Vaginal Oestrogen Therapy for Postmenopausal Women Undergoing Prolapse Surgery: A Multicentre Double-Blind Randomised Placebo-Controlled Clinical Trial
In brief
Vaginal estrogen raises symptom improvement to 92% versus 80% with placebo
In a double-blind trial of 293 postmenopausal women undergoing native-tissue prolapse repair, peri-operative vaginal estrogen cream increased the proportion reporting "much" or "very much" improvement at 12 months from 80% to 92% and improved pelvic-floor quality-of-life scores. Anatomical results and re-operation rates were unchanged, so estrogen can be offered as an adjunct for symptom relief.
- Journal
- BJOG : an international journal of obstetrics and gynaecology (Q1)
- Published
- 28 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Eva V Vodegel, Krista van Rest, Leonie Speksnijder, Astrid Vollebregt, Albert Adriaanse, Eveline J Roos, et al.
- PMID
- 42663275
- DOI
- 10.1111/1471-0528.70311
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 30 August 2026): High-quality evidence in a top journal
- Picked for Obstetrics and Gynecology (top studies of the week, 30 August 2026): Vaginal estrogen improves outcomes after prolapse surgery
Abstract
OBJECTIVE: To determine whether vaginal oestrogen therapy improves outcomes after prolapse surgery in postmenopausal women. DESIGN: Double-blind, randomised, placebo-controlled trial with 12 month follow-up. SETTING: Multicentre, 22 hospitals in the Netherlands. POPULATION: Postmenopausal women with POP-Q stage ≥ 2 scheduled for primary native-tissue prolapse repair. METHODS: Women were randomised (1:1) to vaginal oestriol cream (1 mg/g) or identical placebo, started 4-6 weeks preoperatively and continued to 12 months postoperatively (twice-weekly maintenance). MAIN OUTCOME MEASURE: Subjective improvement in prolapse symptoms at 12 months postoperatively, defined as "much" or "very much" improved on the Patient Global Impression of Improvement (PGI-I) scale. RESULTS: In total 293 women participated, 57 women dropped out. At 12 months, 92% of women in the oestrogen group versus 80% in the placebo group reported improvement on the PGI-I scale (p = 0.02). Pelvic floor-related quality of life was better in the oestrogen group (median score PFDI-20: 17 vs. 25, p = 0.03), and fewer women reported discomfort/pain (EQ-5D-5L: 61% vs. 77%, p = 0.04). Anatomical outcomes, composite surgical success, sexual function and reintervention rates did not differ between groups. The cream was easy to use; 80% would use it for 1 year if it provided meaningful health benefits. CONCLUSIONS: Perioperative vaginal oestrogen improved patient-reported outcomes and pelvic floor-related quality of life at 12 months, without affecting anatomical outcomes. These findings support discussing vaginal oestrogen as an adjunctive treatment option in shared decision-making with postmenopausal women undergoing primary prolapse surgery. TRIAL REGISTRATION: NL-OMON55535, https://www.onderzoekmetmensen.nl/en/trial/55535.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.