelvic tissues. Unfortunately, approximately 12% of women aged 65 and older will require repeat prolapse repair surgery within five years.

Doctors typically prescribe using estrogen-containing vaginal cream for many weeks before and after surgery to combat the vaginal atrophy that occurs with menopause, which is a risk factor for POP. However, no trials have been conducted to determine whether this cream improves surgical success rates.

Dr. Rahn and his colleagues conducted a clinical trial with 186 postmenopausal women with POP who were treated at one of three sites: UT Southwestern, Alabama, and Rhode Island medical facilities. Half of the women used an estrogen lotion for five weeks before surgery and for a year afterwards. The other half was given a placebo that looked exactly like it.

A year following surgery, approximately 19% of women in the vaginal estrogen group reported POP recurrence, compared to 9% in the placebo group, which was not statistically significant.

Dr. Rahn stated that using the estrogen cream has some merit. Women in the vaginal estrogen group were less likely to experience symptoms linked with menopausal vaginal atrophy, such as vaginal dryness and pain during intercourse.

Dr. Rahn went on to say that biomarkers found in vaginal wall biopsies obtained during the study could help determine which women are more likely to have POP recurrence after surgery.

Jessica Pruszynski, Ph.D., Assistant Professor of Obstetrics and Gynecology, and Linda Hynan, Ph.D., Professor in the Peter O’Donnell Jr. School of Medicine, were also involved in this work. The UT Southwestern School of Public Health.

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