Vaginal oestrogen improves prolapse surgery outcomes

In postmenopausal women undergoing primary prolapse surgery, perioperative treatment with vaginal oestrogen is associated with improvements in patient-reported outcomes and pelvic floor-related quality of life, as shown in a multicentre study.

The study was conducted at 22 hospitals in the Netherlands and included 293 postmenopausal women with POP-Q stage ≥2 scheduled for primary native-tissue prolapse repair.

The participants were randomly assigned to receive vaginal oestriol cream (1 mg/g) or identical placebo. Treatment was initiated 4–6 weeks before the prolapse repair procedure and continued to 12 months postoperatively (twice-weekly maintenance). A total of 57 participants dropped out.

The primary outcome was subjective improvement in prolapse symptoms at 12 months postoperatively, defined as “much” or “very much” improved on the Patient Global Impression of Improvement (PGI-I) scale. Pelvic floor-related quality of life and anatomical outcomes, among others, were also evaluated.

At 12 months, the percentage of participants who reported improvement on the PGI-I scale was significantly greater in the oestrogen group than in the placebo group, at 92 percent vs 80 percent (p=0.02).

Additionally, participants in the oestrogen group had better pelvic floor-related quality of life compared with those in the placebo group (median PFDI-20 score, 17 vs 25 points; p=0.03), with fewer participants reporting discomfort/pain (EQ-5D-5L: 61 percent vs 77 percent; p=0.04).

No significant differences in anatomical outcomes, composite surgical success, sexual function, and reintervention rates were observed between the oestrogen and placebo groups.

The cream was easy to use, with 80 percent of participants saying they would use the cream for 1 year if it provided meaningful health benefits.

The findings support the consideration of vaginal oestrogen as an adjunctive treatment option in postmenopausal women undergoing primary prolapse surgery.