The effect of 12 weeks of estriol cream on stress urinary incontinence post‐menopause: A prospective multinational observational study

Abstract

Objective: To quantitate the changes in stress urinary incontinence (SUI) outcome measures after 12 weeks of vaginal estriol cream in women with stress incontinence. Methods:A prospective multicentre observational study conducted in tertiary urogynaecology centers. Postmenopausal women with pure SUI or stress predominant mixed urinary incontinence (MUI), not receiving any other treatment for their incontinence were given written instructions regarding digital application of a standard dose of vaginal estriol cream. Outcomes were measured at baseline and 12 weeks. The primary objective outcome was vaginal pH. The primary subjective outcome was the stress domain of the Urogenital Distress Inventory-6 (UDI-6). The secondary objective outcome used was the erect cough stress test.Two quality of life questionnaires and two patient reported outcomes were also included. Results: The 46 postmenopausal recruits had a median age of 62.1 interquartile range ). At follow up, the primary subjective outcome SUI domain [UDI-6] significantly improved from 83.3 (IQR 50-100) to 33.3 (33.3-66.7, p ≤ 0.001) as did vaginal pH [from 5.1 (4.9-5.9) to 4.9 (4.6-5.0] p ≤ 0.001; 18/43 patients (42%) were dry on cough stress test.Conclusions: Twelve weeks of vaginal estriol cream significantly reduced symptoms of stress urinary incontinence in this sample of postmenopausal women.

Change in microbiota profile after vaginal estriol cream in postmenopausal women with stress incontinence

“…The objective outcomes for stress incontinence were analyzed, showing a trend toward reduction in leakage amount, but results were not statistically significant owing to the small sample size. However, the estriol benefit did achieve significance in the large “parent” cohort (Te West et al, 2023 ).…”

“…results were not statistically significant owing to the small sample size. However, the estriol benefit did achieve significance in the large "parent" cohort (Te West et al, 2023).…”

“…Adherence to the estriol cream instructions was checked with a compliance diary. Estriol crème (Ovestin) applied to the suburethral vagina was chosen, rather than estradiol tablets (Vagifem) placed high in the vagina, because the former has less likelihood of promoting endometrial hyperplasia, and application to the suburethral vagina is more likely to enhance local mucosal proliferation and co-adaptation of the mucosa, to ameliorate stress incontinence (Te West et al, 2023 ).…”

“…Incontinence outcomes including erect cough stress test, International Consultation on Incontinence Questionnaire (ICIQ) were measured at both time points. The present study of microbiome characterization was a subset of a larger clinical trial regarding the benefit of vaginal estriol for stress incontinence in a larger cohort of post-menopausal women, which has previously been published (Te West et al, 2023 ). Ethics approval for the main study and the sub-study was obtained from the local hospital Research Ethics Committee (LNR/13/POWH/685).…”

Pharmacotherapy in Stress Urinary Incontinence; A Literature Review

“…Furthermore, vaginal pH levels notably reduced (from a median of 5.1 to 4.9, p ≤ 0.001) following the 12-week treatment. However, there was no mention of how the pH and urinary symptoms correlated with each other following estrogen therapy [ 23 ].…”