Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 2/2012

01-02-2012 | General Gynecology

Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women

Authors: Giampiero Capobianco, Ermes Donolo, Gianna Borghero, Francesco Dessole, Pier Luigi Cherchi, Salvatore Dessole

Published in: Archives of Gynecology and Obstetrics | Issue 2/2012

Login to get access

Abstract

Purpose

To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women.

Methods

Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized controlled study. Patients were randomly divided into two groups and each group consisted of 103 women. Subjects in the treatment group received intravaginal estriol ovules, such as 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the control group received only intravaginal estriol in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment.

Results

After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 61/83 (73.49%) of the treated patients, and only 10/103 (9.71%) of the control patients referred a subjective improvement of their incontinence. In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure (MUP), in mean urethral closure pressure (MUCP), as well as in the abdominal pressure transmission ratio to the proximal urethra (PTR).

Conclusions

Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women.
Literature
1.
go back to reference Greendale GA, Judd HL (1993) The menopause: health implications and clinical management. J Am Geriatr Soc 41:426–436PubMed Greendale GA, Judd HL (1993) The menopause: health implications and clinical management. J Am Geriatr Soc 41:426–436PubMed
2.
go back to reference Cardozo L, Bachmann G, McClish D, Fonda D, Birgenson L (1998) Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the hormones and urogenital therapy committee. Obstet Gynecol 92:722–727PubMedCrossRef Cardozo L, Bachmann G, McClish D, Fonda D, Birgenson L (1998) Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the hormones and urogenital therapy committee. Obstet Gynecol 92:722–727PubMedCrossRef
3.
go back to reference Barlow DH, Samsioe G, van Geelen JH (1997) A study of European women’s experience of the problems of urogenital ageing and its management. Maturitas 27:239–247PubMedCrossRef Barlow DH, Samsioe G, van Geelen JH (1997) A study of European women’s experience of the problems of urogenital ageing and its management. Maturitas 27:239–247PubMedCrossRef
5.
go back to reference Iosif CS, Batra S, Ek A, Astedt B (1981) Estrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 141:817–820PubMed Iosif CS, Batra S, Ek A, Astedt B (1981) Estrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 141:817–820PubMed
6.
go back to reference Smith P (1993) Estrogens and the urogenital tract. Acta Obstet Gynecol Scand 157(suppl):1–25 Smith P (1993) Estrogens and the urogenital tract. Acta Obstet Gynecol Scand 157(suppl):1–25
7.
go back to reference Samsioe G, Jansson I, Mellstrom D, Svanborg A (1985) Occurrence, nature and treatment of urinary incontinence in a 70-year-old female population. Maturitas 7:335–342PubMedCrossRef Samsioe G, Jansson I, Mellstrom D, Svanborg A (1985) Occurrence, nature and treatment of urinary incontinence in a 70-year-old female population. Maturitas 7:335–342PubMedCrossRef
8.
go back to reference Nilsson K, Heimer G (1992) Low-dose oestradiol in the treatment of urogenital oestrogen deficiency: a pharmacokinetic and pharmacodynamic study. Maturitas 15:121–127PubMedCrossRef Nilsson K, Heimer G (1992) Low-dose oestradiol in the treatment of urogenital oestrogen deficiency: a pharmacokinetic and pharmacodynamic study. Maturitas 15:121–127PubMedCrossRef
9.
go back to reference Smith P, Heimer G, Lindskog M, Ulmsten U (1993) Oestradiol-releasing vaginal ring for treatment of postmenopausal urogenital atrophy. Maturitas 16:145–154PubMedCrossRef Smith P, Heimer G, Lindskog M, Ulmsten U (1993) Oestradiol-releasing vaginal ring for treatment of postmenopausal urogenital atrophy. Maturitas 16:145–154PubMedCrossRef
10.
go back to reference Fantl JA, Cardozo L, McClish DK (1994) Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the hormones and urogenital therapy committee. Obstet Gynecol 83:12–18PubMed Fantl JA, Cardozo L, McClish DK (1994) Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the hormones and urogenital therapy committee. Obstet Gynecol 83:12–18PubMed
11.
go back to reference Dessole S, Rubattu G, Ambrosini G, Gallo O, Capobianco G, Cherchi PL, Marci R, Cosmi E (2004) Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women. Menopause 11:49–56PubMedCrossRef Dessole S, Rubattu G, Ambrosini G, Gallo O, Capobianco G, Cherchi PL, Marci R, Cosmi E (2004) Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women. Menopause 11:49–56PubMedCrossRef
