title: A randomized clinical trial of the impact of local estrogen on postoperative tissue quality after vaginal reconstructive surgery.
abstract: OBJECTIVE
  To evaluate the use and effect of early administration of vaginal estrogen via a continuous low-dose estradiol vaginal ring placed immediately after pelvic reconstructive surgery.
  
  
  METHODS
  This was a randomized controlled trial of 65 postmenopausal women undergoing vaginal reconstructive surgery. The subjects were randomly assigned to receive an estradiol-releasing vaginal ring, placebo vaginal ring, or control without vaginal ring for 12 weeks immediately after vaginal reconstructive surgery. The primary outcome was tissue quality based on vaginal maturation 3 months postoperatively. Secondary outcome measures were subjective and objective signs of atrophy; vaginal pH; the presence of granulation tissue, microscopic inflammation, and major healing abnormalities; and the ability to tolerate an intravaginal ring.
  
  
  RESULTS
  At 12 weeks, the estradiol ring group had a significantly improved maturation value (P<0.01) and objective atrophy assessment (P<0.01) compared with the placebo ring and control arms. Granulation tissue was increased in the placebo ring arm (P<0.01). Subjective atrophy scores did not differ among the groups (P=0.39).
  
  
  CONCLUSIONS
  Early administration of vaginal estrogen after vaginal surgery via an estradiol-releasing ring is feasible and results in improved markers of tissue quality postoperatively compared to placebo and controls.
authors: Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA. debby.karp@emory.edu
authors: Deborah R
authors: DR
authors: Karp
authors: Marjorie
authors: M
authors: Jean-Michel
authors: Yasmin
authors: Y
authors: Johnston
authors: Gabriel
authors: G
authors: Suciu
authors: Vivian C
authors: VC
authors: Aguilar
authors: G Willy
authors: GW
authors: Davila
mesh_terms: D000282:Administration, Intravaginal; D000368:Aged; D001284:Atrophy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D015331:Cohort Studies; D003274:Contraceptive Devices, Female; D004958:Estradiol / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006097:Granulation Tissue / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D016896:Treatment Outcome; D014621:Vagina / Q000187:drug effects* / Q000473:pathology* / Q000601:surgery; D014945:Wound Healing / Q000187:drug effects
chemical_list: D004967:Estrogens; D004958:Estradiol