The Role of Vaginal Oestrogen Therapy in Postmenopausal Women With Pelvic Organ Prolapse: Does It Have Any Impact on Perioperative Outcomes? A Systematic Review of Randomised Controlled Trials

Background: Pelvic organ prolapse (POP) affects up to 50% of postmenopausal women, negatively impacting sexual function and quality of life. While surgery remains the primary treatment, increasing attention has been given to perioperative vaginal oestrogen therapy and its potential impact on surgical outcomes. Objectives: This systematic review aims to evaluate the latest evidence on the role of vaginal oestrogen therapy in perioperative management and its impact on surgical outcomes in postmenopausal women with POP. Search Strategy: A systematic literature search was performed across PubMed, MEDLINE, ClinicalTrials.gov and Embase from inception to December 31, 2024. No geographic restrictions were imposed and only peer-reviewed English-language studies were included. Selection Criteria: Only prospective, randomised controlled trials (RCT) examining perioperative vaginal oestrogen therapy in postmenopausal women undergoing POP surgery were included. Data Collection and Analysis: Study identification and data extraction were independently performed by two and three authors, respectively. The Cochrane Collaboration's tool was used to assess bias, with disagreements resolved by a fourth reviewer. Main Results: Ten studies involving 709 patients were analysed. Vaginal oestrogen therapy showed a positive effect on Vaginal Maturation Index (VMI), vaginal thickness and surgeon's perception of tissue quality. It also appeared to reduce postoperative urinary tract infections (UTIs) and antibiotic use. However, no significant impact on sexual function, surgical ease, rates of surgical failure or POP recurrence was observed. Conclusions: Despite potential benefits in enhancing vaginal tissue quality and reducing UTIs and antibiotic use, current evidence is limited. Further standardised trials are needed for more definitive conclusions.