12.
13.
go back to reference Heimer GM, Englund DE (1992) Effects of vaginally-administered oestriol on post-menopausal urogenital disorders: a cytohormonal study. Maturitas 14:171–179PubMedCrossRef Heimer GM, Englund DE (1992) Effects of vaginally-administered oestriol on post-menopausal urogenital disorders: a cytohormonal study. Maturitas 14:171–179PubMedCrossRef
14.
go back to reference Iosif CS (1992) Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women. Arch Gynecol Obstet 251:115–120PubMedCrossRef Iosif CS (1992) Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women. Arch Gynecol Obstet 251:115–120PubMedCrossRef
15.
go back to reference Foidart JM, Vervliet J, Buytaert P (1991) Efficacy of sustained-release vaginal oestriol in alleviating urogenital and systemic climacteric complaints. Maturitas 13:99–107PubMedCrossRef Foidart JM, Vervliet J, Buytaert P (1991) Efficacy of sustained-release vaginal oestriol in alleviating urogenital and systemic climacteric complaints. Maturitas 13:99–107PubMedCrossRef
16.
go back to reference Van der Linden MC, Gerretsen G, Brandhorst MS, Ooms EC, Kremer CM, Doesburg WH (1993) The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms. Eur J Obstet Gynecol Reprod Biol 51:29–33PubMedCrossRef Van der Linden MC, Gerretsen G, Brandhorst MS, Ooms EC, Kremer CM, Doesburg WH (1993) The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms. Eur J Obstet Gynecol Reprod Biol 51:29–33PubMedCrossRef
17.
go back to reference Henriksson L, Stjernquist M, Boquist L, Alander U, Selinus I (1994) A comparative multicenter study of the effects of continuous low-dose estradiol released from a new vaginal ring versus estriol vaginal pessaries in postmenopausal women with symptoms and signs of urogenital atrophy. Am J Obstet Gynecol 171:624–632PubMed Henriksson L, Stjernquist M, Boquist L, Alander U, Selinus I (1994) A comparative multicenter study of the effects of continuous low-dose estradiol released from a new vaginal ring versus estriol vaginal pessaries in postmenopausal women with symptoms and signs of urogenital atrophy. Am J Obstet Gynecol 171:624–632PubMed
18.
go back to reference Bottiglione F, Volpe A, Esposito G, Aloysio DD (1995) Transvaginal estriol administration in postmenopausal women: a double blind comparative study of two different doses. Maturitas 22:227–232PubMedCrossRef Bottiglione F, Volpe A, Esposito G, Aloysio DD (1995) Transvaginal estriol administration in postmenopausal women: a double blind comparative study of two different doses. Maturitas 22:227–232PubMedCrossRef
19.
go back to reference Barentsen R, van de Weijer PH, Schram JH (1997) Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy. Eur J Obstet Gynecol Reprod Biol 71:73–80PubMedCrossRef Barentsen R, van de Weijer PH, Schram JH (1997) Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy. Eur J Obstet Gynecol Reprod Biol 71:73–80PubMedCrossRef
20.
go back to reference Dugal R, Hesla K, Sordal T, Aase KH, Lilleeidet O, Wickstrom E (2000) Comparison of usefulness of estradiol vaginal tablets and estriol vagitories for treatment of vaginal atrophy. Acta Obstet Gynecol Scand 79:293–297PubMedCrossRef Dugal R, Hesla K, Sordal T, Aase KH, Lilleeidet O, Wickstrom E (2000) Comparison of usefulness of estradiol vaginal tablets and estriol vagitories for treatment of vaginal atrophy. Acta Obstet Gynecol Scand 79:293–297PubMedCrossRef
21.
go back to reference Kanne B, Jenny J (1991) Local administration of low-dose estriol and vital Lactobacillus acidophilus in postmenopause. Gynakol Rundsch 31:7–13PubMedCrossRef Kanne B, Jenny J (1991) Local administration of low-dose estriol and vital Lactobacillus acidophilus in postmenopause. Gynakol Rundsch 31:7–13PubMedCrossRef
22.
go back to reference Raz R, Stamm WE (1993) A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 329:753–756PubMedCrossRef Raz R, Stamm WE (1993) A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 329:753–756PubMedCrossRef
23.
go back to reference Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC (2004) Duloxetine urinary incontinence study group. Duloxetine versus placebo for the treatment of Noth American women with stress urinary incontinence. J Urol 170:1259–1263CrossRef Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC (2004) Duloxetine urinary incontinence study group. Duloxetine versus placebo for the treatment of Noth American women with stress urinary incontinence. J Urol 170:1259–1263CrossRef
24.
