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Histologic and Cytologic Effects of Vaginal Estrogen in Women With Pelvic Organ Prolapse: A Randomized Controlled Trial

Vaccaro, Christine M. DO*; Mutema, George K. MD; Fellner, Angela N. PhD; Crisp, Catrina C. MD§; Estanol, Maria V. MD§; Kleeman, Steven D. MD§; Pauls, Rachel N. MD§

Female Pelvic Medicine & Reconstructive Surgery: January/February 2013 - Volume 19 - Issue 1 - p 34–39
doi: 10.1097/SPV.0b013e318278cc40
Original Article

Objective: This study aimed to evaluate the histologic and cytologic effects of preoperative vaginal estrogen in women with atrophic vaginitis and pelvic organ prolapse.

Methods: Forty-two women with atrophic vaginitis and stage greater than or equal to 2 prolapse were enrolled in this assessor-blinded randomized controlled trial comparing daily vaginal estrogen cream use for 2 to 12 weeks preoperatively versus no intervention. Data were analyzed using t test and analysis of variance.

Results: Of these 42 women, 22 received treatment and 20 were controls. After a mean 7 (3) weeks of use, the vaginal maturity index increased 15.5% in the treatment group and declined 1.5% in the control group (P < 0.001). The vaginal epithelial thickness was 339 (96) μm in the treatment group compared to 302 (119) μm (P = 0.275) in the controls.

Conclusions: Preoperative vaginal estrogen application for 2 to 12 weeks restores vaginal cytology to premenopausal levels, but does not increase vaginal epithelial thickness in women with prolapse.

Preoperative vaginal estrogen restores vaginal cytology to premenopausal levels, but does not increase vaginal epithelial thickness in women with prolapse.

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Madigan Healthcare System, Tacoma, WA; and †Department of Pathology, ‡Hatton Institute for Research and Education, and §Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH.

Reprints: Christine Vaccaro, DO, Madigan Army Medical Center, Urogynecology and Pelvic Reconstructive Surgery, ATTN: MCHJ-CLG-U, 9040 Jackson Ave, Tacoma, WA 98431. E-mail: vaccaro.christine@gmail.com.

The authors have declared they have no conflicts of interest.

Supported by the Hatton Institute for Research and Education, Good Samaritan Hospital, Cincinnati, OH.

Presented at the 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons, April 13, 2012, Baltimore, MD.

The opinions expressed herein are those of the author and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins