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

Research output: Contribution to journalArticle

33 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3-13
Number of pages11
JournalInternational Urogynecology Journal and Pelvic Floor Dysfunction
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2015

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Pelvic Floor Disorders
Practice Guidelines
Estrogens
Overactive Urinary Bladder
Urinary Incontinence
Suburethral Slings
Pelvic Organ Prolapse
Stress Urinary Incontinence
Evidence-Based Practice
Menopause
MEDLINE
Randomized Controlled Trials
Placebos
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Vaginal estrogen use in postmenopausal women with pelvic floor disorders : systematic review and practice guidelines. / Rahn, David D.; Ward, Renée M.; Sanses, Tatiana V.; Carberry, Cassandra; Mamik, Mamta M.; Meriwether, Kate V.; Olivera, Cedric K.; Abed, Husam; Balk, Ethan M.; Murphy, Miles.

In: International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 26, No. 1, 01.01.2015, p. 3-13.

Research output: Contribution to journalArticle

Rahn, David D. ; Ward, Renée M. ; Sanses, Tatiana V. ; Carberry, Cassandra ; Mamik, Mamta M. ; Meriwether, Kate V. ; Olivera, Cedric K. ; Abed, Husam ; Balk, Ethan M. ; Murphy, Miles. / Vaginal estrogen use in postmenopausal women with pelvic floor disorders : systematic review and practice guidelines. In: International Urogynecology Journal and Pelvic Floor Dysfunction. 2015 ; Vol. 26, No. 1. pp. 3-13.
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