TOPLINE

In postmenopausal women who underwent primary pelvic organ prolapse (POP) surgery, perioperative vaginal oestrogen therapy significantly improved patient-reported outcomes and pelvic floor-related quality of life and reduced discomfort or pain at 12 months post-surgery compared with placebo.

METHODOLOGY

• Researchers conducted a double-blind, randomised, placebo-controlled trial across 22 hospitals in Netherlands to assess the efficacy of vaginal oestrogen therapy vs placebo in postmenopausal women who underwent primary POP surgery.
• The trial randomly assigned 311 postmenopausal women with POP Quantification (POP-Q) stage 2 or higher to apply either vaginal oestriol cream (1 mg/g; n = 153) or matching placebo cream (n = 158) before primary prolapse surgery. Of these, 293 underwent surgery and started treatment (144 on oestrogen therapy and 149 on placebo); 236 women (119 in the oestrogen group and 117 in the placebo group) completed 12-month follow-up and were included in the primary analysis.
• Participants self-administered the cream intravaginally for 4-6 weeks before surgery and continued treatment until 12 months after the surgery, with twice-weekly maintenance dosing after an initial 2-week daily regimen.
• The primary outcome was subjective improvement in prolapse symptoms measured using the Patient Global Impression of Improvement scale at 12 months after the surgery.
• Secondary outcomes included surgical success, POP-Q anatomic outcomes, discomfort or pain, pelvic floor-related quality of life, surgery-related complications, sexual function, and reoperation rates.

TAKEAWAY

• At 12 months, 92% of women in the oestrogen group vs 80% of those in the placebo group reported "much" or "very much" improvement in prolapse symptoms (odds ratio, 2.7; P = .02).
• Participants in the oestrogen group had significantly greater improvements in pelvic floor-related quality of life, and more women in the oestrogen group than in the placebo group reported no discomfort or pain (P < .05 for both).
• POP-Q anatomic outcomes, surgical success, surgery-related complications, sexual function, adverse events, and reoperation rates did not differ significantly between the two groups.

IN PRACTICE

"Perioperative vaginal oestrogen therapy should be discussed as an adjunctive treatment option in shared decision-making with postmenopausal women undergoing primary prolapse surgery," the authors wrote.

SOURCE

This study was led by Eva V. Vodegel, Amsterdam University Medical Centre - Location AMC, University of Amsterdam, Amsterdam, Netherlands. It was published online on August 28, 2026, in BJOG: An International Journal of Obstetrics & Gynaecology.

LIMITATIONS

The targeted sample size was not met due to a higher dropout rate than anticipated. COVID-related disruptions partly contributed to participant attrition and missing follow-up data. The lack of long-term follow-up beyond 12 months limited the assessment of long-term effects after discontinuation of therapy.

DISCLOSURES

This study was sponsored by the Amsterdam University Medical Centre - Location AMC. The study also received an unrestricted grant from the "Leading the Change" programme from Stichting Zorgevaluatie Nederland, a Dutch foundation consisting of the Dutch Medical Specialists Federation, the Dutch Health Insurers, and the Dutch Patients' Federation. Aspen Pharmacare provided the trial drug and placebo used for this trial. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.