Vaginal Oestrogen Therapy Enhances Prolapse Surgery Care

Role of Vaginal Oestrogen Therapy in Prolapse Surgery

Pelvic organ prolapse frequently affects postmenopausal women and consequently impairs overall quality of life. Clinicians often evaluate whether perioperative vaginal oestrogen therapy provides meaningful clinical recovery benefits. A multicentre randomised trial in the Netherlands investigated this treatment in women undergoing primary native-tissue prolapse repair. Overall, the study evaluated subjective symptom relief and quality of life over twelve months.

Study Design and Surgical Findings

The double-blind clinical trial enrolled 293 postmenopausal women with POP-Q stage two or higher prolapse. Specifically, researchers randomised participants to receive either vaginal oestriol cream or an identical placebo. Subsequently, patients applied the cream starting four to six weeks before surgery and continued maintenance therapy for twelve months postoperatively. Furthermore, investigators tracked patient-reported improvements, anatomical outcomes, and adverse events across twenty-two hospital sites.

Key Subjective and Functional Outcomes

At the twelve-month follow-up, 92% of women in the oestrogen group reported substantial symptom improvement. In contrast, only 80% of participants in the placebo cohort reported similar symptom relief. In addition, women receiving active treatment achieved significantly better pelvic floor-related quality of life scores. Moreover, fewer patients in the treatment group reported bodily discomfort or pain during daily activities. However, anatomical support, surgical success rates, and reintervention rates remained similar between both study arms.

Clinical Guidance for Gynaecologists

Consequently, local oestrogen cream represents a practical adjunctive measure for postmenopausal surgical candidates. In fact, eighty percent of participants expressed willingness to continue therapy for one full year. Therefore, surgeons should discuss perioperative local oestrogen during shared decision-making to optimize postoperative comfort and patient satisfaction through specialized training such as the Advanced Clinical Practice Program In Urogynaecology.

Frequently Asked Questions

Q1: Does perioperative oestrogen therapy reduce anatomical prolapse recurrence?

No, the trial showed that local oestrogen does not alter anatomical cure rates or surgical reintervention frequencies.

Q2: When should patients initiate topical oestrogen before surgery?

In this trial, patients initiated topical oestriol cream four to six weeks prior to native-tissue prolapse repair.

Q3: What primary benefits did patients experience from the therapy?

Patients experienced superior overall symptom improvement, less bodily discomfort, and better pelvic floor-related quality of life.

References

1. Vodegel EV et al. Vaginal Oestrogen Therapy for Postmenopausal Women Undergoing Prolapse Surgery: A Multicentre Double-Blind Randomised Placebo-Controlled Clinical Trial. BJOG. 2026 Aug 28. doi: 10.1111/1471-0528.70311. PMID: 42663275.
2. Taithongchai A et al. Oestrogen therapy for treating pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev. 2023;7(7):CD012308.
3. Rahn DD et al. Effects of Preoperative Local Estrogen in Postmenopausal Women With Prolapse: A Randomized Trial. J Clin Endocrinol Metab. 2014;99(10):3728-3736.