Estrogen: can it reduce the symptoms of pelvic floor disorders in menopausal women?

Preoperative use of local estrogen can provide benefits in women with pelvic organ prolapse. Can other pelvic floor disorders be treated with estrogen in menopausal women? Let's find out together in this article.

Menopause, pelvic floor disorders, and estrogen

Menopause represents the physiological end of a woman's fertile period. For it to be called menopause, menstrual periods must have been absent for at least 12 consecutive months. The phase preceding menopause, characterized by psychosomatic changes¹, is called the female climacteric.

Underlying the changes induced by menopause is the drastic reduction in the production of female sex hormones (estradiol, estriol, and estrone), commonly referred to as "estrogens." The low concentration of these hormones affects the activity of the ovaries, which therefore become unable to produce ovarian follicles. In addition, estrogens also regulate the activity and health of the other organs associated with the urogenital system.

The pelvic floor is the region of the body that forms the lower boundary of the abdominopelvic cavity, extending from the pubic symphysis to the coccyx. This region holds and supports the bladder, the urethra, and the vagina. The main pelvic floor disorders are:

• Prolapse² of the pelvic organs
• Urinary incontinence
• Dyspareunia³
• Vulvovaginal atrophy.

Previous studies have highlighted the benefits that menopausal women with symptomatic prolapse can obtain from the preoperative application of local estrogen. Can the administration of these hormones be associated with an improvement in other pelvic floor disorders? Some researchers have tried to give a clear and comprehensive answer to this question.

Study characteristics

• Study type: double-blind randomized controlled trial.
• Location: United States.
• Patient type: 199 patients with pelvic floor disorders, with a mean age of 65 years.

Study aim: can local estrogen help with pelvic floor disorders or in menopause?

The main objective of the research was to evaluate any benefits that the use of local estrogen can bring to the pelvic organs. To achieve this aim, the patients underwent periodic visits, during which the researchers assessed the health of the urogenital organs.

Study results

The results of the study indicated that:

• 43% of patients with urinary incontinence reported a slight improvement in symptoms.
• Estrogen produced a moderate improvement in sexual function in women with pelvic organ prolapse.
• There were no significant differences in dyspareunia rates before and after use of the hormones.
• In subjects with atrophy, an objective change in the vaginal epithelium was observed.

Conclusions: can pelvic disorders be treated with estrogen?

Although the use of local estrogen leads to an objective improvement in the vaginal epithelium, the data collected by the researchers showed modest results. In fact, the benefits of these hormones in the treatment of urinary incontinence, vaginal atrophy, and pelvic organ prolapse appeared to be of little significance and below expectations.

Therefore, further research is needed in the future to clarify more comprehensively the role of estrogen in the treatment of pelvic floor disorders.

Sources and notes:

ORIGINAL ARTICLE: Rahn D., Richter H., Sung V., et al. Effects of preoperative intravaginal estrogen on pelvic floor disorder symptoms in postmenopausal women with pelvic organ prolapse. May 24, 2023.

Note 1. The most common symptoms associated with the climacteric and menopause are: vaginal dryness, hot flashes, palpitations, sweating, irritability, mood changes, and reduced sexual desire.

Note 2. Dyspareunia is the pain felt in the genital organs during sexual intercourse.

Note 3. In medicine, the term prolapse refers to the displacement of an organ from its original position. This phenomenon is generally associated with the mechanisms of aging and senescence, which reduce the strength of the connective tissue structures that support the organs.