Estrogen cream does not improve prolapse repair success rate

Newswise — DALLAS — August 15, 2023 — Vaginal estrogen cream, commonly prescribed to help women who have had surgery for pelvic organ prolapse (POP), failed to prevent the condition from recurring, according to results of a multi-center clinical trial led by UT Southwest Medical Center. However, the drug did alleviate symptoms of vaginal atrophy. The results reported in JAMAcould lead to new ways to improve prolapse repair outcomes, the study authors said.

“Our results argue against the routine prescribing of vaginal estrogen to optimize vaginal tissue for prolapse repair, a practice recommended by some experts,” the study leader said David Rahn, MDProfessor the Obstetrics and Gynecology at UT Southwestern.

By age 80, about one in five women will have surgery for either POP — a condition in which pelvic muscles and tissues can no longer support organs like the uterus, bowel or bladder, causing them to bulge into the vagina — or urinary incontinence . The lifetime risk of undergoing POP surgery is about 13%.

The most common surgical techniques for prolapse repair use native tissue in the pelvis. Unfortunately, about 12% of women age 65 and older will have another prolapse repair surgery within five years.

Doctors often recommend using an estrogen-containing vaginal cream for several weeks before and after surgery to counteract the vaginal atrophy associated with menopause, a risk factor for POP. However, no study has examined whether this cream improves surgical success rates.

To answer this question, Dr. Rahn and his colleagues conducted a clinical study in 186 postmenopausal women with POP treated at one of three sites: UT Southwestern and medical centers in Alabama and Rhode Island. Half used an estrogen cream five weeks before surgery and 12 months after. The other half used an identical-looking placebo.

One year after surgery, about 19% of women in the vaginal estrogen group had a POP recurrence compared to 9% of women in the placebo group, which was not statistically significant.

The use of the estrogen cream is not entirely unfounded, said Dr. Rahn. Women in the vaginal estrogen group were less likely to have symptoms related to the vaginal atrophy that typically accompanies menopause, such as B. vaginal dryness and painful intercourse.

dr Rahn added that vaginal wall biopsies taken during the study could provide biomarkers that could predict which women are at greatest risk of POP recurrence after surgery.

Other UTSW researchers who contributed to this study include Jessica Pruszynski, Ph.D., assistant professor of obstetrics and gynecology, and Linda Hynan, Ph.D., professor of obstetrics and gynecology Peter O'Donnell Jr School of Public Health at UT Southwestern.

The study was funded by the National Institute on Aging (R01 AG047290) and received a Bridge Award from the American Board of Obstetrics & Gynecology and the American Association of Obstetricians and Gynecologists Foundation. Database access was provided through the National Center for Advancing Translational Sciences (UL1 TR003163). Pfizer Inc. provided the study drug as part of an investigator-initiated award (WI195371).

About UT Southwestern Medical Center
One of the nation's premier academic medical centers, UT Southwestern combines pioneering biomedical research with exceptional clinical care and education. The institution's faculty is the recipient of six Nobel Prizes and includes 26 members of the National Academy of Sciences, 19 members of the National Academy of Medicine, and 14 researchers from the Howard Hughes Medical Institute. The more than 2,900 full-time faculty members are responsible for pioneering medical advances and are committed to rapidly translating science-based research into new clinical treatments. Physicians at UT Southwestern serve more than 100,000 hospitalized patients in more than 80 specialties, serve more than 360,000 emergency department cases and attend nearly 4 million outpatient visits each year.

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