INTRODUCTION AND HYPOTHESIS: Risk of pelvic floor disorders increases after menopause and may be linked to estrogen deficiency. We aimed to systematically and critically assess the literature on vaginal estrogen in the management of pelvic floor disorders in postmenopausal women and provide evidence-based clinical practice guidelines. METHODS: MEDLINE and Cochrane databases were searched from inception to July 2014 for randomized controlled trials of commercially available vaginal estrogen products compared with placebo, no treatment, or any medication for overactive bladder or urinary incontinence. We double-screened 1,805 abstracts and identified 12 eligible papers. Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality and strength of evidence. RESULTS: Evidence was generally of poor to moderate quality. Vaginal estrogen application before pelvic organ prolapse surgery improved the vaginal maturation index and increased vaginal epithelial thickness. Postoperative vaginal estrogen use after a midurethral sling resulted in decreased urinary frequency and urgency. Vaginal estrogen and immediate-release oxybutynin were similar in improvement of urinary urgency, frequency, and urgency urinary incontinence in women with overactive bladder, but oxybutynin had higher rates of side effects and discontinuation. Conversely, the addition of vaginal estrogen to immediate or extended-release tolterodine did not improve urinary symptoms more than tolterodine alone. One study reported an improvement in stress urinary incontinence with use of vaginal estrogen. CONCLUSION: Vaginal estrogen application may play a useful role as an adjunct in the management of common pelvic floor disorders in postmenopausal women.
INTRODUCTION AND HYPOTHESIS: Risk of pelvic floor disorders increases after menopause and may be linked to estrogen deficiency. We aimed to systematically and critically assess the literature on vaginal estrogen in the management of pelvic floor disorders in postmenopausal women and provide evidence-based clinical practice guidelines. METHODS: MEDLINE and Cochrane databases were searched from inception to July 2014 for randomized controlled trials of commercially available vaginal estrogen products compared with placebo, no treatment, or any medication for overactive bladder or urinary incontinence. We double-screened 1,805 abstracts and identified 12 eligible papers. Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality and strength of evidence. RESULTS: Evidence was generally of poor to moderate quality. Vaginal estrogen application before pelvic organ prolapse surgery improved the vaginal maturation index and increased vaginal epithelial thickness. Postoperative vaginal estrogen use after a midurethral sling resulted in decreased urinary frequency and urgency. Vaginal estrogen and immediate-release oxybutynin were similar in improvement of urinary urgency, frequency, and urgency urinary incontinence in women with overactive bladder, but oxybutynin had higher rates of side effects and discontinuation. Conversely, the addition of vaginal estrogen to immediate or extended-release tolterodine did not improve urinary symptoms more than tolterodine alone. One study reported an improvement in stress urinary incontinence with use of vaginal estrogen. CONCLUSION: Vaginal estrogen application may play a useful role as an adjunct in the management of common pelvic floor disorders in postmenopausal women.
Authors: Susan L Hendrix; Barbara B Cochrane; Ingrid E Nygaard; Victoria L Handa; Vanessa M Barnabei; Cheryl Iglesia; Aaron Aragaki; Michelle J Naughton; Robert B Wallace; S Gene McNeeley Journal: JAMA Date: 2005-02-23 Impact factor: 56.272
Authors: S A Kobata; M J B C Girão; E C Baracat; M Kajikawa; V Di Bella; M G F Sartori; Z I K Jármy-Di Bella Journal: Maturitas Date: 2008-10-09 Impact factor: 4.342
Authors: Vivian W Sung; Rebecca G Rogers; Joseph I Schaffer; Ethan M Balk; Katrin Uhlig; Joseph Lau; Husam Abed; Thomas L Wheeler; Michelle Y Morrill; Jeffrey L Clemons; David D Rahn; James C Lukban; Lior Lowenstein; Kimberly Kenton; Stephen B Young Journal: Obstet Gynecol Date: 2008-11 Impact factor: 7.661
Authors: Byron C Wallace; Thomas A Trikalinos; Joseph Lau; Carla Brodley; Christopher H Schmid Journal: BMC Bioinformatics Date: 2010-01-26 Impact factor: 3.169
Authors: Kate V Meriwether; Ethan M Balk; Danielle D Antosh; Cedric K Olivera; Shunaha Kim-Fine; Miles Murphy; Cara L Grimes; Ambereen Sleemi; Ruchira Singh; Alexis A Dieter; Catrina C Crisp; David D Rahn Journal: Int Urogynecol J Date: 2019-02-11 Impact factor: 2.894
Authors: Maíra de Menezes Franco; Patricia Driusso; Kari Bø; Daniela Cristina Carvalho de Abreu; Lucia Alves da Silva Lara; Ana Carolina Japur de Sá Rosa E Silva; Cristine Homsi Jorge Ferreira Journal: Int Urogynecol J Date: 2016-12-06 Impact factor: 2.894
Authors: Sybil G Dessie; Katherine Armstrong; Anna M Modest; Michele R Hacker; Lekha S Hota Journal: Int Urogynecol J Date: 2016-03-18 Impact factor: 2.894
Authors: Lauren A Cadish; Elizabeth H West; Jessica Sisto; Teresa Longoria; Judith D Bebchuk; Emily L Whitcomb Journal: Int Urogynecol J Date: 2015-08-12 Impact factor: 2.894