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International Urogynecology Journal

, Volume 26, Issue 1, pp 3–13 | Cite as

Vaginal estrogen use in postmenopausal women with pelvic floor disorders: systematic review and practice guidelines

  • David D. Rahn
  • Renée M. Ward
  • Tatiana V. Sanses
  • Cassandra Carberry
  • Mamta M. Mamik
  • Kate V. Meriwether
  • Cedric K. Olivera
  • Husam Abed
  • Ethan M. Balk
  • Miles Murphy
  • for the Society of Gynecologic Surgeons Systematic Review Group
Review Article

Abstract

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.

Keywords

Incontinence Overactive bladder Menopause Pelvic organ prolapse Vaginal estrogen 

Notes

Acknowledgements

The Society of Gynecologic Surgeons provided funding support of a methodology expert in systematic review and clinical practice guideline development (EMB).

Conflicts of interest

None.

Author participation

Project development, data collection/management and analysis: all authors; manuscript writing: D.D. Rahn, R.M. Ward, T.V. Sanses, C. Carberry, E.M. Balk; manuscript editing: all authors.

Supplementary material

192_2014_2554_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)

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Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • David D. Rahn
    • 1
  • Renée M. Ward
    • 2
  • Tatiana V. Sanses
    • 3
  • Cassandra Carberry
    • 4
  • Mamta M. Mamik
    • 5
  • Kate V. Meriwether
    • 6
  • Cedric K. Olivera
    • 5
  • Husam Abed
    • 7
  • Ethan M. Balk
    • 8
  • Miles Murphy
    • 9
  • for the Society of Gynecologic Surgeons Systematic Review Group
  1. 1.Department of Obstetrics and GynecologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Vanderbilt University Medical CenterNashvilleUSA
  3. 3.University of Maryland School of MedicineBaltimoreUSA
  4. 4.Women and Infants Hospital/Alpert Medical School of Brown UniversityProvidenceUSA
  5. 5.Icahn School of Medicine at Mount SinaiNew YorkUSA
  6. 6.University of New Mexico Health Sciences CenterAlbuquerqueUSA
  7. 7.Henry Ford Health SystemDetroitUSA
  8. 8.Center for Evidence Based MedicineBrown University School of Public HealthProvidenceUSA
  9. 9.Institute for Female Pelvic Medicine and Reconstructive SurgeryNorth WalesUSA

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