Friday, 20 June 2014

The Best Evidence for Oestrogen Use in the Management of Prolapse

In the previous articles summarising current research about pessary use and physiotherapy, I explained that a Cochrane Review is a one-stop-shop when it comes to finding out what the latest research tells us.

This article is about the Cochrane Review of Oestrogen to prevent prolapse, which can be found here: Oestrogens for treatment or prevention of pelvic organ prolapse in women.

Oestrogen is a hormone. It is often prescribed to women with Prolapse,  usually in the form of a cream used internally in the vagina. When women go through menopause the amount of Oestrogen in their bodies decreases and this often leads to thinning of the vaginal walls. Doctors therefore believe that Oestrogen cream may thicken the vaginal walls.

The common reasons that women with prolapse are prescribed Oestrogen include:
  • Their symptoms have become worse, or noticed for the first time, since menopause
  • They are about to undergo or have just had prolapse repair surgery, and it is hoped that the cream will help in their healing
  • They are using a Pessary, and the cream is being used to try and prevent irritation or injury caused by the Pessary
  • The prescribing health professional hopes that by thickening the vaginal walls they can lessen the symptoms of the prolapse, or stop it from getting worse
Considering how widely it is prescribed, you may be surprised to hear that the Cochrane Review found no studies about Oestrogen for prolapse.

This doesn't necessarily mean that it doesn't work, or that it is dangerous. However, it does mean that we don't have any clinical evidence either way. Many women report that they find it helpful - and by all means continue to use it if you are one of them.

However, this review does clearly indicate an urgent need for more research on this topic so women with POP can make an informed choice. It is simply not good enough that a medication is being prescribed so widely without firm evidence to back it up.

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