Perioperative Vaginal Estrogen fails to reduce prolapse recurrence after transvaginal repair: JAMA

The primary outcome of the study was the time to failure of prolapse repair within 12 months after surgery. Failure was defined by at least one of three criteria: anatomical/objective prolapse of the anterior or posterior walls beyond the hymen, apex descending more than one-third of the vaginal length, subjective vaginal bulge symptoms, or repeated prolapse treatment.

• The study found that perioperative vaginal estrogen did not significantly improve surgical success rates.
• The 12-month failure incidence was 19% for the vaginal estrogen group and 9% for the placebo group.
• The adjusted hazard ratio was 1.97 (95% CI, 0.92-4.22), indicating no significant difference in outcomes between the two groups.
• The most common component of failure was anatomic recurrence, rather than vaginal bulge symptoms or repeated prolapse treatment.

The assessment of vaginal tissue quality and estrogenization by masked surgeons at the time of the operation was significantly better in the vaginal estrogen group. In participants with bothersome vaginal atrophy symptoms at baseline, the vaginal atrophy score for the most bothersome symptom was significantly better at 12 months with vaginal estrogen.

In conclusion, the study found that perioperative vaginal estrogen application did not lead to improved surgical success rates after native tissue transvaginal prolapse repair. This research contributes valuable insights into the potential effects of estrogen in surgical prolapse management and highlights the complexities of such interventions in postmenopausal women. Further studies may be needed to explore alternative strategies for enhancing surgical outcomes in prolapse repair.