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


CONCLUSIONS
Vaginal estrogen application may play a useful role as an adjunct in the management of common pelvic floor disorders in postmenopausal women.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA, david.rahn@utSouthwestern.edu.
David D
DD
Rahn
Renée M
RM
Ward
Tatiana V
TV
Sanses
Cassandra
C
Carberry
Mamta M
MM
Mamik
Kate V
KV
Meriwether
Cedric K
CK
Olivera
Husam
H
Abed
Ethan M
EM
Balk
Miles
M
Murphy
D000282:Administration, Intravaginal; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D059952:Pelvic Floor Disorders / Q000188:drug therapy* / Q000601:surgery
D004967:Estrogens