The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study

Abstract

Aim: Subjectively and objectively assess stress urinary incontinence (SUI) symptoms before and after topical oestrogen therapy. Methods: A prospective study was performed in 3 centres in South-Africa, Australia and the Netherlands. Postmenopausal women with SUI were treated with topical oestriol cream for 6 weeks. The primary subjective outcome was the Patient's Global Impression of Improvement (PGI-I) scale. The primary objective outcome was vaginal pH. Secondary subjective outcomes were: the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form, the Incontinence Impact Questionnaire, the Urogenital Distress Inventory (UDI-6) and the most bothersome symptom approach. Secondary objective outcome was the erect cough pad test. Compliance was scored. Results: A total of 68 women were enrolled. Half of the participants reported improvement on the PGI-I scale after treatment. Vaginal pH was significantly lower after treatment (median 5.3 (interquartile range (IQR) 4.5-6.0) vs. 5.0 (4.4-5.4), p = 0.002). Improvement on the UDI stress domain was observed (p = 0.01). No statistically significant differences were found in the other subjective outcomes. Baseline and repeat cough pad tests demonstrated a wide variation with no significant difference. Compliance was high (median 100 (IQR 83-100%)). Conclusion: Topical oestriol cream during 6 weeks improved quality of life and vaginal pH but no other objective measures of incontinence.

Quality of Life before and after the Use of Vaginal Estriol in Postmenopausal Women with Lower Urinary Tract Symptoms

“…It showed the highest mean scores in the initial assessment, and presented a statistically significant decrease, demonstrating a subjective improvement in QoL. These results correlate with other studies of the effects of estriol on postmenopausal LUTS, mainly on irritative symptoms such as urinary urgency, frequency, and urge incontinence [17] [18].…”

“…At a time when technology is overemphasized in Medicine, sustaining and enhancing QoL involves making healthcare more focused on people, and various studies have shown that the QoL of postmenopausal women with LUTS is seriously compromised in several contexts, such as at work, in relationships and their social lives [4] [6] [7]. The literature also suggests that vaginal estriol improves vaginal trophism and reduces LUTS, leading to a positive effect on QoL [9] [17] [18]. In the present study, the comparative analysis showed a decreased frequency of urinary symptoms and average scores in all domains of the KHQ questionnaire after the administration of vaginal estriol, indicating that the use of this hormone had a positive effect on the QoL.…”

“…Topical estrogen has proven to be effective also for relieving such symptoms and for preventing the recurrent lower urinary tract infections so prevalent in the post-menopausal period since it facilitates the re-colonization of the vagina with lactobacilli, thus inhibiting the pathogens that cause infections [13] [14]. There is also evidence that it is useful in treating irritative symptoms such as urinary urgency and increased day-time frequency [15] [16] [17] [18]. In terms of estrogen therapy, estriol is one of the formulations most often used.…”

Efficacy of Fractional CO2 Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinical Trial

“…SUI is the most common type of incontinence. The prevalence, estimated between 25% and 35%, increases with age and peaks during the fifth decade of life [12–17]. Overactive bladder (OAB) is characterized by urgency, increased urinary frequency, and nocturia, with or without incontinence, in the absence of relevant pathologies [18].…”

The Efficacy of Fractional Co2 Laser Treatment for the Treatment of Overactive Bladder Syndrome in Menopausal Women- A Three Month Pilot Study

“…(7) More to the point, OAB is found with lower scores in overall health, quality of life, psychological well-being, sexual satisfaction, besides work productivity as opposed to patient controls. (8) In OAB, the onset of urgency incontinence is more likely to be followed by frequency and urgency owing to detrusor over activity. It has been shown detrusor over activity carries more effects on sexual function than urodynamic stress incontinence.…”