go back to reference Berghmans LCM, Hendrikis HJM, Bo K, Hay-Smith EJ, de Bies RA, van Waalwijk, van Doorn ESC (1998) Conservative treatment if stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol 82:181–189PubMedCrossRef Berghmans LCM, Hendrikis HJM, Bo K, Hay-Smith EJ, de Bies RA, van Waalwijk, van Doorn ESC (1998) Conservative treatment if stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol 82:181–189PubMedCrossRef
25.
go back to reference Castro RA, Arruda RM, Zanetti MRD, Santos PD, Sartori MGF, Girao MJBC (2008) Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics 63:465–472PubMedCrossRef Castro RA, Arruda RM, Zanetti MRD, Santos PD, Sartori MGF, Girao MJBC (2008) Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics 63:465–472PubMedCrossRef
26.
go back to reference Leriche B, Conquy S (2010) Guidelines for rehabilitation management of non-neurological urinary incontinence in women. Prog Urol 20:S104–S108PubMedCrossRef Leriche B, Conquy S (2010) Guidelines for rehabilitation management of non-neurological urinary incontinence in women. Prog Urol 20:S104–S108PubMedCrossRef
27.
go back to reference Archer DF (2010) Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause 17:194–203PubMedCrossRef Archer DF (2010) Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause 17:194–203PubMedCrossRef
28.
go back to reference Shumaker SA, Woman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality-of-life measures for women with urinary incontinence—the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res 3:291–306PubMedCrossRef Shumaker SA, Woman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality-of-life measures for women with urinary incontinence—the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res 3:291–306PubMedCrossRef
29.
go back to reference Mishell DR (1987) Menopause: physiology and pharmacology. Yearbook Medical Publisher, Chicago Mishell DR (1987) Menopause: physiology and pharmacology. Yearbook Medical Publisher, Chicago
30.
go back to reference Wied GL, Bibbo M (1975) Evaluation of endocrinologic condition by exfoliative cytology. In: Gold JJ (ed) Textbook of gynaecologic endocrinology. Harper and Row, New York, pp 117–155 Wied GL, Bibbo M (1975) Evaluation of endocrinologic condition by exfoliative cytology. In: Gold JJ (ed) Textbook of gynaecologic endocrinology. Harper and Row, New York, pp 117–155
31.
go back to reference Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S (2001) Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. J Reprod Med 46:213–220PubMed Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S (2001) Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. J Reprod Med 46:213–220PubMed
32.
go back to reference Schar G, Kochli OR, Fritz M, Heller U (1995) Effect of vaginal estrogen therapy on urinary incontinence in postmenopause. Zentralbl Gynakol 117:77–80PubMed Schar G, Kochli OR, Fritz M, Heller U (1995) Effect of vaginal estrogen therapy on urinary incontinence in postmenopause. Zentralbl Gynakol 117:77–80PubMed
33.
go back to reference Lose G, Englev E (2000) Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 107:1029–1034PubMedCrossRef Lose G, Englev E (2000) Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 107:1029–1034PubMedCrossRef
34.
go back to reference Bhatia NN, Bergman A, Karram MM (1989) Effects of estrogen on urethral function in women with urinary incontinence. Am J Obstet Gynecol 160:176–181PubMed Bhatia NN, Bergman A, Karram MM (1989) Effects of estrogen on urethral function in women with urinary incontinence. Am J Obstet Gynecol 160:176–181PubMed
35.
go back to reference Hilton P, Stanton SL (1983) The use of intravaginal estrogen cream in genuine stress incontinence. Br J Obstet Gynaecol 90:940–944PubMedCrossRef Hilton P, Stanton SL (1983) The use of intravaginal estrogen cream in genuine stress incontinence. Br J Obstet Gynaecol 90:940–944PubMedCrossRef
36.
go back to reference Sturdee DW, Panay N, International Menopause Society Writing Group (2010) Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 13:509–522PubMedCrossRef Sturdee DW, Panay N, International Menopause Society Writing Group (2010) Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 13:509–522PubMedCrossRef
Metadata
Title
Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women
Authors
Giampiero Capobianco
Ermes Donolo
Gianna Borghero
Francesco Dessole
Pier Luigi Cherchi
Salvatore Dessole
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 2/2012
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-011-1955-1

Other articles of this Issue 2/2012

Archives of Gynecology and Obstetrics 2/2012 Go to the issue