A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women.
OBJECTIVE
To compare the effects of oral and vaginal estrogen therapy (ET) on the lower urinary tract in postmenopausal women with prior hysterectomy.


METHODS
Randomized, prospective study.


METHODS
Tertiary teaching hospital.


METHODS
Fifty-seven hysterectomized, postmenopausal women.


METHODS
Patients were randomized to receive either oral (0.625 mg of conjugated equine E per tablet; n = 27) or topical (0.625 mg conjugated equine E per 1 g vaginal cream; n = 30) E, administered once daily.


METHODS
All subjects had E2 measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews with the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 3 months after ET.


RESULTS
A higher serum level of E2 was noted in the oral group compared with the topical group after ET. The post-ET pulsatility index of periurethral vessels and bladder neck revealed statistically significant decreases in both groups. The incidences of urinary frequency and nocturia were significantly decreased after 3 months of ET in both groups. Changes in the incidence of other symptoms, including stress incontinence and urge incontinence, were not statistically significant. However, subjective improvement of stress incontinence was found in 72.7% of the oral group and 60% of the topical group.


CONCLUSIONS
The results suggest that ET alone, by an oral or vaginal route, could increase the blood flow around the bladder neck and mid-urethra and relieve the symptoms of overactive bladder and stress incontinence in postmenopausal women with prior hysterectomy. In addition, vaginal preparations are as effective as systemic therapy at the lower serum level of E2.
Long
Cheng-Yu
CY
Department of Obstetrics and Gynecology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Liu
Cheng-Min
CM
Hsu
Shih-Cheng
SC
Chen
Yung-Hung
YH
Wu
Chin-Hu
CH
Tsai
Eing-Mei
EM
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000287:Administration, Topical; D001783:Blood Flow Velocity; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D014521:Urethra / Q000098:blood supply / Q000187:drug effects*; D001743:Urinary Bladder / Q000098:blood supply / Q000187:drug effects*; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014555:Urination Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy
D004967:Estrogens