Local Estrogen Therapy for Pelvic Organ Prolapse in Postmenopausal Women: A Systematic Review and Meta-Analysis

Background: The prevalence of pelvic organ prolapse (POP) is expected to increase in the next few decades, imposing a substantial medical burden. The effect of local estrogen therapy (LET) on POP in postmenopausal women is still controversial; therefore, we aimed to provide reliable evidence to address this issue from the perspective of vaginal health and quality of life (QoL). Methods: We searched in the PubMed, the Web of Science, Embase and the Cochrane Library databases for eligible RCTs from beginning to Apr 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in our study. Results: Seven RCTs(n=570) were included. No significant improvement of the epithelial thickness (SMD=1.38, 95%CI -0.54 to 3.31, P=0.16) or vaginal pH (SMD=-0.98, 95%CI -2.65 to 0.69, P=0.25) after LET compared with the control. A slight increase was observed in the VMI (MD=16.58, 95%CI 1.14 to 32.02, P=0.04). Regarding QoL, no significant differences between the estrogen group and the control group in PFIQ-7 (6m: MD=3.60, 95%CI -3.13 to 10.33, P=0.29; 12m: MD=3.53, 95%CI -3.35 to 10.41, P=0.31), PISQ-12(6m: MD=0.62, 95%CI -0.73 to 1.98, P=0.37; 12m: MD=0.36, 95%CI -1.06 to 1.77, P=0.62), or PGI-I (6m: RR=0.99, 95%CI 0.92 to 1.07, P=0.88; 12m: RR=1.01, 95%CI 0.95 to 1.07, P=0.72) score. Moreover, no more specific adverse events (AEs) (RR=1.11, 95%CI 0.84 to 1.48, P=0.46) were observed in the interventional group. Conclusion: Not find LET caused either a significant improvement in vaginal health and QoL or more AEs.